Abstract and Introduction
The SARS-CoV-2 pandemic continues to place a substantial burden on healthcare systems. Outpatient therapies for mild-to-moderate disease have reduced hospitalizations and deaths in clinical trials, but the real-world effectiveness of monoclonal antibodies and oral antiviral agents in solid organ transplant recipients (SOTR) with coronavirus disease-2019 (COVID-19) is largely uncharacterized. We conducted a single-center, retrospective review of 122 SOTR diagnosed with COVID-19 in the outpatient setting during the Omicron surge to address this knowledge gap. The mean age was 54 years, 57% were males, and 67% were kidney transplant recipients. The mean time from transplant to COVID-19 diagnosis was 75 months. Forty-nine (40%) received molnupiravir, 24 (20%) received sotrovimab, and 1 (0.8%) received nirmatrelvir/ritonavir. No outpatient therapy was administered in 48 (39%). All 122 SOTR had >30 days follow-up. Rates of hospitalization within 30 days of initiating therapy for molnupiravir, nirmatrelvir/ritonavir, and sotrovimab were 16% (8/49), 0% (0/1), and 8% (2/24), respectively, compared to 27% (13/48) in patients without outpatient therapy. There were no deaths in those who received any therapy versus 3 (6%) deaths in patients without outpatient therapy (p = .002). Overall, our experience suggests a role for monoclonal antibodies and oral antiviral agents in reducing COVID-19-related morbidity and mortality in SOTR.
With over 980 000 deaths and 80 million cumulative cases in the United States as of April 24, 2022, the SARS-CoV-2 pandemic places a substantial burden on healthcare delivery systems, and the Omicron variant ensures the continued relevance of coronavirus disease-2019 (COVID-19). Vaccination, in combination with other mitigation efforts, is a key strategy to reduce infection rates. Nonetheless, persons with immune dysfunction are at heightened risk for breakthrough infections after vaccination, and vaccinated solid organ transplant recipients (SOTR) remain at risk for severe disease.
In this setting, outpatient therapies for mild-to-moderate disease are vital for reducing the risk of disease progression and preventing both COVID-19-related hospitalizations and deaths. Monoclonal antibodies (e.g., sotrovimab) and oral antiviral agents (e.g., molnupiravir and nirmatrelvir/ritonavir) have proven efficacious in preventing hospitalization and death in at-risk adults in clinical trials, but the real-world effectiveness of these therapies for COVID-19 in SOTR during the Omicron era is largely uncharacterized. To address this knowledge gap, we conducted a retrospective review of our transplant center's experience with outpatient therapies in SOTR during the recent Omicron surge.
American Journal of Transplantation. 2022;22(10):2458-2463. © 2022 Blackwell Publishing