Treatment with sotrovimab for SARS-CoV-2 infection in a cohort of high-risk kidney transplant recipients

Background Sotrovimab is a neutralizing monoclonal antibody (mAb) that seems to remain active against recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. The evidence on its use in kidney transplant (KT) recipients, however, is limited. Methods We performed a multicenter, r...

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Published in:	Clinical kidney journal Vol. 15; no. 10; pp. 1847 - 1855
Main Authors:	Villanego, Florentino, Mazuecos, Auxiliadora, Cubillo, Beatriz, Merino, M José, Poveda, Inmaculada, Saura, Isabel M, Segurado, Óscar, Cruzado, Leónidas, Eady, Myriam, Zárraga, Sofía, Aladrén, M José, Cabello, Sheila, López, Verónica, González, Esther, Lorenzo, Inmaculada, Espí-Reig, Jordi, Fernández, Constantino, Osma, July, Ruiz-Fuentes, M Carmen, Toapanta, Néstor, Franco, Antonio, Burballa, Carla C, Muñoz, Miguel A, Crespo, Marta, Pascual, Julio
Format:	Journal Article
Language:	English
Published:	Oxford University Press 01-10-2022
Subjects:	Care and treatment Chronic kidney failure Coronaviruses Health aspects Kidneys Medical research Medicine, Experimental Monoclonal antibodies Mortality Organ transplant recipients Original Prevention Risk factors Severe acute respiratory syndrome Spain Transplantation Ventilators Spain COVID-19 mortality immunosuppression kidney transplantation monoclonal antibodies
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Summary:	Background Sotrovimab is a neutralizing monoclonal antibody (mAb) that seems to remain active against recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. The evidence on its use in kidney transplant (KT) recipients, however, is limited. Methods We performed a multicenter, retrospective cohort study of 82 KT patients with SARS-CoV-2 infection {coronavirus disease 2019 [COVID-19]} treated with sotrovimab. Results Median age was 63 years. Diabetes was present in 43.9% of patients, and obesity in 32.9% of patients; 48.8% of patients had an estimated glomerular filtration rate under 30 mL/minute/1.73 m2. Additional anti–COVID-19 therapies were administered to 56 patients, especially intravenous steroids (65.9%). Sotrovimab was administered early (<5 days from the onset of the symptoms) in 46 patients (56%). Early-treated patients showed less likely progression to severe COVID-19 than those treated later, represented as a lower need for ventilator support (2.2% vs 36.1%; P < .001) or intensive care admission (2.2% vs 25%; P = .002) and COVID-19–related mortality (2.2% vs 16.7%; P = .020). In the multivariable analysis, controlling for baseline risk factors to severe COVID-19 in KT recipients, early use of sotrovimab remained as a protective factor for a composite outcome, including need for ventilator support, intensive care, and COVID-19–related mortality. No anaphylactic reactions, acute rejection episodes, impaired kidney function events, or non-kidney side effects related to sotrovimab were observed. Conclusions Sotrovimab had an excellent safety profile, even in high-comorbidity patients and advanced chronic kidney disease stages. Earlier administration could prevent progression to severe disease, while clinical outcomes were poor in patients treated later. Larger controlled studies enrolling KT recipients are warranted to elucidate the true efficacy of monoclonal antibody therapies. Graphical Abstract Graphical Abstract
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Julio Pascual and Marta Crespo share co-senior authorship. Auxiliadora Mazuecos and Florentino Villanego share co-first authorship.
ISSN:	2048-8505 2048-8513
DOI:	10.1093/ckj/sfac177