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Effectiveness of REGEN-COV combination monoclonal antibody infusion to reduce risk of COVID-19 hospitalization in pregnancy: A retrospective cohort study

Williams et al., American Journal of Obstetrics and Gynecology, doi:10.1016/j.ajog.2022.09.017

Sep 2022

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Casirivimab/imdevimab

16th treatment shown to reduce risk in March 2021

^*, now known with p = 0.000018 from 28 studies, recognized in 42 countries. Efficacy is variant dependent.

Lower risk for hospitalization, progression, recovery, cases, and viral clearance.

No treatment is 100% effective. Protocols combine complementary and synergistic treatments. ^* >10% efficacy in meta analysis with ≥3 clinical studies.

4,100+ studies for 60+ treatments. c19early.org

Retrospective 764 pregnant patients with COVID-19 in the USA, 88 treated with casirivimab/imdevimab, showing no significant difference in outcomes.

Efficacy is variant dependent. In Vitro research suggests a lack of efficacy for many omicron variants Haars, Liu, Pochtovyi, Sheward, Tatham, VanBlargan.

1. Haars et al., Prevalence of SARS-CoV-2 Omicron Sublineages and Spike Protein Mutations Conferring Resistance against Monoclonal Antibodies in a Swedish Cohort during 2022–2023, Microorganisms, doi:10.3390/microorganisms11102417.mdpi.com, doi.org.

2. Liu et al., Striking Antibody Evasion Manifested by the Omicron Variant of SARS-CoV-2, bioRxiv, doi:10.1101/2021.12.14.472719.biorxiv.org, doi.org.

3. Pochtovyi et al., In Vitro Efficacy of Antivirals and Monoclonal Antibodies against SARS-CoV-2 Omicron Lineages XBB.1.9.1, XBB.1.9.3, XBB.1.5, XBB.1.16, XBB.2.4, BQ.1.1.45, CH.1.1, and CL.1, Vaccines, doi:10.3390/vaccines11101533.mdpi.com, doi.org.

4. Sheward et al., Variable loss of antibody potency against SARS-CoV-2 B.1.1.529 (Omicron), bioRxiv, doi:10.1101/2021.12.19.473354.biorxiv.org, doi.org.

5. Tatham et al., Lack of Ronapreve (REGN-CoV; casirivimab and imdevimab) virological efficacy against the SARS-CoV 2 Omicron variant (B.1.1.529) in K18-hACE2 mice, bioRxiv, doi:10.1101/2022.01.23.477397.biorxiv.org, doi.org.

6. VanBlargan et al., An infectious SARS-CoV-2 B.1.1.529 Omicron virus escapes neutralization by several therapeutic monoclonal antibodies, bioRxiv, doi:10.1101/2021.12.15.472828.biorxiv.org, doi.org.

Important missing comments or errors? Let us know.

risk of oxygen therapy, 20.8% higher, RR 1.21, p = 0.87, treatment 1 of 88 (1.1%), control 6 of 676 (0.9%), odds ratio converted to relative risk.

risk of severe case, 1.0% higher, RR 1.01, p = 0.99, treatment 1 of 88 (1.1%), control 7 of 676 (1.0%), odds ratio converted to relative risk.

risk of hospitalization, 13.9% lower, RR 0.86, p = 0.90, treatment 1 of 88 (1.1%), control 8 of 676 (1.2%), NNT 2125, odds ratio converted to relative risk.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

Williams et al., 12 Sep 2022, retrospective, USA, peer-reviewed, 6 authors. Contact: frank.williams2@ochsner.org.

This Paper Casirivimab/i..All

Effectiveness of REGEN-COV combination monoclonal antibody infusion to reduce the risk of COVID-19 hospitalization in pregnancy: a retrospective cohort study

MD/MPH Frank B Williams, MD John A Morgan, MPH Ardem Elmayan, MD Jane K Martin, MD Naiha Mussarat, MD Joseph R Biggio

American Journal of Obstetrics and Gynecology, doi:10.1016/j.ajog.2022.09.017

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

References

Halalau, Imam, Karabon, External validation of a clinical risk score to predict hospital admission and in-hospital mortality in COVID-19 patients, Ann Med, doi:10.1080/07853890.2020.1828616

Jamieson, Rasmussen, An update on COVID-19 and pregnancy, Am J Obstet Gynecol, doi:10.1016/j.ajog.2021.08.054

Kalafat, Prasad, Birol, An internally validated prediction model for critical COVID-19 infection and intensive care unit admission in symptomatic pregnant women, Am J Obstet Gynecol, doi:10.1016/j.ajog.2021.09.024J

Weinreich, Sivapalasingam, Norton, REGEN-COV Antibody Combination and Outcomes in Outpatients with Covid-19, N Engl J Med, doi:10.1056/NEJMoa2108163

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