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. 2024 Oct 18;17(11):sfae309.
doi: 10.1093/ckj/sfae309. eCollection 2024 Nov.

Tixagevimab-cilgavimab for preventing breakthrough COVID-19 in dialysis patients: a prospective study

Sarinya Boongird  1 , Thatsaphan Srithongkul  2 , Sethanant Sethakarun  3 , Jackrapong Bruminhent  4 , Sasisopin Kiertiburanakul  4 , Arkom Nongnuch  1 , Chagriya Kitiyakara  1 , Suchai Sritippayawan  2
Affiliations

Tixagevimab-cilgavimab for preventing breakthrough COVID-19 in dialysis patients: a prospective study

Sarinya Boongird et al. Clin Kidney J. .

Abstract

Background: The effectiveness of tixagevimab-cilgavimab as pre-exposure prophylaxis (PrEP) against breakthrough coronavirus disease 2019 (COVID-19) in dialysis patients remains uncertain due to limited data.

Methods: In this multicenter prospective study, we enrolled vaccinated dialysis patients and divided them into two groups: a tixagevimab-cilgavimab group (received a 150 mg/150 mg intramuscular dose of tixagevimab-cilgavimab) and a control group (age-matched patients not receiving tixagevimab-cilgavimab). The primary outcome was the breakthrough COVID-19 rate at 6 months, whereas secondary outcomes included COVID-19-related hospitalization, intensive care unit admission, endotracheal intubation and mortality. The safety of tixagevimab-cilgavimab was assessed.

Results: Two hundred participants were enrolled, with equal numbers in each group (n = 100 each). Baseline characteristics were comparable between groups, except for a higher number of COVID-19 vaccine doses in the tixagevimab-cilgavimab group [median (IQR) 4 (3-5) vs. 3 (3-4); P = .01]. At 6 months, the breakthrough COVID-19 rates were comparable between the tixagevimab-cilgavimab (17%) and control (15%) groups (P = .66). However, the median (IQR) time to diagnosis of breakthrough infections tended to be longer in the tixagevimab-cilgavimab group [4.49 (2.81-4.98) vs 1.96 (1.65-2.91) months; P = .08]. Tixagevimab-cilgavimab significantly reduced COVID-19-related hospitalization rates (5.9% vs 40.0%; P = .02) among participants with breakthrough infections. All tixagevimab-cilgavimab-related adverse events were mild.

Conclusion: The use of tixagevimab-cilgavimab as PrEP in vaccinated dialysis patients during the Omicron surge did not prevent breakthrough infections but significantly reduced COVID-19-related hospitalizations. Further research should prioritize alternative strategies.

Keywords: breakthrough COVID-19; dialysis; prophylaxis; safety; tixagevimab–cilgavimab.

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Conflict of interest statement

None declared.

Figures

Figure 1:
Figure 1:
Study flowchart.
Figure 2:
Figure 2:
Cumulative incidence of breakthrough COVID-19 in the tixagevimab–cilgavimab and control groups over 6-month follow-up.
Figure 3:
Figure 3:
Event-free probabilities of severe COVID-19 outcomes among breakthrough cases. (a) Hospitalization. (b) ICU admission. (c) Endotracheal intubation. (d) COVID-19-related death.
Figure 4:
Figure 4:
Event-free probabilities of severe COVID-19 outcomes in the entire study population. (a) Hospitalization. (b) ICU admission. (c) Endotracheal intubation. (d) COVID-19-related death.
See this image and copyright information in PMC

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