BREAKTHROUGH ACUTE COVID-19 INFECTION DURING THE US OMICRON SURGE FOLLOWING ADMINISTRATION OF TIXAGEVIMAB/CILGAVIMAB IN IMMUNOCOMPROMISED PATIENTS WITH RHEUMATOLOGIC DISORDERS
Authors: Podgorski C et al.
Protection with Tixagevimab/Cilgavimab (Evusheld®) from breakthrough COVID-19 infection in immunosuppressed patients with rheumatic disorders, especially in high risk patients under treatment with rituximab, is recommended but not well-established. This study aimed to the risk of breakthrough infection despite prophylaxis in these patients with Tixagevimab/Cilgavimab (Evusheld®). 157 fully vaccinated rheumatic patients received Tixagevimab/Cilgavimab. No serious adverse events occurred. There were 24 cases (15.3%) of breakthrough acute COVID-19 infection following Tixagevimab/Cilgavimab administration after an average of 99.5 days (ranging from 5-195 days) between the last dose and the date of breakthrough infection. Of these 24 Patients with different inflammatory rheumatic diseases (RA, SLE, ANCA Vasculitis, Poly/Dermatomyositis etc.) and breakthrough infections, 70% were under treatment with rituximab. The rest had different immunosuppressive medications. Most of the patients had mild to moderate symptoms and only two required hospitalisations.
In high risk patients with inflammatory rheumatic disease under immunosuppressive medication 6 monthly prophylaxis with Tixagevimab/Cilgavimab (Evusheld®) does not protect completely from breakthrough COVID-19 infection, but seems to prevent severe disease.
In my opinion this prophylaxis is especially recommended for patients under treatment with rituximab who developed no antibody response to SARS-CoV2 vaccination.