medwireNews: The prophylactic use of tixagevimab–cilgavimab may reduce the incidence and severity of COVID-19 in patients with hematologic cancers, suggests an Italian cohort study.
The study authors explain in a research letter to JAMA Oncology that “[t]ixagevimab and cilgavimab are fully human SARS-CoV-2–neutralizing monoclonal antibodies derived from B cells of patients that recovered from SARS-CoV-2.”
And the combination (also known as AZD7442) has been shown “to be a safe and efficient option for COVID-19 immunoprophylaxis in adults who are at higher risk of an inadequate vaccine response,” they add.
To address the conflicting results thus far seen for tixagevimab–cilgavimab in studies involving patients with hematologic malignancies, the research team drew on the medical records of an Italian hospital to identify 204 patients eligible for tixagevimab–cilgavimab between 1 June and 1 September 2022. Of these, 64% received the medication, at the dose approved in the European Union (150/150 mg), while the remaining 36% did not.
Participants were aged a median of 64.5–68.5 years and just over half (52–54%) were men. The majority had lymphoproliferative disorders or multiple myeloma (77–81%) and were undergoing active anticancer treatment (92–95%).
At data cutoff on 1 March 2023, the proportion of patients with a breakthrough COVID-19 infection was significantly lower among those who did versus did not receive tixagevimab–cilgavimab, at 21% and 38%, respectively.
This equated to an incidence per 10,000 person–days of 13.8 and 28.0, respectively, and a significant hazard ratio (HR) in favor of tixagevimab–cilgavimab use of 0.47.
The incidence of severe or critical COVID-19 was also significantly lower among patients who took tixagevimab–cilgavimab than those who did not, at 1.4 versus 4.0 per 10,000 person–years (HR=0.18), and so was the rate of hospitalization, at 1.3 versus 4.0 per 10,000 person–years (HR=0.19).
Marco Salvini, from ASST Sette Laghi in Varese, and colleagues note that the significantly reduced risk for COVID-19 with the use of tixagevimab–cilgavimab was maintained in a sensitivity analysis involving 52 propensity score-matched patients in each group.
The analysis “mitigated the absence of randomization and confirmed the comparability of the 2 groups,” they comment.
Despite the limitations of the study, such as the heterogeneity of hematologic malignancies and varied vaccination status, the researchers believe that prophylactic tixagevimab–cilgavimab “may be a complementary tool to vaccination boosters” in this patient population.
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