Decoding REGEN-COV2 for Mild to Moderate SARS-CoV-2 Infection in Kidney Transplant Recipients

Kidney transplant recipients are an immunocompromised population, with comorbid conditions such as obesity, diabetes, and coronary artery disease, which increases their risk for progressing to severe COVID-19. Although COVID-19 vaccination is currently widespread and recommended for the prevention of severe COVID-19 infection, some transplant programs delay administering vaccinations immediately post-transplant to avoid all immune stimulation. Also, immunosuppressed kidney transplant recipients may have impaired antibody responses.

In the current study, REGN-COV2 was administered to 14 kidney transplant recipients with mild to moderate COVID-19 infection. To be eligible for REGN-COV2, all recipients must test positive by nasopharyngeal swab for SARS-CoV-2 via RT-PCR.

Results

Baseline Characteristics

• The median age of treated recipients was 62 years (IQ range 52-69), and the median time from transplant was 5 years (IQ range 1-9)
• Preexisting risk factors for the severe disease were identified in our recipients and included age > 65 years, hypertension, coronary disease, and diabetes mellitus.
• The median time to REGN-COV2 infusion was 5 days (interquartile range 4-7).
• 3/14 recipients received corticosteroid maintenance therapy. Overall, immunosuppression was reduced in 6 patients after COVID-19 diagnosis. 

Safety

• A single REGN-COV2 infusion of casirivimab 1200 mg and imdevimab 1200 mg was tolerated by our kidney transplant recipients.
• No cases of hypersensitivity reactions were observed. 
• During infusion, 1 adverse event occurred where a recipient complained of burning sensation in the hands, which resolved following a dose of acetaminophen.
• 1 individual, aged 61 years, was hospitalized 6 days after infusion for worsening symptoms and required supplemental oxygen. This patient received dexamethasone, remdesivir, and tocilizumab, and up to 15 L oxygen. Further, the patient continued to improve and no longerneed oxygen supplement 2 weeks after discharge.

 Efficacy

In kidney transplant recipients who are unable to obtain or have impaired antibody response to vaccinations, timely administration of REGN-COV2 in COVID-19–positive kidney transplant recipients may prevent progression to severe illness.

Conclusion:

Neutralizing antibody therapy with REGN-COV2 was well tolerated and will continue to be useful in kidney transplant recipients with mild to moderate COVID-19 regardless of vaccination status.

Reference:

Liu EC, Lee JH, Loo A, MazurS, Sultan S, Aull M, Lee JB, MuthukumarT, Hartono C. Casirivimab-Imdevimab (REGN-COV2) for Mild to Moderate SARS-CoV-2 Infection in Kidney Transplant Recipients. Kidney Int Rep. 2021 Nov;6(11):2900-2902.

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