Pre-exposure Prophylaxis with Tixagevimab-cilgavimab did not Reduce Severity of COVID-19 in Lung Transplant Recipients with Breakthrough Infection
MD Devika Sindu, MD Deepika Razia, RN, MSN Katherine Grief, MD Lauren Cherrier, MD Ashraf Omar, MD Rajat Walia, MD Sofya Tokman
Transplantation Direct, doi:10.1097/txd.0000000000001485
I nfection with the severe acute respiratory syndrome coro- navirus 2 (SARS-CoV-2) and the resulting COVID-19 have led to significant morbidity and mortality among solid organ transplant recipients since the start of the pandemic. 1 Mutations in the viral spike protein have led to the emergence of numerous variants, with the Omicron variant and its sublineages dominating since December 2021. 2, 3 Although the rates of hospitalization and in-hospital mortality fell in the general population during the Omicron surge, the morbidity and mortality among solid organ transplant recipients remained disproportionately high. 4, 5 Vaccination is the cornerstone of prevention of severe COVID-19 in the general population; however, the immune response to vaccination among solid organ transplant recipients is often inadequate, leaving them susceptible to severe illness. A study of 658 solid organ transplant recipients, including 71 lung transplant recipients (LTRs), showed that only 39% of LTRs developed an antibody response after 2 doses of a SARS-CoV-2 mRNA vaccine. 6 Furthermore, although a third vaccine dose improved the humoral response
Lung Transplantation Background. Lung transplant recipients (LTRs) have an increased risk of COVID-19-related morbidity and mortality. Tixagevimab-cilgavimab (tix-cil) is a long-acting monoclonal antibody combination granted Emergency Use Authorization approval by the US Food and Drug Administration for COVID-19 pre-exposure prophylaxis (PrEP) in immunocompromised patients. We sought to determine whether tix-cil 300-300 mg reduced the incidence and disease severity of severe acute respiratory syndrome coronavirus 2 infection in LTRs during the Omicron wave. Methods. We performed a retrospective, single-center cohort study of LTRs who had received a COVID-19 diagnosis between December 2021 and August 2022. We compared baseline characteristics and clinical outcomes after COVID-19 between LTRs who received tix-cil PrEP and those who did not. We then conducted propensity-score matching based on baseline characteristics and therapeutic interventions and compared clinical outcomes between the 2 groups. Results. Of 203 LTRs who received tix-cil PrEP and 343 who did not, 24 (11.8%) and 57 (16.6%), respectively, developed symptomatic COVID-19 (hazard ratio [HR], 0.669; 95% confidence interval [CI], 0.415-1.079; P = 0.099). The hospitalization rate of LTRs with COVID-19 during the Omicron wave trended lower in the tix-cil group than in the non-tix-cil group (20.8% versus 43.1%; HR, 0.430; 95% CI, 0.165-1.118; P = 0.083). In propensity-matched analyses, 17 LTRs who received tix-cil and 17 LTRs who did not had similar rates of hospitalization (HR, 0.468;
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