MO659: First Experience of Bamlanivimab for Covid-19 Positive Haemodialysis Patients: A Case-Control Study

Abstract

BACKGROUND AND AIMSThe previous study showed a higher prevalence of coronavirus (COVID-19) in end-stage renal disease (ESRD) patients than in the general population (3.1% versus 0.1%). The presence of COVID-19 infection significantly increased the mortality rate of patients on dialysis compared to non-COVID patients (20.2% versus 0.2%). To date, no clear guidelines exist for the management of COVID-19 in renal patients. Bamlanivimab is a potent neutralizing monoclonal antibody that blocks severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) attachment and entry into human cells, which could potentially lead to therapeutic benefit. To our knowledge, this is the first study to use bamlanivimab in COVID-19+ haemodialysis (HD) patients with the aim to determine the effect of bamlanivimab on the mortality of these patients.METHODWe conducted a retrospective case-control study across a single HD centre of non-hospitalized HD patients, with documented positive SARS-CoV-2 testing. We analysed the period from October 1 to November 14 2021, in which COVID-19+ patients were dialyzed in our institution. Cases were defined as HD patients who received bamlanivimab and controls were patients who did not receive bamlanivimab. Descriptive statistics, including chi-squared and Mann–Whitney U test, were performed. We used multinomial logistic regression to find the independent relationship between bamlanivimab use, disease severity, coronary artery disease (CAD), heart failure and 1-month mortality risk.RESULTSPatients who received bamlanivimab frequently had the chronic obstructive pulmonary disease (COPD) than those in the control group. There were no significant differences between groups in any of the other parameters assessed (Table 1). Besides higher baseline ferritin levels in the control group, no other significant differences in biochemical markers were found between examined groups (Table 2). Over a 1-month follow-up, one patient (7.7%) died in the bamlinivimab group, while 8 patients (44.4%) died in the control group. Multinomial logistic regression revealed that no bamlanivimab treatment was given. CAD and disease severity increased the risks of mortality 39.1 times (P = 0.12), 81.7 times (P = 0.08) and 99.9 times (P = 0.04), respectively.CONCLUSIONIn COVID-19+ HD patients, bamlanivimab has been a safe and effective treatment method, lowering mortality although not statistically significant. We also discovered that having a more severe clinical presentation at baseline, as well as having a CAD, was related to a greater risk of mortality. Our findings imply that larger, more conclusive clinical studies of bamlanivimab in HD patients with COVID 19 should be conducted.Table 1.Baseline characteristics of 31 COVID-19 and haemodialysis patientsCharacteristicsBamlanivimab therapy (n = 13)No bamlanivimab (n = 18) P-valueMales, n %69.267.71.000Mean age, years62.2 ± 11.365.9 ± 15.8.476BMI25.9 ± 3.624.2 ± 2.8.167Diabetes (main disease or co-morbidity), n %23.122.2.955Arteriovenous fistula, n %100.017/94.41.000Dialysis vintage, monthsMedian (IQR)60 (25.5–134.0)45 (8.5–100).281 COPD (yes), n % 38.5 0.0 .008 Stroke (yes), n %7.70.0.419CAD (yes), n %30.838.9.468Covid-19 vaccine (yes), n %69.283.3.354Duration of symptoms before bamlanivimab administration, median days (IQR)/3 (2.5–4.5)/Table 2.Symptoms, signs and laboratory parameters of COVID-19 in 31 haemodialysis patients (yes), %Bamlanivimab Therapy (n = 13)No Bamlanivimab (n = 18) P-valueCough38.544.41.000Fever61.572.2.701Fatigue30.833.31.000Rhinorrhea0.05.61.000Sore throat7.716.7.621Diarrhoea7.711.11.000Nausea15.45.6.361Vomiting15.40.0.168Disease Severity, n %AsymptomaticMildModerateSevere7.753.830.87.711.133.333.322.2.604Nutri-CoV score, %Low riskModerate riskHigh riskVery high risk0.061.530.87.711.133.327.827.8.224C-reactive protein, mg/L, median (IQR)43.0 (6.5–155.5)43.0 (22.8–63.8).880 Ferritin, ng/mL median (IQR) 528.5 (215.6–718.5) 840 (544.7–1576) .020 D dimer, mg/L1.14 ± 0.871.34 ± 0.99.523