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Pre-exposure prophylaxis with tixagevimab and cilgavimab (Evusheld) for COVID-19 among 1112 severely immunocompromised patients

2022; Elsevier BV; Volume: 28; Issue: 12 Linguagem: Inglês

10.1016/j.cmi.2022.07.015

1469-0691

Yann Nguyen, Adrien Flahault, Nathalie Chavarot, Cléa Melenotte, Morgane Cheminant, P Deschamps, Nicolas Carlier, Emmanuel Lafont, M. Thomas, Edouard Flamarion, David Lebeaux, Caroline Charlier, A. Rachline, Corinne Guérin, Robert Ratiney, J Touchard, Hélène Péré, Flore Rozenberg, Fanny Lanternier, Jean‐Benoît Arlet, Jérôme Avouac, Véronique Boussaud, R. Guillemain, Marguerite Vignon, Éric Thervet, Anne Scemla, Laurence Weiss, Luc Mouthon,

Pneumocystis jirovecii pneumonia detection and treatment

Abstract Objective Immunocompromised patients have an increased risk of a severe form of COVID-19. The clinical efficacy of the tixagevimab/cilgavimab monoclonal antibody combination as pre-exposure prophylaxis against BA.1 and BA.2 SARS-CoV-2 Omicron sublineages is unknown. We aimed to describe the incidence and outcomes of COVID-19 among immunocompromised patients receiving tixagevimab/cilgavimab as preexposure prophylaxis during the Omicron wave in France. Methods This was an observational multicentre cohort study of immunocompromised patients receiving tixagevimab/cilgavimab as preexposure prophylaxis between December 28, 2021 and March 31, 2022. Patients received tixagevimab/cilgavimab 150/150 mg intramuscularly if they had impaired vaccine response and a high risk of severe form of COVID-19. Results Tixagevimab/cilgavimab was administered to 1112 immunocompromised patients. After a median (range) follow-up of 63 (49–73) days, COVID-19 was confirmed in 49/1112 (4.4%) ≥5 days after treatment. During the study period, mean weekly incidence rate was 1669 in 100 000 inhabitants in Ile-de-France and 530 in 100 000 among patients who received tixagevimab/cilgavimab prophylaxis. Among infected patients, 43/49 (88%) had a mild-to-moderate form and 6/49 (12%) had a moderate-to-severe form of COVID-19. Patients with moderate-to-severe illnesses were less likely to have received early therapies than patients with mild forms (53.5% vs. 16.7% respectively) and 2/49 (4%) patients died from COVID-19. Discussion Our study reported a low rate of infections and severe illnesses among immunocompromised patients treated with tixagevimab/cilgavimab. A global preventive strategy including vaccines, preexposure prophylaxis with monoclonal antibodies, and early therapies might be effective to prevent severe forms of COVID-19 among severely immunocompromised patients.