Doubtful Clinical Benefit of Casirivimab-Imdevimab Treatment for Disease Severity Outcome of High-Risk Patients with SARS-CoV-2 Delta Variant Infection
Shopen et al., Doubtful Clinical Benefit of Casirivimab-Imdevimab Treatment for Disease Severity Outcome of High-Risk.., medRxiv, doi:10.1101/2022.01.29.22270090 (Preprint)
Retrospective 359 COVID+ patients in Israel, 116 treated with casirivimab/imdevimab, showing no significant difference with treatment in multivariable analysis.Efficacy is variant dependent. In Vitro research suggests a lack of efficacy for omicron [Liu, Sheward, Tatham, VanBlargan].
risk of severe case, 45.6% higher, RR 1.46, p = 0.26, treatment 24 of 116 (20.7%), control 26 of 243 (10.7%), adjusted per study, odds ratio converted to relative risk.
Abstract: medRxiv preprint doi: https://doi.org/10.1101/2022.01.29.22270090; this version posted January 31, 2022. The copyright holder for this preprint
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
All rights reserved. No reuse allowed without permission.
1
Doubtful Clinical Benefit of Casirivimab-Imdevimab Treatment for Disease
Severity Outcome of High-Risk Patients with SARS-CoV-2 Delta Variant
Infection
Noah Shopen 1,5*, Michal Dekel2,5*, Michal Mizrahi1,5, Efrat Zandberg1,5, Nancy Bishouty4,5, Daniel Talmud1,5, Ben
Vaknin1,5, Shira Haberman5, Malka Katz Shalhav1,5, David Zeltser1,5, Neta Cohen1,3,5
*Equal contribution
1
Emergency Department, 2Division of Infectious Disease, 3Pediatric Emergency Department, Dana Dwek Children
Hospital, 4Clinical Pharmacy Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the 5Sackler
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Corresponding author: Neta Cohen, MD, Emergency Department, Tel Aviv Sourasky Medical Center, 6 Weizman
Street, Tel Aviv, 6423906 Israel. E-mail: netarab81@gmail.com. ORCID ID: 0000-0001-7694-6407.
Key words: Casirivimab/Imdevimab therapy, SARS-CoV-2 Delta Variant, High-Risk Patients, Severe outcome,
BNT162b2 vaccine.
Statements and Declarations
Funding: None.
Conflict of interest statement: The authors have no conflict of interests to disclose.
NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.
medRxiv preprint doi: https://doi.org/10.1101/2022.01.29.22270090; this version posted January 31, 2022. The copyright holder for this preprint
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
All rights reserved. No reuse allowed without permission.
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ABSTRACT
Casirivimab/Imdevimab therapy reportedly retains neutralization potency against circulating SARS-CoV-2 variants,
including Delta (B.1.617.2), but there are sparse data on its clinical benefit against the Delta variant among
vaccinated and unvaccinated patients. We explored its therapeutic effect on COVID-19 severity outcome in terms of
room air saturation <93% within 14 days of initial presentation and 45-day all-cause mortality among high-risk
patients with SARS-CoV-2 Delta variant infection and compared its effect between vaccinated and unvaccinated
patients. We conducted a retrospective cohort study at a tertiary care medical center between 6/2021 and 9/2021 and
included patients who presented with a positive PCR for SARS-CoV-2 and fulfilled the criteria for
Casirivimab/Imdevimab treatment. Of the 359 suitable patients (52% female, median age 63 years), 116 were
treated with Casirivimab/Imdevimab and 243 were not. Two-hundred and one (56%) patients had received at least 2
SARS-CoV-2 vaccinations. Casirivimab/Imdevimab treatment was not an independent protective factor of COVID19 severity outcome (multivariable analysis). Chronic kidney disease (aOR=3.51 [95%CI: 1.34-9.20], P=0.01),
lower saturation levels (aOR=0.7 [95%CI: 0.58–0.85], P<0.01), abnormal chest x-ray findings (aOR=2.92, [95%CI:
1.24–6.87, P=0.01), and higher C-reactive protein levels (aOR=1.01 [95%CI: 1.00–1.01], P=0.008) were
independent risk factors of COVID-19 severity. Positive immunization status was an independent protective factor
(aOR=0.33 [95%CI: 0.14–0.77],..
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