Vena Antonio, Cenderello Giovanni, Balletto Elisa, Mezzogori Laura, Santagostino Barbone Alessandro, Berruti Marco, Ball Lorenzo, Battaglini Denise, Bonsignore Alessandro, Dentone Chiara, Giacobbe Daniele Roberto, Eldin Tarek Kamal, Mikulska Malgorzata, Rebesco Barbara, Robba Chiara, Scintu Ambra, Stimamiglio Andrea, Taramasso Lucia, Pelosi Paolo, Artioli Stefania, Bassetti Matteo
Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, 16132 Genoa, Italy.
Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy.
J Clin Med. 2021 Oct 13;10(20):4682. doi: 10.3390/jcm10204682.
Monoclonal antibodies, such as bamlanivimab and etesevimab combination (BEC), have been proposed for patients with mild or moderate coronavirus disease 2019 (COVID-19). However, few studies have assessed the factors associated with the early administration of BEC or the impact of early BEC treatment on the clinical evolution of the patients. We conducted a retrospective cohort study of all adults with COVID-19 who received BEC at three institutions in the Liguria region. The primary endpoint was to investigate the clinical variables associated with early BEC infusion. Secondary endpoints were 30-day overall mortality and the composite endpoint of requirement of hospital admission or need for supplemental oxygen during the 30-day follow-up period. A total of 127 patients (median age 70 years; 56.7% males) received BEC. Of those, 93 (73.2%) received BEC within 5 days from symptoms onset (early BEC). Patients with a higher Charlson comorbidity index were more likely to receive early treatment (odds ratio (OR) 1.60, 95% confidence interval (CI) 1.04-2.45; = 0.03) in contrast to those reporting fever at presentation (OR 0.26, 0.08-0.82; = 0.02). Early BEC was associated with lower likelihood of hospital admission or need for supplemental oxygen (OR 0.19, 0.06-0.65; = 0.008). Five patients who received early BEC died during the follow-up period, but only one of them due to COVID-19-related causes. Early bamlanivimab and etesevimab combination was more frequently administered to patients with a high Charlson comorbidity index. Despite this, early BEC was associated with a lower rate of hospital admission or need for any supplementary oxygen compared to late administration. These results suggest that efforts should focus on encouraging early BEC use in patients with mild-moderate COVID-19 at risk for complications.
已有人提出将巴瑞替尼单抗和etesevimab联合使用（BEC）的单克隆抗体用于治疗轻度或中度2019冠状病毒病（COVID-19）患者。然而，很少有研究评估与早期使用BEC相关的因素或早期BEC治疗对患者临床病程的影响。我们对利古里亚地区三家机构中所有接受BEC治疗的成年COVID-19患者进行了一项回顾性队列研究。主要终点是调查与早期BEC输注相关的临床变量。次要终点是30天全因死亡率以及在30天随访期内入院需求或补充氧气需求的复合终点。共有127例患者（中位年龄70岁；56.7%为男性）接受了BEC治疗。其中，93例（73.2%）在症状出现后5天内接受了BEC治疗（早期BEC）。与就诊时发热的患者相比，Charlson合并症指数较高的患者更有可能接受早期治疗（比值比（OR）为1.60，95%置信区间（CI）为1.04 - 2.45；P = 0.03）。早期BEC与入院需求或补充氧气需求的可能性较低相关（OR为0.19，0.06 - 0.65；P = 0.008）。5例接受早期BEC治疗的患者在随访期间死亡，但其中只有1例死于COVID-19相关原因。早期巴瑞替尼单抗和etesevimab联合治疗在Charlson合并症指数较高的患者中应用更为频繁。尽管如此，与延迟给药相比，早期BEC与较低的入院率或任何补充氧气需求率相关。这些结果表明，应努力鼓励在有并发症风险的轻度至中度COVID-19患者中早期使用BEC。
