1135. Monoclonal Antibody Therapeutics in US Veterans against Delta and Omicron SARS-CoV-2 Variants

Abstract

Abstract Background Anti-SARS-CoV-2 monoclonal antibodies (mABs) target the viral spike protein and have been shown to have clinical benefit in treating COVID-19. The FDA had given emergency use authorization to mAB products: bamlanivimab+etesevinab (BAM), casirivimab+imdevimab (CAS), sotrovimab (SOT). However, due to reduced activity against the omicron variant the FDA recommended against use of BAM and CAS. SOT has retained efficacy against omicron. We reviewed the utilization of mABS in our institution during the pandemic as delta variant was replaced by omicron. Methods Retrospective chart review of US Veterans (USV) with confirmed SARS-CoV-2 infection who received mABs from 9/1/2021 to 2/28/22 at Northport Veterans Affairs Medical Center. Demographic data, comorbidities, choice of mAB, history of COVID-19 vaccination, SARS-CoV-2 sequencing, and IgG levels to the receptor-biding domain (RBD) of the spike protein in vaccinated USV were reviewed. Results 66 USV received mAB therapy, tolerated well. 30 got CAS, 29 BAM, 7 SOT. 52 doses were given from Dec 2021 to Jan 2022, none were given in Feb. The median age of the cohort was 72.5 (range 32 to 97 years). 97% were men. 85% White, 12% Black, 3% Hispanic. 22 USV were not vaccinated. The vaccine recipients were: 3 Janssen, Moderna-2 shots (MOD-2): 6; MOD-3: 3; Pfizer 2 (PFZ-2) shots: 22; PFZ-3:10 The median days of COVID diagnosis from last dose of vaccine: Janssen 211 days (104 to 257); MOD-2 291 (205-322); MOD-3 56 (16-61), PFZ-2 222 (96-302) PFZ-3 78 (8-112). 62% had cough, dyspnea 24%, malaise 50%, diarrhea 11%, anosmia 11%, sore throat 17%, nasal congestion 41%, fever 32% Median BMI 30.8 (16.6 - 47.3). 36% had Diabetes, HTN 67%. COPD 23%, Asthma 11%, CAD 32%, HLD 67%; one woman was 28 weeks pregnant. Two coinfections with rhinovirus, 1 with RSV. 20 vaccine recipients had anti-SARS-CoV-2 RBD titers at presentation, median 2.60 (0.06-48.08). 11 USV were hospitalized but only 4 got steroids/remdesivir. 3 USV died but not directly due to COVID. 15 USV with omicron who received CAS (8) and BAM (7) survived. See tables for further data. Demographic Data of US Veterans after receiving monoclonal antibody therapy Data on hospitalized US Veterans after receiving monoclonal antibody therapy Conclusion As the pandemic transitioned from Delta to Omicron variants, mAB treatments in USV remained successful even in those USV who received therapies not active for omicron. Delta and omicron infections were seen in vaccinated and boosted USV. Disclosures All Authors: No reported disclosures.