Comparison of Dual Monoclonal Antibody Therapies for COVID-19 Evolution: A Multicentric Retrospective Study

• Published in: Viruses Vol. 16; no. 10; p. 1542
• Main Authors: Zafilaza, Karen, Bellet, Jonathan, Truffot, Aurélie, Foulongne, Vincent, Onambele, Manuela Mireille, Salmona, Maud, Vellas, Camille, Périllaud-Dubois, Claire, Mirand, Audrey, André-Garnier, Elisabeth, Alidjinou, Enagnon Kazali, Brichler, Ségolène, Fenaux, Honorine, Bouvier-Alias, Magali, Hartard, Cédric, Dorival, Céline, Carrat, Fabrice, Marcelin, Anne-Geneviève, Stefic, Karl, Soulie, Cathia
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 29.09.2024; MDPI
• Subjects: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized - therapeutic use; Antibodies, Neutralizing - immunology; Antibodies, Neutralizing - therapeutic use; Antiviral Agents - therapeutic use; Comorbidity; COVID-19; COVID-19 - immunology; COVID-19 - mortality; COVID-19 - virology; COVID-19 Drug Treatment; Disease; Drug Combinations; Female; Firing rate; Glycoproteins; Hospitalization; Humans; immune escape mutation; Immunotherapy; Male; Middle Aged; Monoclonal antibodies; monoclonal antibody therapy; Mutation; Patients; Retrospective Studies; Risk groups; SARS-CoV-2; SARS-CoV-2 - genetics; SARS-CoV-2 - immunology; Severe acute respiratory syndrome coronavirus 2; spike gene; Spike Glycoprotein, Coronavirus - genetics; Spike Glycoprotein, Coronavirus - immunology; Spike protein; Steroids; Treatment Outcome; COVID-19; SARS-CoV-2; monoclonal antibody therapy; spike gene; immune escape mutation
• ISSN: 1999-4915; 1999-4915
• DOI: 10.3390/v16101542

Neutralizing antibodies targeting the SARS-CoV-2 Spike protein reduce COVID-19-related risk of hospitalization, particularly in high-risk individuals. The COCOPREV-R study aimed to evaluate and compare clinical outcomes in high-risk SARS-CoV-2 patients treated with dual monoclonal antibody therapies and to identify associated virological factors. The COCOPREV-R study retrospectively collected real-world data from high-risk patients receiving Bamlanivimab/Etesevimab or Casirivimab/Imdevimab dual monoclonal antibody therapies (22 February 2021 to 15 June 2021). The study included 1004 patients with COVID-19, of whom 691 received Bamlanivimab/Etesevimab and 313 received Casirivimab/Imdevimab. The alpha variant represented 90.1% of those for whom data were available. The risk of hospitalization within 30 days was lower with Bamlanivimab/Etesevimab (12.7%, CI 95% [9.9-16.3%]) compared to Casirivimab/Imdevimab (28.4%, CI 95% [22.7-35.1%) ( < 0.001). The 30-day mortality rates were comparable between both groups ( = 0.982). Analysis of SARS-CoV-2 PCR negativity showed no difference between the two treatment groups (95.2% [93.0-96.9%] and 93.5% [89.1-96.6%] until day 30, = 0.851 for Bamlanivimab/Etesevimab and Casirivimab/Imdevimab, respectively). Among persistently positive samples with available sequencing results ( = 43), Spike protein changes occurred only in Bamlanivimab/Etesevimab (42.9%) vs. Casirivimab/Imdevimab (0.0%) groups. Q493R (25.0%) and E484K (12.5%) were the most common mutations selected by Bamlanivimab/Etesevimab in follow-up samples. Other factors (immunodepression, comorbidities, and age) did not appear to be associated with the occurrence of Spike protein mutations. A higher rate of hospitalization was seen with Casirivimab/Imdevimab (RONAPREVE ) in comparison with Bamlanivimab/Etesevimab treatment, but with the emergence of Spike mutations only in the Bamlanivimab/Etesevimab group.