Kidney Week

Abstract: TH-PO1157

Tixagevimab-Cilgavimab for Breakthrough COVID-19 Prevention in Dialysis Patients: A Prospective Study

Session Information

• COVID-19
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Coronavirus (COVID-19)

• 000 Coronavirus (COVID-19)

Authors

• Sritippayawan, Suchai, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

Suchai Sritippayawan, MD, PhD

• Boongird, Sarinya, Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Sarinya Boongird, MD

• Srithongkul, Thatsaphan, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

Thatsaphan Srithongkul

• Sethakarun, Sethanant, Bhumirajanagarindra Kidney Institute, Bangkok, Thailand

Sethanant Sethakarun, MD

• Bruminhent, Jackrapong, Division of Infectious diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand

Jackrapong Bruminhent

• Kiertiburanakul, Sasisopin, Division of Infectious diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand

Sasisopin Kiertiburanakul, MD

• Nongnuch, Arkom, Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Arkom Nongnuch, MD

• Kitiyakara, Chagriya, Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Chagriya Kitiyakara, MD

Background

Tixagevimab-cilgavimab (T/C), a monoclonal antibody for pre-exposure prophylaxis (PrEP), holds promise among immunocompromised individuals for preventing COVID-19. However, data on T/C effectiveness in the dialysis population is limited.

Methods

This multi-center, prospective study evaluated the impact of T/C as PrEP for breakthrough COVID-19 in vaccinated dialysis patients during the Omicron BA.2.75 and XBB variant surge. Patients were assigned to either the T/C group, receiving a single 150 mg/150 mg intramuscular dose, or an age-matched control group not receiving T/C. All participants were followed for a period of 6 months. The primary outcome was breakthrough COVID-19 rate. Secondary outcomes included COVID-19 related hospitalization, ICU admission, and mortality. Safety of T/C was assessed in the intervention group.

Results

A total of 200 participants (100 in the T/C and 100 in the control group) were enrolled. The mean age of participants was 66 years old, with over 80% on hemodialysis. At 6 months, the cumulative incidence of breakthrough infection did not differ significantly between groups (17% T/C vs. 15% control; p = 0.66). However, among those who developed breakthrough infections, the median (IQR) time to diagnosis tended to be longer in the T/C group compared to controls [4.9 (2.81–4.98) months vs. 1.96 (1.65–2.91) months; p = 0.08]. T/C administration significantly reduced COVID-19 related hospitalization rates (5.9% vs. 40.0%; p = 0.02) among participants with breakthrough infections. No significant differences were observed in ICU admission, intubation, or death rates from COVID-19. All reported T/C-related adverse events were mild and resolved within 7 days.

Conclusion

Breakthrough COVID-19 can occur in vaccinated dialysis patients receiving T/C during the Omicron surge; however, these patients are likely to experience fewer hospitalizations. Further research on other investigational monoclonal antibody or alternative prevention strategies is needed for this population.

Cumulative incidence of breakthrough COVID-19

Funding

• Clinical Revenue Support