Nefrología (May 2024)
Tixagevimab-cilgavimab como tratamiento profiláctico preexposición frente a SARS-CoV-2 en pacientes trasplantados renales
Abstract
Resumen: Introducción: Se ha documentado que tras la administración de vacunas de ARNm o de vectores virales del SARS-CoV-2 un porcentaje significativo de los receptores de trasplante no desarrolla una respuesta inmune efectiva. Ante esta situación, en marzo de 2022 la Agencia Europea del Medicamento aprobó el uso de tixagevimab-cilgavimab para la profilaxis de COVID-19 previa a la exposición al virus en pacientes inmunocomprometidos. El estudio que presentamos a continuación describe nuestra experiencia tras administrar tixagevimab-cilgavimab como tratamiento profiláctico en pacientes trasplantados renales. Material y métodos: Se trata de un estudio prospectivo de una cohorte de receptores de trasplante renal, en el que se incluyeron un total de 55 pacientes que presentaban títulos de anticuerpos IgG insuficientes ( 260 BAU/mL). De los 7 pacientes diagnosticados de infección por SARS-CoV-2, uno de ellos precisó ingreso hospitalario y falleció tras 5 días de ingreso con sospecha de neumonía con sobreinfección bacteriana. Conclusiones: En nuestra experiencia, el tratamiento profiláctico con los anticuerpos monoclonales tixagevimab-cilgavimab consiguió alcanzar niveles de anticuerpos superiores a 260 BAU/mL en todos los pacientes, cumpliendo con un perfil de seguridad aceptable, sin eventos adversos significativos o irreversibles. Abstract: Introduction: It has been reported that after vaccination with RNAm or viral vectors from SARS-CoV-2 a significant number of solid organ transplant recipients do not develop an effective immune response. In this scenario, the use of tixagevimab-cilgavimab was approved by the European Medicines Agency for COVID-19 prophylaxis in immunocompromised patients in March 2022. We present our experience with a group of kidney transplant recipients who received prophylactic treatment with tixagevimab-cilgavimab. Material and methods: Prospective study from a cohort of kidney transplant recipients who had been previously vaccinated with 4 doses and did not achieve a satisfactory immune response to vaccination, presenting antibody titers lower than 260 BAU/mL when measured by ELISA. A total of 55 patients who received a single dose of 150 mg of tixagevimab and 150 mg of cilgavimab between May and September of 2022 were included in this study. Results: No immediate or severe adverse reactions, including worsening of kidney function, were observed after administering the drug or during follow up. All patients who had received the drug 3 months prior presented positive antibody titers (> 260 BAU/mL). Seven patients were diagnosed with COVID, and one of those patients had to be admitted to the hospital and died 5 days later from infectious complications and a suspected diagnosis of bacterial coinfection. Conclusions: In our experience, all kidney transplant recipients reached antibody titers higher than 260 BAU/mL 3 months after receiving prophylactic treatment with tixagevimab-cilgavimab with no severe or irreversible adverse reactions.
