Nephrotic-range proteinuria: a potential risk factor for failure of tixagevimab-cilgavimab prophylaxis

Background Pre-exposure prophylaxis with tixagevimab-cilgavimab has been shown to reduce the incidence of SARS-CoV-2 infection in immunocompromised individuals. Individuals with nephrotic-range proteinuria can lose immunoglobulins such as tixagevimab-cilgavimab in the urine and, therefore, may deriv...

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Bibliographic Details
Published in:Journal of nephrology 2024-01, Vol.37 (1), p.141-147
Main Authors: Al Jurdi, Ayman, El Mouhayyar, Christopher, Efe, Orhan, Jeyabalan, Anushya, Riella, Leonardo V.
Format: Article
Language:English
Subjects:
Antibodies, Monoclonal
COVID-19 - complications
COVID-19 - epidemiology
Humans
Medicine
Medicine & Public Health
Nephrology
original Article
Prospective Studies
Proteinuria - etiology
Proteinuria - prevention & control
Retrospective Studies
Urology
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Summary:Background Pre-exposure prophylaxis with tixagevimab-cilgavimab has been shown to reduce the incidence of SARS-CoV-2 infection in immunocompromised individuals. Individuals with nephrotic-range proteinuria can lose immunoglobulins such as tixagevimab-cilgavimab in the urine and, therefore, may derive less benefit from tixagevimab-cilgavimab. There are no published studies evaluating the association of nephrotic-range proteinuria with failure of tixagevimab-cilgavimab prophylaxis. Methods We conducted a retrospective observational cohort study of all individuals at our center who received tixagevimab-cilgavimab while they had nephrotic-range proteinuria. Each individual in the nephrotic group was matched 1:3 with controls who were matched for B cell depletion therapy in addition to the total dose and date of first tixagevimab-cilgavimab administration. The primary outcome was the development of breakthrough SARS-CoV-2 infection after receiving tixagevimab-cilgavimab. Results Sixteen patients received tixagevimab-cilgavimab between January 1st, 2022, and June 30th, 2022, at a time when they had nephrotic-range proteinuria. Proteinuria levels and serum creatinine levels were higher while serum albumin levels were lower in the nephrotic group compared to the control group. At a median follow-up of 251 days, 38% of individuals in the nephrotic group had developed breakthrough SARS-CoV-2 infections, compared to only 13% in the control group at a median follow-up of 238 days. Nephrotic-range proteinuria was associated with a higher incidence of breakthrough infection (log-rank P  = 0.04). Conclusions Nephrotic-range proteinuria may increase the risk of failure of tixagevimab-cilgavimab pre-exposure prophylaxis. Prospective studies to validate these findings and to evaluate the optimal dosing strategy of antibody-based prophylaxis in this group of patients are needed.
ISSN:1724-6059
1724-6059
DOI:10.1007/s40620-023-01750-5