Real-world clinical outcomes of treatment with casirivimab-imdevimab among patients with mild-to-moderate coronavirus disease 2019 during the Delta variant pandemic

Yasuhito Suzuki¹, Yoko Shibata¹, Hiroyuki Minemura¹, Takefumi Nikaido^1,2, Yoshinori Tanino¹, Atsuro Fukuhara^1,9, Ryuzo Kanno³, Hiroyuki Saito⁴, Shuzo Suzuki⁴, Taeko Ishii⁵, Yayoi Inokoshi⁵, Eiichiro Sando⁶, Hirofumi Sakuma⁷, Tatsuho Kobayashi⁸, Hiroaki Kume⁹, Masahiro Kamimoto¹⁰, Hideko Aoki¹¹, Akira Takama¹², Takamichi Kamiyama¹³, Masaru Nakayama¹⁴, Kiyoshi Saito¹⁵, Koichi Tanigawa¹⁶, Masahiko Sato¹⁷, Toshiyuki Kanbe¹⁸, Norio Kanzaki¹⁹, Teruhisa Azuma²⁰, Keiji Sakamoto²¹, Yuichi Nakamura²¹, Hiroshi Ohtani²², Mitsuru Waragai²³, Shinsaku Maeda²⁴, Tokiya Ishida²⁵, Keishi Sugino²⁶, Yasuhiko Tsukada²⁷, Ryuki Yamada¹, Riko Sato¹, Takumi Onuma¹, Hikaru Tomita¹, Mikako Saito¹, Natsumi Watanabe¹, Mami Rikimaru¹, Takaya Kawamata¹, Takashi Umeda¹, Julia Morimoto¹, Ryuichi Togawa¹, Yuki Sato¹, Junpei Saito¹, Kenya Kanazawa¹, Ken Iseki^27✉

1. Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
2. Department of Pulmonary Medicine, Ohara General Hospital, Fukushima, Japan
3. Department of Thoracic Surgery, Fukushima Red Cross Hospital, Fukushima, Japan
4. Department of Internal Medicine, Fujita General Hospital, Fukushima, Japan
5. Department of Pulmonary Medicine, Saiseikai Fukushima General Hospital, Fukushima, Japan
6. Department of General Internal Medicine and Clinical Infectious Diseases, Fukushima Medical University, Fukushima, Japan
7. Department of Internal Medicine, Saiseikai Kawamata Hospital, Fukushima, Japan
8. Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Fukushima, Japan
9. Department of Infectious Disease and Pulmonary Medicine, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
10. Department of Internal Medicine, Takeda General Hospital, Fukushima, Japan
11. Department of Pediatric Medicine, Bange Kousei General Hospital, Fukushima, Japan
12. Department of Surgery, Yurin Hospital, Fukushima, Japan
13. Department of Pediatric Surgery, Iwaki City Medical Center, Fukushima, Japan
14. Department of Internal Medicine, Kashima Hospital, Fukushima, Japan
15. Department of Neurosurgery, Fukushima Rosai Hospital, Fukushima, Japan
16. Department of Emergency and Critical Care Medicine, Futaba Medical Center, Fukushima, Japan
17. Department of Internal Medicine, Soma General Hospital, Fukushima, Japan
18. Department of Pulmonary Medicine, Minami-Soma Municipal General Hospital, Fukushima, Japan
19. Department of Surgery, Onahama Chuo Clinic, Fukushima, Japan
20. Department of General Medicine, Shirakawa Satellite for Teaching and Research, Fukushima Medical University, Fukushima, Japan
21. Department of Cardiology and Vascular Medicine, Hoshi General Hospital, Fukushima, Japan
22. Department of Internal Medicine, Iwase General Hospital, Sukagawa, Japan
23. Department of Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
24. Department of Pulmonary Medicine, Jusendo General Hospital, Fukushima, Japan
25. Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, Fukushima, Japan
26. Department of Respiratory Medicine, Tsuboi Hospital, Fukushima, Japan
27. Department of Emergency and Critical Care Medicine, Fukushima Medical University, Fukushima, Japan

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Citation:
Suzuki Y, Shibata Y, Minemura H, Nikaido T, Tanino Y, Fukuhara A, Kanno R, Saito H, Suzuki S, Ishii T, Inokoshi Y, Sando E, Sakuma H, Kobayashi T, Kume H, Kamimoto M, Aoki H, Takama A, Kamiyama T, Nakayama M, Saito K, Tanigawa K, Sato M, Kanbe T, Kanzaki N, Azuma T, Sakamoto K, Nakamura Y, Ohtani H, Waragai M, Maeda S, Ishida T, Sugino K, Tsukada Y, Yamada R, Sato R, Onuma T, Tomita H, Saito M, Watanabe N, Rikimaru M, Kawamata T, Umeda T, Morimoto J, Togawa R, Sato Y, Saito J, Kanazawa K, Iseki K. Real-world clinical outcomes of treatment with casirivimab-imdevimab among patients with mild-to-moderate coronavirus disease 2019 during the Delta variant pandemic. Int J Med Sci 2022; 19(5):834-841. doi:10.7150/ijms.71132. Available from https://www.medsci.org/v19p0834.htm

Abstract

Background: Mutations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may reduce the efficacy of neutralizing monoclonal antibody therapy against coronavirus disease 2019 (COVID-19). We here evaluated the efficacy of casirivimab-imdevimab in patients with mild-to-moderate COVID-19 during the Delta variant surge in Fukushima Prefecture, Japan.

Methods: We enrolled 949 patients with mild-to-moderate COVID-19 who were admitted to hospital between July 24, 2021 and September 30, 2021. Clinical deterioration after admission was compared between casirivimab-imdevimab users (n = 314) and non-users (n = 635).

Results: The casirivimab-imdevimab users were older (P < 0.0001), had higher body temperature (≥ 38°C) (P < 0.0001) and greater rates of history of cigarette smoking (P = 0.0068), hypertension (P = 0.0004), obesity (P < 0.0001), and dyslipidemia (P < 0.0001) than the non-users. Multivariate logistic regression analysis demonstrated that receiving casirivimab-imdevimab was an independent factor for preventing deterioration (odds ratio 0.448; 95% confidence interval 0.263-0.763; P = 0.0023). Furthermore, in 222 patients who were selected from each group after matching on the propensity score, deterioration was significantly lower among those receiving casirivimab-imdevimab compared to those not receiving casirivimab-imdevimab (7.66% vs 14.0%; p = 0.021).

Conclusion: This real-world study demonstrates that casirivimab-imdevimab contributes to the prevention of deterioration in COVID-19 patients after hospitalization during a Delta variant surge.

Keywords: casirivimab-imdevimab, COVID-19, SARS-CoV-2, Delta variant, real-world effectiveness