Viral clearance and escape during therapy of COVID-19 outpatients: A prospective cohort study
et al., iScience, doi:10.1016/j.isci.2025.114226, Dec 2025
19th treatment shown to reduce risk in
March 2021, now with p = 0.000095 from 34 studies, recognized in 52 countries.
Efficacy is variant dependent.
No treatment is 100% effective. Protocols
combine treatments.
6,300+ studies for
210+ treatments. c19early.org
|
Prospective cohort study of 114 high-risk COVID-19 outpatients showing that monoclonal antibody treatments with suboptimal neutralizing activity against infecting variants resulted in higher viral loads and increased emergence of escape mutations.
Efficacy is variant dependent. In Vitro research suggests a lack of efficacy for many omicron variants1-7.
Study covers casirivimab/imdevimab, sotrovimab, and tixagevimab/cilgavimab.
1.
Liu et al., Striking Antibody Evasion Manifested by the Omicron Variant of SARS-CoV-2, bioRxiv, doi:10.1101/2021.12.14.472719.
2.
Sheward et al., Variable loss of antibody potency against SARS-CoV-2 B.1.1.529 (Omicron), bioRxiv, doi:10.1101/2021.12.19.473354.
3.
VanBlargan et al., An infectious SARS-CoV-2 B.1.1.529 Omicron virus escapes neutralization by several therapeutic monoclonal antibodies, bioRxiv, doi:10.1101/2021.12.15.472828.
4.
Tatham et al., Lack of Ronapreve (REGN-CoV; casirivimab and imdevimab) virological efficacy against the SARS-CoV 2 Omicron variant (B.1.1.529) in K18-hACE2 mice, bioRxiv, doi:10.1101/2022.01.23.477397.
5.
Pochtovyi et al., In Vitro Efficacy of Antivirals and Monoclonal Antibodies against SARS-CoV-2 Omicron Lineages XBB.1.9.1, XBB.1.9.3, XBB.1.5, XBB.1.16, XBB.2.4, BQ.1.1.45, CH.1.1, and CL.1, Vaccines, doi:10.3390/vaccines11101533.
Martin-Blondel et al., 31 Dec 2025, prospective, France, peer-reviewed, median age 54.5, 24 authors, study period September 2021 - November 2022.
Contact: martin-blondel.g@chu-toulouse.fr (corresponding author), martin-blondel.g@chu-toulouse.fr (corresponding author), timothee.bruel@pasteur.fr.
Viral clearance and escape during therapy of COVID-19 outpatients: A prospective cohort study
iScience, doi:10.1016/j.isci.2025.114226
Baseline viral load, neutralization, and therapy govern viral clearance
RESOURCE AVAILABILITY Lead contact Further information and requests for resources and reagents should be directed to and will be fulfilled by the Lead Contact, Timothe ´ e Bruel (timothee.bruel@pasteur.fr).
Materials availability All unique/stable reagents generated in this study are available from the corresponding authors with a completed Materials Transfer Agreement.
Data and code availability • This study did not generate any new codes. • The raw sequencing data contains traces of human genomic DNA and cannot be made publicly available according to French law. However, this data is available upon request. • The viral sequences are available on GISAID
STAR★METHODS Detailed methods are provided in the online version of this paper and include the following: Treatment was determined at the discretion of the treating physician. During the study period, patients received either a single infusion of Casirivimab/Imdevimab, 26 of Sotrovimab, 27 of Tixagevimab/Cilgavimab, 28 or 5 days of oral Nirmatrelvir/Ritonavir, 29 or 3 days of intravenous Remdesivir. 30 Baseline demographics, clinical and biological data were collected during the inclusion visit (day 0, prior to treatment initiation), then at day 7 and month 1. Nasopharyngeal (NP) swabs were collected at days 0 and 7, and repeated weekly in patients with a SARS-CoV-2 PCR with a cycle threshold (CT) < 31. Blood samples were obtained at days 0 and 7. The protocol has been approved by the ''CPP Sud-Est IV''..
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