Effectiveness of Casirivimab-Imdevimab Monoclonal Antibody Treatment Among High-Risk Patients With Severe Acute Respiratory Syndrome Coronavirus 2 B.1.617.2 (Delta Variant) Infection

Mohanad M Al-Obaidi; Ahmet B Gungor; Saman Nematollahi; Tirdad T Zangeneh; Edward J Bedrick; Katherine M Johnson; Nicole E Low-Adegbija; Ruhaniyah Alam; Pooja Rangan; C William Heise; Venkatesh K Ariyamuthu; Aneesha Shetty; Abd Assalam Qannus; Sangeetha Murugapandian; Mehmet M S Ayvaci; Prince Mohan Anand; Bekir Tanriover

doi:10.1093/ofid/ofac186

Effectiveness of Casirivimab-Imdevimab Monoclonal Antibody Treatment Among High-Risk Patients With Severe Acute Respiratory Syndrome Coronavirus 2 B.1.617.2 (Delta Variant) Infection

Open Forum Infect Dis. 2022 Apr 12;9(7):ofac186. doi: 10.1093/ofid/ofac186. eCollection 2022 Jul.

Authors

Mohanad M Al-Obaidi¹, Ahmet B Gungor², Saman Nematollahi¹, Tirdad T Zangeneh¹, Edward J Bedrick³, Katherine M Johnson⁴, Nicole E Low-Adegbija⁵, Ruhaniyah Alam⁴, Pooja Rangan⁶, C William Heise⁷, Venkatesh K Ariyamuthu⁸, Aneesha Shetty⁸, Abd Assalam Qannus⁸, Sangeetha Murugapandian⁸, Mehmet M S Ayvaci⁹, Prince Mohan Anand¹⁰, Bekir Tanriover⁸

Affiliations

¹ Division of Infectious Disease, College of Medicine, University of Arizona, Tucson, Arizona, USA.
² Division of Nephrology, Banner University Medical Center, Tucson, Arizona, USA.
³ Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson, Arizona, USA.
⁴ Division of Clinical Pharmacy, Banner University Medical Center, Tucson, Arizona, USA.
⁵ Department of Surgery, Banner University Medical Center, Tucson, Arizona, USA.
⁶ Department of Medicine, Banner University Medical Center Phoenix, Phoenix, Arizona, USA.
⁷ Division of Clinical Data Analytics and Decision Support, Department of Medicine, College of Medicine-Phoenix, University of Arizona, Phoenix, Arizona, USA.
⁸ Division of Nephrology, College of Medicine, University of Arizona, Tucson, Arizona, USA.
⁹ Information Systems, Naveen Jindal School of Management, University of Texas at Dallas, Dallas, Texas, USA.
¹⁰ Medical University of South Carolina, Lancaster, South Carolina, USA.

Abstract

Background: Real-world data on the effectiveness of neutralizing casirivimab-imdevimab monoclonal antibody (Cas-Imd mAb) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among high-risk patients may inform the response to future SARS-CoV-2 variants.

Methods: This study covers an observational retrospective data analysis in Banner Health Care System sites, mainly in Arizona. During the study period, the prevalence of SARS-CoV-2 Delta variant was between 95% and 100%. Of 29 635 patients who tested positive for coronavirus disease 2019 (COVID-19) between 1 August 2021 and 30 October 2021, in the Banner Health Care System, the study cohort was split into 4213 adult patients who received Cas-Imd mAb (1200 mg) treatment compared to a PS-matched 4213 untreated patients. The primary outcomes were the incidence of all-cause hospitalization, intensive care unit (ICU) admission, and mortality within 30 days of Cas-Imd mAb administration or Delta variant infection.

Results: Compared to the PS-matched untreated cohort, the Cas-Imd mAb cohort had significantly lower all-cause hospitalization (4.2% vs 17.6%; difference in percentages, -13.4 [95% confidence interval {CI}, -14.7 to -12.0]; P < .001), ICU admission (0.3% vs 2.8%; difference, -2.4 [95% CI, -3.0 to -1.9]; P < .001), and mortality (0.2% vs 2.0%; difference, -1.8 [95% CI, -2.3 to -1.3]; P < .001) within 30 days. The Cas-Imd mAb treatment was associated with lower rate of hospitalization (hazard ratio [HR], 0.22 [95% CI, .19-.26]; P < .001) and mortality (HR, 0.11 [95% CI, .06-.21]; P < .001).

Conclusions: Cas-Imd mAb treatment was associated with a lower hospitalization rate, ICU admission, and mortality within 30 days among patients infected with the SARS-CoV-2 Delta variant.

Keywords: Delta variant; SARS-CoV-2; all-cause hospitalization; casirivimab-imdevimab monoclonal antibody; mortality; propensity matching.