The following is a summary of “Mortality and risk factors of vaccinated and unvaccinated frail patients with COVID-19 treated with anti-SARS-CoV-2 monoclonal antibodies: A real-world study,” published in the June 2023 issue of Infectious Disease by Nevola et al.
The outcomes and predictors of therapeutic failure of monoclonal antibodies (mAbs) in frail patients with COVID-19 are poorly understood. A prospective study involving COVID-19 outpatients referred to mAb therapy by primary care physicians. The outcomes evaluated were mortality at 60 days, latency to SARS-CoV-2 clearance, hospitalization requirement, and oxygen therapy. About 60.2% of enrolled COVID-19 patients received casirivamab/imdevimab, and 39.8% received sotrivimab.
The median age was 63 years, 52.4% were males, and the median interval between a positive nasopharyngeal swab and the administration of mAbs was 3 days (range: 2-5). 78.1% were immunized. Overall, mortality at 60 days was 2.14%. There were no disparities in outcomes between the two mAbs utilized. There was no difference in mortality between vaccinated and unvaccinated patients (P = 0.925); however, vaccinated patients had a lower rate of hospitalization (P<0.005), less need for oxygen therapy (P<0.0001), and shorter nasopharyngeal swab negativity time (P<0.0001).
Early administration of mAbs was associated with decreased mortality (P<0.007), while corticosteroid use was associated with a worse prognosis (P<0.004). Age (P<0.0001), the presence of active hematologic malignancies (P<0.0001), renal failure (P<0.041), and the need for O2 therapy were independent predictors of higher mortality. This study demonstrates that mAbs are equally efficacious regardless of vaccination status and identifies COVID-19 patients in whom mAbs are ineffective.