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Treatment with sotrovimab for SARS-CoV-2 infection in a cohort of high-risk kidney transplant recipients

Villanego et al., Clinical Kidney Journal, doi:10.1093/ckj/sfac177
Jul 2022  
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Retrospective 82 kidney transplant recipients treated with sotrovimab, showing lower risk of serious COVID-19 outcomes with early treatment.
Efficacy is variant dependent. In Vitro studies predict lower efficacy for BA.1 Liu, Sheward, VanBlargan and a lack of efficacy for BA.2 Zhou. US EUA has been revoked.
Villanego et al., 28 Jul 2022, retrospective, Spain, peer-reviewed, median age 63.0, 25 authors, study period 1 December, 2021 - 28 February, 2022.
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Treatment with sotrovimab for SARS-CoV-2 infection in a cohort of high-risk kidney transplant recipients
Florentino Villanego, Auxiliadora Mazuecos, Beatriz Cubillo, M José Merino, Inmaculada Poveda, Isabel M Saura, Óscar Segurado, Leónidas Cruzado, Myriam Eady, Sofía Zárraga, M José Aladrén, Sheila Cabello, Verónica López, Esther González, Inmaculada Lorenzo, Jordi Espí-Reig, Constantino Fernández, July Osma, M Carmen Ruiz-Fuentes, Néstor Toapanta, Antonio Franco, Carla C Burballa, Miguel A Muñoz, Marta Crespo, Julio Pascual
Clinical Kidney Journal, doi:10.1093/ckj/sfac177
Background. Sotrovimab is a neutralizing monoclonal antibody (mAb) that seems to remain active against recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. The evidence on its use in kidney transplant (KT) recipients, however, is limited. Methods. We performed a multicenter, retrospective cohort study of 82 KT patients with SARS-CoV-2 infection {coronavirus disease 2019 [COVID-19]} treated with sotrovimab. Results. Median age was 63 years. Diabetes was present in 43.9% of patients, and obesity in 32.9% of patients; 48.8% of patients had an estimated glomerular filtration rate under 30 mL/minute/1.73 m 2 . Additional anti-COVID-19 therapies were administered to 56 patients, especially intravenous steroids (65.9%). Sotrovimab was administered early (<5 days from the onset of the symptoms) in 46 patients (56%). Early-treated patients showed less likely progression to severe COVID-19 than those treated later, represented as a lower need for ventilator support (2.2% vs 36.1%; P < .001) or intensive care admission (2.2% vs 25%; P = .002) and COVID-19-related mortality (2.2% vs 16.7%; P = .020). In the multivariable analysis, controlling for baseline risk factors to severe COVID-19 in KT recipients, early use of sotrovimab remained as a protective factor for a composite outcome, including need for ventilator support, intensive care, and COVID-19-related mortality. No anaphylactic reactions, acute rejection episodes, impaired kidney function events, or non-kidney side effects related to sotrovimab were observed. Conclusions. Sotrovimab had an excellent safety profile, even in high-comorbidity patients and advanced chronic kidney disease stages. Earlier administration could prevent progression to severe disease, while clinical outcomes were poor in patients treated later. Larger controlled studies enrolling KT recipients are warranted to elucidate the true efficacy of monoclonal antibody therapies.
SUPPLEMENTARY DATA Supplementary data are available at ckj online. AUTHORS' CONTRIBUTIONS F.V., A.M., M.C., and J.P. designed the study, analyzed the data, and drafted the article. All authors revised the article, made substantial contributions, and approved the final version of the article. F.V. and A.M. have contributed equally to this work. M.C. and J.P. share senior authorship to this work. CONFLICT OF INTEREST STATEMENT None declared.
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