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Breakthrough COVID-19 After Tixagevimab/Cilgavimab Among Patients With Systemic Autoimmune Rheumatic Diseases.
Kawano, Yumeko; Wang, Xiaosong; Patel, Naomi J; Qian, Grace; Kowalski, Emily; Bade, Katarina J; Vanni, Kathleen M M; Jonsson, A Helena; Williams, Zachary K; Cook, Claire E; Srivatsan, Shruthi; Wallace, Zachary S; Sparks, Jeffrey A.
Affiliation
  • Kawano Y; Y. Kawano, MD, A.H. Jonsson, MD, PhD, J.A. Sparks, MD, MMSc, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, and Harvard Medical School.
  • Wang X; X. Wang, MS, G. Qian, BA&Sc, E. Kowalski, BS, K.J. Bade, BS, K.M.M. Vanni, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital.
  • Patel NJ; N.J. Patel, MD, Z.S. Wallace, MD, MSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Harvard Medical School.
  • Qian G; X. Wang, MS, G. Qian, BA&Sc, E. Kowalski, BS, K.J. Bade, BS, K.M.M. Vanni, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital.
  • Kowalski E; X. Wang, MS, G. Qian, BA&Sc, E. Kowalski, BS, K.J. Bade, BS, K.M.M. Vanni, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital.
  • Bade KJ; X. Wang, MS, G. Qian, BA&Sc, E. Kowalski, BS, K.J. Bade, BS, K.M.M. Vanni, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital.
  • Vanni KMM; X. Wang, MS, G. Qian, BA&Sc, E. Kowalski, BS, K.J. Bade, BS, K.M.M. Vanni, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital.
  • Jonsson AH; Y. Kawano, MD, A.H. Jonsson, MD, PhD, J.A. Sparks, MD, MMSc, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, and Harvard Medical School.
  • Williams ZK; Z.K. Williams, BA, C.E. Cook, MPH, S. Srivatsan, BA, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Cook CE; Z.K. Williams, BA, C.E. Cook, MPH, S. Srivatsan, BA, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Srivatsan S; Z.K. Williams, BA, C.E. Cook, MPH, S. Srivatsan, BA, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Wallace ZS; N.J. Patel, MD, Z.S. Wallace, MD, MSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Harvard Medical School.
  • Sparks JA; Y. Kawano, MD, A.H. Jonsson, MD, PhD, J.A. Sparks, MD, MMSc, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, and Harvard Medical School; jsparks@bwh.harvard.edu.
J Rheumatol ; 51(3): 305-312, 2024 Mar 01.
Article in En | MEDLINE | ID: mdl-37839812
OBJECTIVE: To determine the incidence and baseline factors associated with breakthrough coronavirus disease 2019 (COVID-19) after preexposure prophylaxis (PrEP) with tixagevimab/cilgavimab among patients with systemic autoimmune rheumatic diseases (SARDs). METHODS: We performed a retrospective cohort study among patients with SARDs who received tixagevimab/cilgavimab between January 2, 2022, and November 16, 2022. The primary outcome was breakthrough COVID-19 after tixagevimab/cilgavimab. We performed multivariable Cox regression models adjusted for baseline factors to identify risk factors for breakthrough COVID-19. RESULTS: We identified 444 patients with SARDs who received tixagevimab/cilgavimab (mean age 62.0 years, 78.2% female). There were 83 (18.7%) breakthrough COVID-19 cases (incidence rate 31.5/1000 person-months, 95% CI 24.70-38.24), 7 (1.6%) hospitalizations, and 1 (0.2%) death. Older age was inversely associated with breakthrough COVID-19 (adjusted hazard ratio [aHR] 0.86/10 years, 95% CI 0.75-0.99). Higher baseline spike antibody levels were associated with lower risk of breakthrough COVID-19 (aHR 0.42, 95% CI 0.18-0.99 for spike antibody levels > 200 vs < 0.4 units). CD20 inhibitor users had a similar risk of breakthrough COVID-19 (aHR 1.05, 95% CI 0.44-2.49) compared to conventional synthetic disease-modifying antirheumatic drug (DMARD) users. CONCLUSION: We found that patients with SARDs had frequent breakthrough COVID-19, but the proportion experiencing severe COVID-19 was low. DMARD type, including CD20 inhibitors, did not significantly affect risk of breakthrough COVID-19. Evidence of prior humoral immunity was protective against breakthrough infection, highlighting the continued need for a multimodal approach to prevent severe COVID-19 as novel PrEP therapies are being developed.
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Full text: 1 Database: MEDLINE Main subject: Rheumatic Diseases / Antirheumatic Agents / COVID-19 / Antibodies, Monoclonal Limits: Female / Humans / Male / Middle aged Language: En Journal: J Rheumatol Year: 2024 Type: Article
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Full text: 1 Database: MEDLINE Main subject: Rheumatic Diseases / Antirheumatic Agents / COVID-19 / Antibodies, Monoclonal Limits: Female / Humans / Male / Middle aged Language: En Journal: J Rheumatol Year: 2024 Type: Article