The monoclonal antibody sotrovimab can be used safely in kidney transplant recipients with COVID-19, including older individuals and those with comorbidities, investigators suggest.
Spanish investigators conducted a retrospective study of 82 kidney transplant recipients with COVID-19, of whom 46 (56%) received sotrovimab within 5 days of symptom onset (early group) and 36 (44%) received sotrovimab after 5 days (late group). Of 41 patients for whom SARS-CoV-2 genotype was determined, 40 (97.5%) were infected with the Omicron variant.
Patients in the early treatment group were less likely to progress to severe COVID-19 compared with the late treatment group with a significantly lower need for ventilator support (2.2% vs 36.1%) and intensive care admission (2.2% vs 25%) and lower COVID-19-related mortality (2.2% vs 16.7%). In an adjusted multivariable analysis, early use of sotrovimab was significantly associated with 97.4% decreased odds of a composite of these 3 outcomes, Florentino Villanego, MD, PhD, of Hospital Universitario Puerta del Mar, Cádiz, Spain, and colleagues reported in Clinical Kidney Journal.
Six of the 7 patients who died had received sotrovimab later than 5 days. The deceased group presented with more severe COVID-19 illness and had more pneumonia compared with the recovered group. They were also significantly older (72 vs 63 years) and had more comorbidities, especially cardiovascular disease. These possible confounders prevent firm conclusions about sotrovimab’s efficacy in kidney transplant recipients, according to the investigators.
Most of the full cohort were vaccinated. No patient received another monoclonal antibody, but 68% received other COVID-19 therapies, especially intravenous steroids (65.9%). A total of 86.6% of patients had chronic kidney disease, including 48.8% who had an estimated glomerular filtration rate less than 30 mL/min/1.73 m2.
The investigators found no anaphylactic reactions, acute rejection episodes, impaired kidney function events, or non-kidney side effects after sotrovimab administration.
“Our multicenter study supports the safety of sotrovimab in KT recipients with COVID-19, even in high-comorbidity patients and those with advanced-stage CKD,” Dr Villanego’s team wrote. “Patients treated early were unlikely to progress to severe COVID-19, while clinical outcomes were poor in those treated later. Therefore, our experience reinforces the importance of an early diagnosis in these patients with a high rate of nonresponse to vaccines.”
Villanego F, Mazuecos A, Cubillo B, et al. Treatment with sotrovimab for SARS-CoV-2 infection in a cohort of high-risk kidney transplant recipients. Clin Kidney J. 15(10):1847-1855. doi:10.1093/ckj/sfac177