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. 2023 Oct;23(6):2739-2748.
doi: 10.1007/s10238-023-01019-y. Epub 2023 Feb 13.

Outpatient anti-spike monoclonal antibody administration is associated with decreased morbidity and mortality among patients with cancer and COVID-19

Panos Arvanitis  1 , Alexis Hope Lerner  1 , Kendra Vieira  1 , Nouf Almaghlouth  1 , Dimitrios Farmakiotis  2
Affiliations

Outpatient anti-spike monoclonal antibody administration is associated with decreased morbidity and mortality among patients with cancer and COVID-19

Panos Arvanitis et al. Clin Exp Med. 2023 Oct.

Abstract

Patients with cancer have many comorbidities that increase their risk of death from Coronavirus disease 2019 (COVID-19). Anti-spike monoclonal antibodies (mAbs) reduce the risk of hospitalization or death from COVID-19 in the general population. To our knowledge, no studies have focused on the clinical efficacy of mAbs compared to no outpatient treatment exclusively among patients with solid tumors and hematologic malignancies, who are often excluded from clinical trials. We studied patients with cancer who had COVID-19 between 11.9.2020 and 7.21.2022 and received mAbs in an outpatient setting. We compared hospitalization and mortality rates to those of patients with cancer concurrently diagnosed with COVID-19, who were eligible for mAbs, but did not receive any outpatient treatment. 63 patients received mAbs and 89 no outpatient treatment. Administration of mAbs was associated with lower 90-day hospitalization (20.6% vs. 60.7%, p <0.001), all-cause (6.3% vs. 19.1%, p 0.025) and COVID-19-attributed (3.2% vs. 14.6%, p 0.019) mortality rates, and lower peak O2 requirements (ordinal Odds Ratio [OR] = 0.33, 95% Confidence Intervals [CI] = 0.20-0.53). Administration of mAbs (aHR 0.21, p <0.001), age (≥ 60 years, adjusted Hazard Ratio [aHR] 1.86, p=0.033), and metastases (aHR 0.41, p 0.007) were independently associated with hospitalization. mAb treatment remained significantly associated with all-cause (aHR 0.27, p 0.019) and COVID-19-attributed (aHR 0.19, p 0.031) mortality, after adjustment for other factors. mAb administration was associated with improved clinical outcomes among vulnerable patients with cancer and COVID-19. With no mAbs approved currently for treatment against the prevalent circulating variants, the development of new mAbs should be a research priority.

Keywords: Anti-spike monoclonal antibodies; COVID-19; Cancer; Infection; SARS-CoV-2.

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Conflict of interest statement

DF has received research support from Viracor, Astellas and Merck, and consultant fee from Viracor. All other authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
Patient selection. Footnotes Flow diagram illustrating patient selection. mAbs Anti-spike monoclonal antibodies, EUA Emergency use authorization
Fig. 2
Fig. 2
Kaplan-Meier survival curves. Footnotes Kaplan-Meier 90-day All-cause Mortality and COVID-19 attributed mortality curves for patients who received anti-spike monoclonal antibodies for the treatment of SARS-CoV-2 infection (mAbs) and those who did not (Non-mAbs)
Fig. 3
Fig. 3
Peak O2 requirement ordinal scale value distribution by mAb status. Footnotes LFNC low-flow nasal cannula, HFNC high-flow nasal cannula, 4, NIMV non-invasive mechanical ventilation (BiPAP, CPAP), IMV invasive mechanical ventilation
Fig. 4
Fig. 4
aHR for 90-day hospitalization, all-cause mortality and COVID-19-related mortality. Footnotes Multivariable Cox regression model for primary outcome (COVID-19-related hospital admission within 90-days after positive test) and secondary outcomes (90 Day All-cause Mortality and COVID-19 attributed mortality). mAbs anti-spike monoclonal antibodies
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