SARS-CoV-2 pre-exposure prophylaxis with tixagevimab/cilgavimab (AZD7442) provides protection in inborn errors of immunity with antibody defects: a real-world experience

Frontiers in Immunology

Immunology

Rita Carsetti¹  Maria Carrabba²  Maddalena Sciannamea³  Cinzia Milito³  Giulia Garzi³  Eleonora Sculco³  Eva Piano Mortari⁴  Lilia Cinti⁵  Anna Napoli⁵  Guido Antonelli⁵  Alessandra Punziano⁶  Piergiorgio Roberto⁷  Federica Pulvirenti⁸  Isabella Quinti⁹ 

[1] B Cell Unit, Immunology Research Area, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy;Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy;Department of Molecular Medicine, Sapienza University, Rome, Italy;Department of Molecular Medicine, Sapienza University, Rome, Italy;B Cell Unit, Immunology Research Area, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy;Department of Molecular Medicine, Sapienza University, Rome, Italy;Microbiology and Virology Unit, Sapienza University Hospital “Policlinico Umberto I”, Rome, Italy;Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy;Microbiology and Virology Unit, Sapienza University Hospital “Policlinico Umberto I”, Rome, Italy;Reference Centre for Primary Immune Deficiencies, Sapienza University Hospital “Policlinico Umberto I”, Rome, Italy;Reference Centre for Primary Immune Deficiencies, Sapienza University Hospital “Policlinico Umberto I”, Rome, Italy;Department of Molecular Medicine, Sapienza University, Rome, Italy;

关键词: SARS-CoV-2;    COVID-19;    inborn errors of immunity;    immunoglobulin replacement (IgRT);    monoclonal antibody;    tixagevimab/cilgavimab prophylaxis;    common variable immune deficiency (CVID);   

DOI  :  10.3389/fimmu.2023.1249462

 received in 2023-06-28, accepted in 2023-10-03,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundPreventive strategies against severe COVID-19 in Inborn Errors of Immunity (IEI) include bivalent vaccines, treatment with SARS-CoV-2 monoclonal antibodies (mAbs), early antiviral therapies, and pre-exposure prophylaxis (PrEP).ObjectiveTo assess the effectiveness of the PrEP with tixagevimab/cilgavimab (AZD7442) in IEI with primary antibody defects during the COVID-19 Omicron wave.MethodsA six-month prospective study evaluated the SARS-CoV-2 infection rate and the COVID-19 severity in the AZD7442 group, in the no-AZD7442 group, and in a group of patients with a recent SARS-CoV-2 infection (< three months). Spike-specific IgG levels were measured at regular intervals.ResultsSix out of thirty-three patients (18%) and 54/170 patients (32%) became infected in the AZD7442 group and in the no-AZD7442 group, respectively. Within 90 days post-administration, the AZD7442 group was 85% less likely to be infected and 82% less likely to have a symptomatic disease than the no-AZD7442 group. This effect was lost thereafter. In the entire cohort, no mortality/hospitalisation was observed. The control group of 35 recently infected patients was 88% and 92% less likely to be infected than the AZD7442 and no-AZD7442 groups. Serum anti-Spike IgG reached the highest peak seven days post-AZD7442 PrEP then decreased, remaining over 1000 BAU/mL 180 days thereafter.ConclusionIn patients with IEI and antibody defects, AZD7442 prophylaxis had a transient protective effect, possibly lost possibly because of the appearance of new variants. However, PrEP with newer mAbs might still represent a feasible preventive strategy in the future in this population.

【 授权许可】

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Copyright © 2023 Pulvirenti, Garzi, Milito, Sculco, Sciannamea, Napoli, Cinti, Roberto, Punziano, Carrabba, Piano Mortari, Carsetti, Antonelli and Quinti