COVID-19 PrEP With Texagevimab and Cilgavimab Does Not Up Cardiovascular Risk

No additional cardiovascular risk was observed with the use of tixagevimab and cilgavimab for COVID-19 pre-exposure prophylaxis.

Tixagevimab and cilgavimab for pre-exposure prophylaxis (PrEP) against COVID-19 infection is not associated with an increased risk for myocardial infarction (MI), arrhythmia, or heart failure within 90 days of initiation, including in patients with preexisting cardiovascular disease (CVD). These study results were published in Clinical Infectious Diseases.

Researchers conducted a retrospective, propensity-matched cohort study among adult patients to assess the effects of tixagevimab and cilgavimab for PrEP against COVID-19 infection. Data captured from 78 million patients across 54 health care organizations were analyzed. Included patients were those who did and did not (control) receive treatment with tixagevimab and cilgavimab. The cohorts were balanced 1:1 using greedy, nearest-neighbor propensity scores, with patients matched by demographic characteristics, comorbidities, and current medication regimen. The generalized Schoenfeld approach was used to test for the proportional hazard assumption. The researchers assessed the relative risk (RR) for MI, arrhythmia, or heart failure within 30 and 90 days following treatment administration.

Prior to matching, patients in the intervention cohort were more likely to be men (53.4% vs 37.8%), older (mean age, 61.6 vs 53.7 years), and Black (8.9% vs 4.7%) vs those in the control cohort. Rates of hypertension (64.3% vs 35.3%), hyperlipidemia (55.5% vs 38.9%), and type 2 diabetes (32.7% vs 13.4%) were also higher among patients in the intervention vs control cohorts.

At 30 days, no increase in the risk for MI (RR, 0.81; 95% CI, 0.73-0.90), arrhythmia (RR, 0.92; 95% CI, 0.84-1.01), or heart failure (RR, 0.94; 95% CI, 0.70-1.27) was observed among patients in the intervention vs control cohorts. Similar results were observed between these cohorts at 90 days.

[T]here is no additional cardiovascular risk associated with the administration of T&C in the first 90 days after administration, potentially encouraging more persons to use this life-saving medication.

Results of a subgroup analysis performed among patients with a history of CVD also showed no increase in the risk for MI, arrhythmia, or heart failure within 30 or 90 days of treatment administration.

Study limitations include the use of propensity-score matching, potential misclassification bias, and the lack of data on cardiovascular outcomes beyond 90 days.

According to the researchers, “there is no additional cardiovascular risk associated with the administration of T&C [tixagevimab and cilgavimab] in the first 90 days after administration, potentially encouraging more persons to use this life-saving medication.

References:

Birabaharan M, Hill E, Begur M, Kaelber DC, Martin TCS, Mehta SR. Cardiovascular outcomes after tixagevimab and cilgavimab use for pre-exposure prophylaxis against COVID-19: a population-based propensity-matched cohort study. Clin Infect Dis. Published online November 16, 2022. doi:10.1093/cid/ciac894