The cilgavimab−tixagevimab combination retains a partial in vitro neutralizing activity against the current SARS-CoV-2 variants of concern (omicron BA.1, BA.1.1, and BA.2). Here, we examined whether preexposure prophylaxis with cilgavimab−tixagevimab can effectively protect kidney transplant recipients (KTRs) against the omicron variant. Of the 416 KTRs who received intramuscular prophylactic injections of 150 mg tixagevimab and 150 mg cilgavimab, 39 (9.4%) developed COVID-19. With the exception of one case, all patients were symptomatic. Hospitalization and admission to an intensive care unit were required for 14 (35.9%) and three patients (7.7%), respectively. Two KTRs died of COVID-19-related acute respiratory distress syndrome. SARS-CoV-2 sequencing was carried out in 15 cases (BA.1, n = 5; BA.1.1, n = 9; BA.2, n = 1). Viral neutralizing activity of the serum against the BA.1 variant was negative in the 12 tested patients, suggesting that this prophylactic strategy does not provide sufficient protection against this variant of concern. In summary, preexposure prophylaxis with cilgavimab−tixagevimab at the dose of 150 mg of each antibody does not adequately protect KTRs against omicron. Further clarification of the optimal dosing can assist in our understanding of how best to harness its protective potential.

中文翻译：

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尽管在肾移植受者中使用 150 mg tixagevimab 和 150 mg cilgavimab 进行预防，但 COVID-19 病例仍取得突破

cilgavimab-tixagevimab 组合保留了针对当前关注的 SARS-CoV-2 变体（omicron BA.1、BA.1.1 和 BA.2）的部分体外中和活性。在这里，我们检查了使用 cilgavimab−tixagevimab 进行的暴露前预防是否可以有效保护肾移植受者 (KTR) 免受 omicron 变体的侵害。在接受肌内预防性注射 150 mg tixagevimab 和 150 mg cilgavimab 的 416 名 KTR 中，39 名 (9.4%) 患上了 COVID-19。除一例外，所有患者均有症状。分别有 14 名 (35.9%) 和 3 名 (7.7%) 患者需要住院治疗和入住重症监护病房。两名 KTR 死于与 COVID-19 相关的急性呼吸窘迫综合征。对 15 个病例进行了 SARS-CoV-2 测序（BA.1，n  = 5；BA.1.1，n  = 9; BA.2，n  = 1）。血清对 BA.1 变体的病毒中和活​​性在 12 名受试患者中呈阴性，表明该预防策略不能提供足够的保护来对抗这种令人担忧的变体。总之，使用每种抗体 150 mg 剂量的 cilgavimab−tixagevimab 进行暴露前预防不足以保护 KTR 免受 omicron 的侵害。进一步阐明最佳剂量有助于我们了解如何最好地利用其保护潜力。