key: cord-0759891-d6m1j166
authors: DUCLOUX, Didier; COURIVAUD, Cécile
title: REGEN-Cov antibody combination to prevent COVID-19 infection in kidney transplant recipient without detectable antibody response to optimal vaccine scheme
date: 2022-01-04
journal: Kidney Int
DOI: 10.1016/j.kint.2021.12.015
sha: bff6a31829fd87948286ddf79faccc46491cc57d
doc_id: 759891
cord_uid: d6m1j166

nan

A large part of kidney transplant recipient (KTR) do not respond to anti-SARS-Cov-2 vaccine. Indeed, concordant data indicate that about thirty percent of KTR do not develop antibodies after three doses of mRNA vaccines (1, 2) . However, KTR are at high risk of severe forms of COVID-19 infection. Mortality rates are reported to reach 15 to 20% and need for hospitalization in intensive unit care is even more likely (3) .

In this setting, consideration for alternative prevention strategy of COVID-19 infection is particularly required. Recently, REGEN-Cov antibody combination (Casirivimab + Imdevimab) has been proven to be efficient to prevent infection in persons at risk for infection because of household exposure to a person with SARS-CoV-2 infection (4).

Nevertheless, no data are available for pre-exposition prevention in patients at risk.

The French government recently authorizes the use of REGEN-Cov to prevent COVID-19 infection in immunocompromised patients without any antibody response after three doses of anti-SARS-Cov-2 vaccine (https://www.hassante.fr/jcms/p_3281999/fr/covid-19-autorisation-d-acces-precoce-accordee-a-untraitement-prophylactique).

We reported the use of REGEN-Cov in pre-exposition prevention in KTR.

Among 402 KTR having received three doses of vaccines and for whom serology was available, 119 (29.6%) had no antibody response (Anti-S titer < 50 AU, SARS-Cov-2 immunoassay, Abbott® designed to detect IgG antibodies to the receptorbinding domain (RBD) of the S1 subunit of the spike protein of SARS-CoV-2). Preexposition prevention was proposed to all of them.

During the study period, the delta variant accounted for more than 99% of COVID cases. Regen-Cov is effective against the delta variant (5).

The first dose of REGEN-Cov (1200 mg) was administered intravenously. The subsequent doses (600 mg) were administered subcutaneously every 4 weeks. Nasopharyngeal swabs were obtained for patients to test for SARS-Cov-2 by RT-qPCR before each administration of REGEN-Cov. Anti-S antibodies were also measured before each treatment. 

Factors associated with humoral response after BNT162b2 mRNA COVID-19 vaccination in kidney transplant patients

Humoral Response after SARS-CoV-2 mRNA Vaccination in a Cohort of Hemodialysis Patients and Kidney Transplant Recipients

Is COVID-19 infection more severe in kidney transplant recipients?

Phase 3 Prevention Trial Team. Subcutaneous REGEN-COV Antibody Combination to Prevent Covid-19

The monoclonal antibody combination REGEN-COV protects against SARS-CoV-2 mutational escape in preclinical and human studies