Tixagevimab-Cilgavimab Effectively Prevents COVID-19 Infection in Patients with End-Stage Kidney Disease

Patients with end-stage kidney disease (ESKD) often exhibit suboptimal responses to COVID-19 vaccination. Tixagevimab-Cilgavimab, a neutralizing long-acting antibody (LAAB), has demonstrated effectiveness in preventing severe COVID-19 and hospitalization among immunocompromised populations. This study aimed to evaluate the efficacy and safety of Tixagevimab-Cilgavimab in ESKD patients receiving hemodialysis, peritoneal dialysis, or kidney transplantation. This single-center, retrospective cohort study was conducted at Naresuan University Hospital, Phitsanulok, Thailand, and included patients with end-stage kidney disease (ESKD) receiving maintenance hemodialysis, peritoneal dialysis, or kidney transplantation between June 2022 and June 2023, during the peak of the Omicron variant. Patients who received a single 150/150 mg dose of Tixagevimab-Cilgavimab were compared to those who did not, in terms of time to first COVID-19 infection and hospitalization within 6 months. Cox proportional hazards models were used to evaluate associations, adjusted for age, sex, type 2 diabetes, dyslipidemia, systolic and diastolic blood pressure, serum creatinine, number of COVID-19 vaccine doses, and prior COVID-19 infection. Safety was assessed by comparing creatine kinase (CK) levels before and after treatment using generalized estimating equations (GEE). Of 117 patients, 58 received Tixagevimab-Cilgavimab (mean age 59 ± 15 years); 92% were on dialysis and 8% had undergone kidney transplantation. COVID-19 infection occurred in 10.3% of the LAAB group versus 11.9% in the control group. In the adjusted Cox model, LAAB use was significantly associated with a reduced risk of COVID-19 infection (adjusted HR: 0.20; 95% CI: 0.04-0.95; p = 0.043). No variables were significantly associated with hospitalization, although LAAB use showed a non-significant trend toward reduced hospitalization risk (adjusted HR: 0.08; 95% CI: 0.01-1.56; p = 0.096). No local or systemic adverse effects were reported. CK levels remained unchanged after administration. Tixagevimab-Cilgavimab was effective in reducing the risk of COVID-19 infection among ESKD patients, without evidence of adverse effects, supporting its use as a prophylactic agent in this high-risk population.