Sotrovimab and Anti-CD20 Antibody Therapy for COVID-19 May Be Ineffective

Early administration of sotrovimab likely reduced risk for COVID-19 hospitalization among patients with hematologic malignancies.

Patients with hematologic malignancies (HM) who receive sotrovimab for COVID-19 infection are at increased risk for hospitalization if they relapse, experience recurrent HM, or if they also receive anti-CD20 antibody treatment for COVID-19 infection. These study findings were published in Clinical Infectious Diseases.

Researchers conducted an observational study at Memorial Sloan Kettering Cancer Center in the United States between December 2021 and January 2022. Patients (N=156) with HM who tested positive for COVID-19 infection and received a sotrovimab infusion were evaluated for outcomes at 60 days.

Participants in the study population had a median age of 61.5 (range, 12-91) years and 50% were men or boys. The most common HMs were leukemia or myelodysplastic syndrome (42%) and lymphoma (40%). The median time from allogenic (7%) or autologous (6%) hematopoietic stem-cell transplant or chimeric antigen receptor T-cell therapy (2%) to COVID-19 infection was 93.5 days. Most participants (81%) were fully vaccinated against COVID-19.

The median time from symptom onset to sotrovimab infusion was 3 (range, 0-16) days.

A total of 29 participants were hospitalized after receiving sotrovimab for COVID-19 (n=17) or for other reasons (n=12). The participants hospitalized for COVID-19 had a median age of 63 years, 52.9% were women or girls, and 11.8% were unvaccinated against COVID-19. The median hospitalization time was 8 (range, 1-64) days, 11.8% developed severe COVID-19 infection, 17.6% developed post-COVID-19 condition, 23.5% were readmitted for COVID-19 infection after discharge, and 17.6% had COVID-19-related mortality.

In the univariate analysis, COVID-19 hospitalization was associated with heart failure, atrial fibrillation, receipt of anti-CD20 therapy, and relapsed or refractory HM.

After adjusting for cofounders, risk for hospitalization was associated with having relapsed or refractory disease (adjusted odds ratio [aOR], 5.69; 95% CI, 1.69-19.16; P =.005), and receiving anti-CD20 therapy (aOR, 5.59; 95% CI, 1.73-18.12; P =.004).

[P]atients treated with anti-CD20 therapies remain at higher risk for COVID-19-related adverse outcomes.

Overall, the time from sotrovimab infusion to viral clearance among all patients was 62.5 (range, 8-133) days. Three mutations associated with sotrovimab resistance were detected among 11 patients, 8 of whom were hospitalized with COVID-19 infection. Mutated viral samples were detected a median of 20 days after sotrovimab administration, and viral escape was detected up to 90 days after sotrovimab infusion.

The study was limited by the small sample size and the fact that not all patients had available data for viral genome sequencing.

The study authors conclude, “[E]arly sotrovimab use reduced COVID-19-related hospitalization and severity in high-risk hematologic malignancy patients. However, there is a high occurrence of treatment-related mutations. Most importantly, patients treated with anti-CD20 therapies remain at higher risk for COVID-19-related adverse outcomes.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

References:

Yan J, Steiger SN, Kodama R, et al. Predictors of COVID-19 hospitalization after sotrovimab in hematologic malignancy patients during the BA.1 Omicron surge. Clin Infect Dis. 2022;ciac916. doi:10.1093/cid/ciac916