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Breakthrough COVID-19 After Tixagevimab/Cilgavimab Among Patients With Systemic Autoimmune Rheumatic Diseases

Yumeko Kawano1, Xiaosong Wang2, Naomi J Patel3

  • 1Y. Kawano, MD, A.H. Jonsson, MD, PhD, J.A. Sparks, MD, MMSc, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, and Harvard Medical School.

The Journal of Rheumatology
|October 15, 2023
PubMed

Insights

Patients with systemic autoimmune rheumatic diseases (SARDs) frequently experienced breakthrough COVID-19 after tixagevimab/cilgavimab. Prior humoral immunity offered protection, but DMARD type did not impact breakthrough risk.

Area of Science:

  • Immunology
  • Rheumatology
  • Infectious Diseases

Background:

  • Systemic autoimmune rheumatic diseases (SARDs) increase susceptibility to infections.
  • Pre-exposure prophylaxis (PrEP) with tixagevimab/cilgavimab aims to prevent COVID-19 in high-risk populations.
  • Understanding breakthrough infections is crucial for managing COVID-19 in SARDs patients.

Purpose of the Study:

  • To determine the incidence of breakthrough COVID-19 in SARDs patients receiving tixagevimab/cilgavimab.
  • To identify baseline factors associated with breakthrough COVID-19 post-PrEP.
  • To evaluate the impact of disease-modifying antirheumatic drug (DMARD) type on breakthrough risk.

Main Methods:

  • Retrospective cohort study of 444 SARDs patients who received tixagevimab/cilgavimab.
  • Primary outcome: breakthrough COVID-19.
  • Multivariable Cox regression models analyzed risk factors, including baseline spike antibody levels and DMARD use.

Main Results:

  • Breakthrough COVID-19 occurred in 18.7% of patients (incidence rate 31.5/1000 person-months).
  • Older age was inversely associated with breakthrough infection.
  • Higher baseline spike antibody levels correlated with reduced breakthrough risk; CD20 inhibitor use showed similar risk to conventional DMARDs.

Conclusions:

  • SARDs patients on tixagevimab/cilgavimab experienced frequent breakthrough COVID-19, though severe outcomes were rare.
  • Prior humoral immunity was protective against breakthrough infection.
  • A multimodal strategy is essential for preventing severe COVID-19, especially with evolving PrEP therapies.
Abstract

Keywords:
COVID-19autoimmune diseasespreexposure prophylaxistixagevimab/cilgavimab

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