Casirivimab–Imdevimab treatment is associated with reduced rates of hospitalization among high-risk patients with mild to moderate coronavirus disease-19
Raymund R Razonable, Colin Pawlowski, John C O'horo, Lori L Arndt, Richard Arndt, Dennis M Bierle, Molly Destro Borgen, Sara N Hanson, Michelle C Hedin, Patrick Lenehan, Arjun Puranik, Maria T Seville, Leigh L Speicher, Sidna M Tulledge-Scheitel, A J Venkatakrishnan, Caroline G Wilker, Andrew D Badley, Ravindra Ganesh
EClinicalMedicine, doi:10.1016/j.eclinm.2021.101102
Background: Real-world clinical data to support the use of casirivimabÀimdevimab for the treatment of outpatients with mild to moderate coronavirus disease-19 (COVID-19) is needed. This study aimed to assess the outcomes of casirivimabÀimdevimab treatment of mild to moderate COVID-19. Methods: A retrospective cohort of 696 patients who received casirivimabÀimdevimab between December 4, 2020 and April 9, 2021 was compared to a propensity-matched control of 696 untreated patients with mild to moderate COVID-19 at Mayo Clinic sites in Arizona, Florida, Minnesota, and Wisconsin. Primary outcome was rate of hospitalization at days 14, 21 and 28 after infusion. Findings: The median age of the antibody-treated cohort was 63 years (interquartile range, 52À71); 45¢5% were 65 years old; 51.4% were female. High-risk characteristics were hypertension (52.4%), body mass index 35 (31.0%), diabetes mellitus (24.6%), chronic lung disease (22.1%), chronic renal disease (11.4%), congestive heart failure (6.6%), and compromised immune function (6.7%). Compared to the propensitymatched untreated control, patients who received casirivimabÀimdevimab had significantly lower all-cause hospitalization rates at day 14 (1.3% vs 3.3%; Absolute Difference: 2.0%; 95% confidence interval (CI): 0.5À3.7%), day 21 (1.3% vs 4.2%; Absolute Difference: 2.9%; 95% CI: 1.2À4.7%), and day 28 (1.6% vs 4.8%; Absolute Difference: 3.2%; 95% CI: 1.4À5.1%). Rates of intensive care unit admission and mortality at days 14, 21 and 28 were similarly low for antibody-treated and untreated groups. Interpretation: Among high-risk patients with mild to moderate COVID-19, casirivimabÀimdevimab treatment was associated with a significantly lower rate of hospitalization. Funding: Mayo Clinic.
Funding
Mayo Clinic
Contributors Concept and Design: Razonable, Pawlowski, Ganesh Acquisition, Analysis, or Interpretation of Data: Razonable, Pawlowski, Lenehan, Puranik, Venkatakrishnan, O'Horo, Badley, Ganesh Drafting of the Manuscript:
Supplementary materials Supplementary material associated with this article can be found in the online version at doi:10.1016/j.eclinm.2021.101102.
References
Beigel, Tomashek, Dodd, Remdesivir for the treatment of Covid-19 -final report, N Engl J Med
Bhimraj, Morgan, Schumaker, Infectious diseases society of America guidelines on the treatment and management of patients with COVID-19
Caliendo, Kopeinig, Some practical guidance for the implementation of propensity score matching, J Econ Surv
Chen, Nirula, Heller, SARS-CoV-2 neutralizing antibody LY-CoV555 in outpatients with Covid-19, N Engl J Med
Crane, Ganesh, Post, Jacobson, Telemedicine consultations and followup of patients with COVID-19, Mayo Clin Proc
Davidson-Pilon, Kalderstam, Zivich, CamDavidsonPilon/lifelines: v0. 21.3. Zenodo
Ganesh, Salonen, Bhuiyan, Managing patients in the COVID-19 pandemic: a virtual multidisciplinary approach, Mayo Clinic Proc: Innovat, Qual Outcomes
Garcia-Vidal, Cozar-Llisto, Meira, Trends in mortality of hospitalised COVID-19 patients: a single centre observational cohort study from Spain, Lancet Reg Health Eur
Group, Horby, Lim, Dexamethasone in hospitalized patients with Covid-19 -preliminary report, N Engl J Med
Horwitz, Jones, Cerfolio, Trends in COVID-19 risk-adjusted mortality rates, J Hosp Med
Hosmer, Lemeshow, May, Applied survival analysis: regression modeling of time-to-event data
Huang, Yang, Xu, Xu, Liu, Structural and functional properties of SARS-CoV-2 spike protein: potential antivirus drug development for COVID-19, Acta Pharmacol Sin
Nih, Anti, SARS-CoV-2 monoclonal antibodies
O'horo, Cerhan, Cahn, Outcomes of COVID-19 with the mayo clinic model of care and research
Razonable, Aloia, Anderson, A framework for outpatient infusion of anti-spike monoclonal antibodies to high-risk patients with mild to moderate coronavirus disease-19: the mayo clinic model
Richardson, Hirsch, Narasimhan, Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area, JAMA
Tian, Schuemie, Suchard, Evaluating large-scale propensity score performance through real-world and synthetic data experiments, Int J Epidemiol
Weinreich, Sivapalasingam, Norton, REGN-COV2, a neutralizing antibody cocktail, in outpatients with Covid-19, N Engl J Med
Zhou, Yu, Du, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Lancet
DOI record:
{
"DOI": "10.1016/j.eclinm.2021.101102",
"ISSN": [
"2589-5370"
],
"URL": "http://dx.doi.org/10.1016/j.eclinm.2021.101102",
"alternative-id": [
"S2589537021003825"
],
"article-number": "101102",
"author": [
{
"ORCID": "http://orcid.org/0000-0001-5248-0227",
"affiliation": [],
"authenticated-orcid": false,
"family": "Razonable",
"given": "Raymund R.",
"sequence": "first"
},
{
"affiliation": [],
"family": "Pawlowski",
"given": "Colin",
"sequence": "additional"
},
{
"affiliation": [],
"family": "O'Horo",
"given": "John C.",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Arndt",
"given": "Lori L.",
"sequence": "additional"
},
{
"ORCID": "http://orcid.org/0000-0003-4723-689X",
"affiliation": [],
"authenticated-orcid": false,
"family": "Arndt",
"given": "Richard",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Bierle",
"given": "Dennis M.",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Borgen",
"given": "Molly Destro",
"sequence": "additional"
},
{
"ORCID": "http://orcid.org/0000-0003-2517-638X",
"affiliation": [],
"authenticated-orcid": false,
"family": "Hanson",
"given": "Sara N.",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Hedin",
"given": "Michelle C.",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Lenehan",
"given": "Patrick",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Puranik",
"given": "Arjun",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Seville",
"given": "Maria T",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Speicher",
"given": "Leigh L.",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Tulledge-Scheitel",
"given": "Sidna M.",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Venkatakrishnan",
"given": "AJ",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Wilker",
"given": "Caroline G.",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Badley",
"given": "Andrew D.",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Ganesh",
"given": "Ravindra",
"sequence": "additional"
}
],
"container-title": "EClinicalMedicine",
"container-title-short": "EClinicalMedicine",
"content-domain": {
"crossmark-restriction": false,
"domain": []
},
"created": {
"date-parts": [
[
2021,
8,
30
]
],
"date-time": "2021-08-30T11:00:58Z",
"timestamp": 1630321258000
},
"deposited": {
"date-parts": [
[
2021,
10,
25
]
],
"date-time": "2021-10-25T21:24:45Z",
"timestamp": 1635197085000
},
"funder": [
{
"DOI": "10.13039/100007048",
"doi-asserted-by": "publisher",
"name": "Mayo Clinic"
},
{
"DOI": "10.13039/100004337",
"doi-asserted-by": "publisher",
"name": "Roche"
},
{
"DOI": "10.13039/100005564",
"doi-asserted-by": "publisher",
"name": "Gilead Sciences"
}
],
"indexed": {
"date-parts": [
[
2023,
5,
20
]
],
"date-time": "2023-05-20T05:19:10Z",
"timestamp": 1684559950727
},
"is-referenced-by-count": 93,
"issued": {
"date-parts": [
[
2021,
10
]
]
},
"language": "en",
"license": [
{
"URL": "https://www.elsevier.com/tdm/userlicense/1.0/",
"content-version": "tdm",
"delay-in-days": 0,
"start": {
"date-parts": [
[
2021,
10,
1
]
],
"date-time": "2021-10-01T00:00:00Z",
"timestamp": 1633046400000
}
},
{
"URL": "http://creativecommons.org/licenses/by-nc-nd/4.0/",
"content-version": "vor",
"delay-in-days": 0,
"start": {
"date-parts": [
[
2021,
8,
12
]
],
"date-time": "2021-08-12T00:00:00Z",
"timestamp": 1628726400000
}
}
],
"link": [
{
"URL": "https://api.elsevier.com/content/article/PII:S2589537021003825?httpAccept=text/xml",
"content-type": "text/xml",
"content-version": "vor",
"intended-application": "text-mining"
},
{
"URL": "https://api.elsevier.com/content/article/PII:S2589537021003825?httpAccept=text/plain",
"content-type": "text/plain",
"content-version": "vor",
"intended-application": "text-mining"
}
],
"member": "78",
"original-title": [],
"page": "101102",
"prefix": "10.1016",
"published": {
"date-parts": [
[
2021,
10
]
]
},
"published-print": {
"date-parts": [
[
2021,
10
]
]
},
"publisher": "Elsevier BV",
"reference": [
{
"article-title": "An EUA for bamlanivimab-a monoclonal antibody for COVID-19",
"journal-title": "JAMA",
"key": "10.1016/j.eclinm.2021.101102_bib0001",
"year": "2020"
},
{
"article-title": "An EUA for casirivimab and imdevimab for COVID-19",
"first-page": "201",
"issue": "1614",
"journal-title": "Med Lett Drugs Ther",
"key": "10.1016/j.eclinm.2021.101102_bib0002",
"volume": "62",
"year": "2020"
},
{
"article-title": "An EUA for bamlanivimab and etesevimab for COVID-19",
"first-page": "49",
"issue": "1621",
"journal-title": "Med Lett Drugs Ther",
"key": "10.1016/j.eclinm.2021.101102_bib0003",
"volume": "63",
"year": "2021"
},
{
"DOI": "10.1038/s41401-020-0485-4",
"article-title": "Structural and functional properties of SARS-CoV-2 spike protein: potential antivirus drug development for COVID-19",
"author": "Huang",
"doi-asserted-by": "crossref",
"first-page": "1141",
"issue": "9",
"journal-title": "Acta Pharmacol Sin",
"key": "10.1016/j.eclinm.2021.101102_bib0004",
"volume": "41",
"year": "2020"
},
{
"DOI": "10.1056/NEJMoa2035002",
"article-title": "REGN-COV2, a neutralizing antibody cocktail, in outpatients with Covid-19",
"author": "Weinreich",
"doi-asserted-by": "crossref",
"first-page": "238",
"issue": "3",
"journal-title": "N Engl J Med",
"key": "10.1016/j.eclinm.2021.101102_bib0005",
"volume": "384",
"year": "2021"
},
{
"key": "10.1016/j.eclinm.2021.101102_bib0006",
"unstructured": "Bhimraj A, Morgan R, Schumaker AH, et al. Infectious diseases society of America guidelines on the treatment and management of patients with COVID-19. Available at: https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/. Accessed 05/10/ 2021."
},
{
"key": "10.1016/j.eclinm.2021.101102_bib0007",
"unstructured": "NIH. Anti-SARS-CoV-2 monoclonal antibodies. Available at: https://www.covid19treatmentguidelines.nih.gov/anti-sars-cov-2-antibody-products/anti-sars-cov-2-monoclonal-antibodies/. Accessed May 10, 2021."
},
{
"author": "Razonable",
"key": "10.1016/j.eclinm.2021.101102_bib0008",
"series-title": "A framework for outpatient infusion of anti-spike monoclonal antibodies to high-risk patients with mild to moderate coronavirus disease-19: the mayo clinic model",
"year": "2021"
},
{
"DOI": "10.1111/j.1467-6419.2007.00527.x",
"article-title": "Some practical guidance for the implementation of propensity score matching",
"author": "Caliendo",
"doi-asserted-by": "crossref",
"first-page": "31",
"issue": "1",
"journal-title": "J Econ Surv",
"key": "10.1016/j.eclinm.2021.101102_bib0009",
"volume": "22",
"year": "2008"
},
{
"DOI": "10.1093/ije/dyy120",
"article-title": "Evaluating large-scale propensity score performance through real-world and synthetic data experiments",
"author": "Tian",
"doi-asserted-by": "crossref",
"first-page": "2005",
"issue": "6",
"journal-title": "Int J Epidemiol",
"key": "10.1016/j.eclinm.2021.101102_bib0010",
"volume": "47",
"year": "2018"
},
{
"author": "Hosmer",
"key": "10.1016/j.eclinm.2021.101102_bib0011",
"series-title": "Applied survival analysis: regression modeling of time-to-event data",
"year": "2008"
},
{
"key": "10.1016/j.eclinm.2021.101102_bib0012",
"unstructured": "Davidson-Pilon C, Kalderstam J, Zivich P, et al. CamDavidsonPilon/lifelines: v0. 21.3. Zenodo 2019."
},
{
"DOI": "10.1001/jama.2020.6775",
"article-title": "Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area",
"author": "Richardson",
"doi-asserted-by": "crossref",
"first-page": "2052",
"issue": "20",
"journal-title": "JAMA",
"key": "10.1016/j.eclinm.2021.101102_bib0013",
"volume": "323",
"year": "2020"
},
{
"DOI": "10.1016/S0140-6736(20)30566-3",
"article-title": "Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study",
"author": "Zhou",
"doi-asserted-by": "crossref",
"first-page": "1054",
"issue": "10229",
"journal-title": "Lancet",
"key": "10.1016/j.eclinm.2021.101102_bib0014",
"volume": "395",
"year": "2020"
},
{
"DOI": "10.1056/NEJMoa2029849",
"article-title": "SARS-CoV-2 neutralizing antibody LY-CoV555 in outpatients with Covid-19",
"author": "Chen",
"doi-asserted-by": "crossref",
"first-page": "229",
"issue": "3",
"journal-title": "N Engl J Med",
"key": "10.1016/j.eclinm.2021.101102_bib0015",
"volume": "384",
"year": "2021"
},
{
"article-title": "Telemedicine consultations and follow-up of patients with COVID-19",
"author": "Crane",
"issue": "9s",
"journal-title": "Mayo Clin Proc",
"key": "10.1016/j.eclinm.2021.101102_bib0016",
"volume": "95",
"year": "2020"
},
{
"article-title": "Managing patients in the COVID-19 pandemic: a virtual multidisciplinary approach",
"author": "Ganesh",
"first-page": "118",
"issue": "1",
"journal-title": "Mayo Clinic Proc: Innovat, Qual Outcomes",
"key": "10.1016/j.eclinm.2021.101102_bib0017",
"volume": "5",
"year": "2021"
},
{
"author": "O'Horo",
"key": "10.1016/j.eclinm.2021.101102_bib0018",
"series-title": "Outcomes of COVID-19 with the mayo clinic model of care and research",
"year": "2020"
},
{
"DOI": "10.1056/NEJMoa2007764",
"article-title": "Remdesivir for the treatment of Covid-19 - final report",
"author": "Beigel",
"doi-asserted-by": "crossref",
"first-page": "1813",
"issue": "19",
"journal-title": "N Engl J Med",
"key": "10.1016/j.eclinm.2021.101102_bib0019",
"volume": "383",
"year": "2020"
},
{
"article-title": "Dexamethasone in hospitalized patients with Covid-19 - preliminary report",
"author": "Group",
"first-page": "693",
"issue": "8",
"journal-title": "N Engl J Med",
"key": "10.1016/j.eclinm.2021.101102_bib0020",
"volume": "384",
"year": "2020"
},
{
"article-title": "Trends in mortality of hospitalised COVID-19 patients: a single centre observational cohort study from Spain",
"author": "Garcia-Vidal",
"journal-title": "Lancet Reg Health Eur",
"key": "10.1016/j.eclinm.2021.101102_bib0021",
"volume": "3",
"year": "2021"
},
{
"DOI": "10.12788/jhm.3552",
"article-title": "Trends in COVID-19 risk-adjusted mortality rates",
"author": "Horwitz",
"doi-asserted-by": "crossref",
"first-page": "90",
"issue": "2",
"journal-title": "J Hosp Med",
"key": "10.1016/j.eclinm.2021.101102_bib0022",
"volume": "16",
"year": "2021"
},
{
"key": "10.1016/j.eclinm.2021.101102_bib0023",
"unstructured": "Medicine JHU. Coronavirus resource center. Available at: https://coronavirus.jhu.edu/. Accessed 06/02/ 2021."
}
],
"reference-count": 23,
"references-count": 23,
"relation": {},
"resource": {
"primary": {
"URL": "https://linkinghub.elsevier.com/retrieve/pii/S2589537021003825"
}
},
"score": 1,
"short-title": [],
"source": "Crossref",
"subject": [
"General Medicine"
],
"subtitle": [],
"title": "Casirivimab–Imdevimab treatment is associated with reduced rates of hospitalization among high-risk patients with mild to moderate coronavirus disease-19",
"type": "journal-article",
"volume": "40"
}