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New Combination Therapy Reduces Symptomatic COVID-19 Infection


The combination of casirivimab and imdevimab prevents COVID-19 from progressing from asymptomatic to symptomatic.


New Combination Therapy Reduces Symptomatic COVID-19 Infection
Image: New Combination Therapy Against COVID-19 | InStyleHealth

According to a recent study, treatment with the combination therapy of casirivimab and imdevimab reduces the chance of acquiring symptomatic COVID-19 in a household close-contact scenario among asymptomatic persons with SARS-CoV-2 infection.


"Although the core study population was made up of people who had never been infected before (seronegative),... The researchers found that casirivimab and imdevimab reduced the risk of developing symptomatic infection by 35.4 percent and 33.9 percent, respectively, when compared to placebo.



The phase III trial looked at 314 people (mean age 41.0 years, 51.6 percent female) who had SARS-CoV-2 infection but were asymptomatic at the time of the RT-qPCR* result and then acquired signs and symptoms of COVID-19 within 14 days. During the 28-day efficacy assessment period, or until two consecutive nasopharyngeal swabs tested negative, weekly RT-qPCR testing was performed to determine SARS-CoV-2 viral load. Participants were given either subcutaneous casirivimab and imdevimab 1,200 mg, each at a dose of 600 mg (n=155) or placebo (n=156). [JAMA 2022;doi:10.1001/jama.2021] [JAMA 2022;doi:10.1001/jama.2021] .24939]



Within 28 days, 29.0 percent of the 204 asymptomatic and seronegative infected people in the casirivimab-imdevimab group developed symptomatic COVID-19 compared to 42.3 percent in the placebo group (odds ratio, 0.54; p=0.04).



The casirivimab-imdevimab group also had a significantly shorter symptomatic SARS-CoV-2 infection than the placebo group (895.7 vs 1,637.4 weeks per 1,000 individuals; p=0.03), with a mean symptomatic participant duration of 3.1 vs 3.9 weeks, respectively.



Casirivimab-imdevimab recipients also had a lower total number of weeks with high viral load (>4 log10 copies/mL) than placebo recipients (489.8 vs 811.9 weeks per 1,000 individuals; p=0.001), with a mean reduction of 0.5 vs 0.8 weeks per participant with high viral load.



On day 8, those on casirivimab-imdevimab had a significant reduction in nasopharyngeal SARS-CoV-2 viral load compared to those on placebo (adjusted least-squares mean difference, -1.5 log10 copies/mL).



When assessing individuals who only had infections at day 4, those on casirivimab-imdevimab had a lower risk of developing symptomatic infection than those on placebo (5.0 percent vs 21.2 percent), according to a post hoc analysis, "but this finding should be considered hypothesis generating," the researchers noted.



The casirivimab-imdevimab group had a lower rate of grade 1 treatment-emergent adverse events (TEAEs) than the placebo group (33.5 percent vs 48.1 percent), with fewer AEs linked to COVID-19 (25.8 percent vs 39.7 percent).



There were no major TEAEs recorded in the casirivimab-imdevimab group, but four in the placebo group, with no deaths reported in either therapy group.



"Treatment with subcutaneous casirivimab and imdevimab antibody combination vs placebo significantly reduced the frequency of symptomatic COVID-19 over 28 days among asymptomatic SARS-CoV-2 RT-qPCR-positive persons living with an infected household contact," the researchers concluded.



"Casirivimab and imdevimab reduced the duration of symptoms in those who became symptomatic, the duration of weeks of detectable viral load and high viral load, and reduced peak viral load in all participants combined, with similar numerical trends in the seropositive-only population in most analyses," the researchers wrote.



"Reductions in progression to symptomatic infection and other outcomes as demonstrated herein could have clinical implications for the use of monoclonal antibody treatments in early COVID-19 treatment," researchers noted.

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