To the editor:
Coronavirus disease 2019 (COVID-19) vaccines are efficient to prevent severe COVID-19 infections. Immunocompromised patients are at increased risk of both severe COVID-19 and poor immunologic response to anti–severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines.
Preexposure prophylaxis using anti-spike neutralizing monoclonal antibodies to prevent COVID-19 infection has been proposed as an alternative in patients with no immunologic response after 3 doses of COVID-19 vaccines.1 , 2 We herein provide the first report, to our knowledge, of breakthrough COVID-19 infections in immunocompromised patients treated preventively with REGEN-Cov (Regeneron; casirivimab + imdevimab).
Between September 24, 2021 and December 23, 2021, 80 patients who had received at least 3 doses of a COVID-19 vaccine and had a negative anti–SARS-CoV-2 spike protein antibody response received at least 1 injection of 600 mg of casirivimab and imdevimab for preexposure prophylaxis in our center (Figure 1 ). Causes of poor immunologic response to vaccination were kidney transplantation (n = 57 [71%]), treatment with rituximab (n = 9 [11%]), end-stage kidney disease (n = 7 [9%]), and other (n = 7 [9%]). All patients were asked to report COVID-19 infection.
Figure 1.
Occurrence of coronavirus disease 2019 (COVID-19) breakthrough infections is associated with the occurrence of the Omicron variant in Ile-de-France, France. Green dashed line: cumulative number of REGEN-Cov administrations. Red line: cumulative number of COVID-19 infections among patients treated with REGEN-Cov in our cohort. Black curve: COVID-19 incidence rate in Ile de France, France, per 100,000 inhabitants. Blue area: proportion of COVID-19 cases with the suspected Delta variant (the presence of the L452R mutation) in Ile-de-France, France. Pink area: proportion of COVID-19 cases with suspected Omicron variant (the lack of the L452R mutation) in Ile-de-France, France. Data for Ile de France were obtained from Santé Publique France (https://geodes.santepubliquefrance.fr) on January 22, 2022.
Among this cohort, we received 12 reports of COVID-19 infection between December 25, 2021, and January 18, 2022 (Figure 1). SARS-CoV-2 infection was diagnosed using an antigenic test in 1 case and by polymerase chain reaction test in the remaining 11 cases. The Omicron variant (the lack of the L452R mutation) was detected in 8 cases, whereas screening for Omicron was unavailable in the remaining 3 polymerase chain reaction–proven cases. Two patients were hospitalized because of severe symptoms but did not require a transfer to the intensive care unit. These breakthrough COVID-19 infections due to the Omicron variant are consistent with in vitro evidence of a complete escape of SARS-CoV-2 variant Omicron to casirivimab and imdevimab.3 , 4
References
- 1.Ducloux D., Courivaud C. REGEN-Cov antibody combination to prevent COVID-19 infection in kidney transplant recipient without detectable antibody response to optimal vaccine scheme. Kidney Int. 2022;101:645–646. doi: 10.1016/j.kint.2021.12.015. [DOI] [PMC free article] [PubMed] [Google Scholar]
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