Clinical efficacy of casirivimab and imdevimab in preventing COVID-19 in the Omicron BA.5 subvariant epidemic: a retrospective study

DOI record: { "DOI": "10.1186/s40780-025-00501-x", "ISSN": [ "2055-0294" ], "URL": "http://dx.doi.org/10.1186/s40780-025-00501-x", "abstract": "<jats:title>Abstract</jats:title>\n <jats:sec>\n <jats:title>Background</jats:title>\n <jats:p>The neutralizing monoclonal antibody combination of casirivimab and imdevimab (CAS + IMD) is the only therapy approved for preventing coronavirus disease 2019 (COVID-19) following exposure to severe acute respiratory syndrome coronavirus 2. However, the efficacy of CAS + IMD against Omicron variants remains uncertain, with in vitro studies indicating reduced neutralizing activity. This study aimed to evaluate the clinical efficacy of CAS + IMD in preventing COVID-19 among uninfected hospitalized contacts of patients with COVID-19.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Methods</jats:title>\n <jats:p>\n A retrospective chart review was conducted on 154 inpatients exposed to patients with COVID-19 between October and December 2022. Fifty-two uninfected participants who were unvaccinated or immunosuppressed and had risk factors for severe COVID-19 were included. The primary endpoint was the COVID-19 incidence rate. Statistical analyses included the chi-square test, Fisher's exact test, and Mann–Whitney U test, as appropriate. Factors associated with COVID-19 incidence (\n <jats:italic>p</jats:italic>\n  &lt; 0.05) in univariate analysis were included in the multivariate logistic regression. Statistical significance was set at\n <jats:italic>p</jats:italic>\n  &lt; 0.05.\n </jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Results</jats:title>\n <jats:p>\n Among the 52 participants, 14 and 38 were included in the CAS + IMD and non-CAS + IMD groups, respectively. The COVID-19 incidence rate was significantly lower in the CAS + IMD group than in the non-CAS + IMD group (14.3% vs. 52.6%,\n <jats:italic>p</jats:italic>\n  = 0.013). Multivariate analysis identified CAS + IMD administration as significantly associated with reduced COVID-19 incidence (adjusted odds ratio [OR], 0.121; 95% confidence interval [CI], 0.020–0.710;\n <jats:italic>p</jats:italic>\n  = 0.019), whereas long-term use of immunosuppressive therapy was associated with increased incidence (adjusted OR, 4.320; 95% CI, 1.090–17.126;\n <jats:italic>p</jats:italic>\n  = 0.037).\n </jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Conclusions</jats:title>\n <jats:p>CAS + IMD may be effective for post-exposure prophylaxis of COVID-19 during the Omicron BA.5 subvariant epidemic. However, prudent clinical use should consider the circulating variant profile. Further research is warranted to validate CAS + IMD’s role in COVID-19 post-exposure prophylaxis.</jats:p>\n </jats:sec>", "alternative-id": [ "501" ], "article-number": "94", "assertion": [ { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Received", "name": "received", "order": 1, "value": "3 May 2025" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Accepted", "name": "accepted", "order": 2, "value": "30 September 2025" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "First Online", "name": "first_online", "order": 3, "value": "27 October 2025" }, { "group": { "label": "Declarations", "name": "EthicsHeading" }, "name": "Ethics", "order": 1 }, { "group": { "label": "Ethics approval and consent to participate", "name": "EthicsHeading" }, "name": "Ethics", "order": 2, "value": "This study adhered to the “Ethical Guidelines for Medical and Biological Research Involving Human Subjects” and was approved by the Ethics Committee of Toho University Omori Medical Center (approval number: M24037 22285). Patients were informed of their option to opt out, with details clearly outlined on the institutional website." }, { "group": { "label": "Consent for publication", "name": "EthicsHeading" }, "name": "Ethics", "order": 3, "value": "Not applicable." }, { "group": { "label": "Competing interests", "name": "EthicsHeading" }, "name": "Ethics", "order": 4, "value": "The authors declare no competing interests." } ], "author": [ { "affiliation": [], "family": "Ohtani", "given": "Mariko", "sequence": "first" }, { "affiliation": [], "family": "Yokoo", "given": "Takuya", "sequence": "additional" }, { "affiliation": [], "family": "Miyazaki", "given": "Taito", "sequence": "additional" }, { "affiliation": [], "family": "Yasuda", "given": "Hiroshi", "sequence": "additional" }, { "affiliation": [], "family": "Nishikawa", "given": "Eriko", "sequence": "additional" }, { "affiliation": [], "family": "Tomida", "given": "Manabu", "sequence": "additional" }, { "affiliation": [], "family": "Tsukada", "given": "Mayumi", "sequence": "additional" }, { "affiliation": [], "family": "Sato", "given": "Emi", "sequence": "additional" }, { "affiliation": [], "family": "Hirayama", "given": "Shinobu", "sequence": "additional" }, { "affiliation": [], "family": "Murakami", "given": "Hinako", "sequence": "additional" }, { "affiliation": [], "family": "Yoshizawa", "given": "Sadako", "sequence": "additional" }, { "affiliation": [], "family": "Matsumoto", "given": "Takahiro", "sequence": "additional" }, { "affiliation": [], "family": "Tateda", "given": "Kazuhiro", "sequence": "additional" } ], "container-title": "Journal of Pharmaceutical Health Care and Sciences", "container-title-short": "J Pharm Health Care Sci", "content-domain": { "crossmark-restriction": false, "domain": [ "link.springer.com" ] }, "created": { "date-parts": [ [ 2025, 10, 27 ] ], "date-time": "2025-10-27T13:11:17Z", "timestamp": 1761570677000 }, "deposited": { "date-parts": [ [ 2025, 10, 27 ] ], "date-time": "2025-10-27T13:11:18Z", "timestamp": 1761570678000 }, "indexed": { "date-parts": [ [ 2025, 10, 27 ] ], "date-time": "2025-10-27T14:17:19Z", "timestamp": 1761574639498, "version": "build-2065373602" }, "is-referenced-by-count": 0, "issue": "1", "issued": { "date-parts": [ [ 2025, 10, 27 ] ] }, "journal-issue": { "issue": "1", "published-online": { "date-parts": [ [ 2025, 12 ] ] } }, "language": "en", "license": [ { "URL": "https://creativecommons.org/licenses/by/4.0", "content-version": "tdm", "delay-in-days": 0, "start": { "date-parts": [ [ 2025, 10, 27 ] ], "date-time": "2025-10-27T00:00:00Z", "timestamp": 1761523200000 } }, { "URL": "https://creativecommons.org/licenses/by/4.0", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2025, 10, 27 ] ], "date-time": "2025-10-27T00:00:00Z", "timestamp": 1761523200000 } } ], "link": [ { "URL": "https://link.springer.com/content/pdf/10.1186/s40780-025-00501-x.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://link.springer.com/article/10.1186/s40780-025-00501-x/fulltext.html", "content-type": "text/html", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://link.springer.com/content/pdf/10.1186/s40780-025-00501-x.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "297", "original-title": [], "prefix": "10.1186", "published": { "date-parts": [ [ 2025, 10, 27 ] ] }, "published-online": { "date-parts": [ [ 2025, 10, 27 ] ] }, "publisher": "Springer Science and Business Media LLC", "reference": [ { "author": "AM Carabelli", "first-page": "162", "journal-title": "Nat Rev Microbiol", "key": "501_CR1", "unstructured": "Carabelli AM, Peacock TP, Thorne LG, Harvey WT, Hughes J, COVID-19 Genomics UK Consortium, et al. 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