key: cord-0872325-dczvf57c
authors: Fernandes, Guillaume; Devresse, Arnaud; Scohy, Anais; Yombi, Jean Cyr; Belkhir, Leila; De Greef, Julien; Darius, Tom; Buemi, Antoine; Kabamba, Benoit; Goffin, Eric; Kanaan, Nada
title: Monoclonal Antibody Therapy for SARS-CoV-2 Infection in Kidney Transplant Recipients: A Case Series From Belgium
date: 2021-10-26
journal: Transplantation
DOI: 10.1097/tp.0000000000003974
sha: 4eaf8c4b16ec3539df4ec66c39ae4ab56beaeae4
doc_id: 872325
cord_uid: dczvf57c

nan

K idney transplant recipients (KTRs) are particularly vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and may remain at risk after complete vaccination because of poor response rate. 1, 2 Neutralizing monoclonal antibodies (Abs) have been shown to be safe and efficient in reducing viral load in immunocompetent outpatients with coronavirus disease 2019 (COVID-19). 3 In immunocompromised patients, including solid organ transplant recipients, few reports have reported similar results. 4, 5 In this article, we report the efficacy and safety of monoclonal Ab therapy (intravenous casirivimab 1200 mg and imdevimab 1200 mg, Regeneron Pharmaceuticals, Terrytown, NY) in 12 KTRs infected by SARS-CoV-2 who were treated in our center between June and September 2021. The study received institutional review board approval.

The mean age was 47 (range, 21-78) y and 6 patients (50%) were male ( Table 1 ). The mean time from transplantation was 112 mo (range, 2-264). Eight patients (75%) were treated with an association of tacrolimus (Tac), mycophenolate (MPA), and steroids, and 4 patients (25%) were treated with dual therapy (Tac/MPA n = 2; Tac/steroids n = 1; Tac/azathioprine n = 1). Ten patients had received 2 doses of the mRNA BNT162b2 (Pfizer-BioNTech), with a mean time of 111 (range, 39-200) d before SARS-CoV-2 infection. Two of the vaccinated patients had a prior history of COVID-19. Patients presented with mild symptoms (fever n = 8; cough n = 6; headache n = 3; myalgia n = 3; rhinorrhea n = 2; diarrhea n = 1) and tested positive for SARS-CoV-2 using polymerase chain reaction on nasopharyngeal swab. The mean time between the beginning of symptoms and diagnosis was 3.75 (range, 2-7) d. The mean viral load at diagnosis was 3.62 × 10 6 (range, 171 × 10 3 -85 × 10 6 ) copies/mL. Viral genotyping (available for 5 patients) revealed the Delta variant (n = 4) and the Gamma variant (n = 1) according to World Health Organization nomenclature.

MPA was discontinued for 10 d in all patients. Nine patients were discharged the day of the diagnosis after receiving the Ab therapy. Three patients were hospitalized, and interestingly, the 2 unvaccinated KTRs required oxygen supplementation for 24 h. All were discharged the day after.

One patient experienced a mild allergic reaction during Ab infusion that required a brief interruption of the perfusion. No other side effect was reported.

The follow-up consisted of a repeated polymerase chain reaction on nasopharyngeal swab 7 d after treatment administration. The viral load was <1000 copies/mL in all patients. All KTRs reported a rapid resolution of symptoms and none necessitated a new hospitalization.

Our results show that monoclonal Ab therapy is safe and associated with favorable outcomes in SARS-CoV-2infected KTRs. Additional studies are required to assess the efficacy of this treatment in larger cohorts and in more severe forms of COVID-19 infection.

COVID-19 vaccination in kidney transplant recipients

Disappointing immunization rate after two doses of the BNT162b2 vaccine in a Belgian cohort of kidney transplant recipients

REGN-COV2, a neutralizing antibody cocktail, in outpatients with Covid-19

Preemptive antibody therapy for vaccine breakthrough SARS-CoV-2 infection in immunocompromised patients

Anti-SARS-CoV-2 monoclonal antibodies in solid-organ transplant patients