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Sci Rep . Dose-dependent impact of tixagevimab-cilgavimab as primary prevention against SARS-CoV-2 in immunocompromised individuals

tetano

Editor, Senior Moderator
Sci Rep


. 2025 May 21;15(1):17578.
doi: 10.1038/s41598-025-02240-3. Dose-dependent impact of tixagevimab-cilgavimab as primary prevention against SARS-CoV-2 in immunocompromised individuals

Daniela Dluzynski[SUP] 1 [/SUP], Paddy Ssentongo[SUP] 2 [/SUP], Cory M Hale[SUP] 3 [/SUP], Shareef K Shaheen[SUP] 1 [/SUP], Natella Maglakelidze[SUP] 1 [/SUP], Jeffrey M Sivik[SUP] 3 [/SUP], Maria Paula Henao[SUP] 4 [/SUP], Vernon M Chinchilli[SUP] 5 [/SUP], Catharine I Paules[SUP] 6 [/SUP]



Affiliations
Abstract

Tixagevimab-cilgavimab was available for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prevention from December 2021 to January 2023, with dosing changes to reflect circulating variants. In a retrospective analysis of 597 immunocompromised individuals, incidence of SARS-CoV-2 infection was compared between those who did and did not receive tixagevimab-cilgavimab. A proportional hazards regression model with a time-dependent regressor for tixagevimab-cilgavimab dose was applied to assess cumulative doses. Secondary analyses were performed in hematopoietic stem cell transplant (HSCT) and chimeric antigen receptor (CAR)-T cell therapy recipients. There was no difference in SARS-CoV-2 infections between tixagevimab-cilgavimab recipients and controls (p = 0.27). There was a trend towards protection with increasing dose from 150 (HR 0.83, CI 0.50-1.38) to 600 mg (HR 0.48, CI 0.06-3.63) when truncating data on November 1st, 2022, which was also seen in HSCT or CAR-T cell therapy recipients, 150 mg (HR 0.71, CI 0.31-1.65) to 600 mg (HR 0.26, CI 0.01-7.47). This was most evident in immunocompromised individuals when variants neutralized by tixagevimab-cilgavimab in vitro were circulating; effectiveness 74%. Supports a proof of concept for monoclonal antibodies in immunocompromised individuals as a prevention strategy against novel viruses.

Keywords: COVID-19; Chimeric antigen receptor (CAR)-T cell therapy; Hematopoietic stem cell transplant; Monoclonal antibody; Tixagevimab–cilgavimab.

 
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