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Impact of Casirivimab-Imdevimab on Severe Acute Respiratory Syndrome Coronavirus 2 Delta Variant Nasopharyngeal Virus Load and Spike Quasispecies

Authors
  • Vellas, Camille1, 2, 3
  • Del Bello, Arnaud2, 3, 4
  • Gaube, Geraldine5
  • Tremeaux, Pauline1
  • Jeanne, Nicolas1
  • Ranger, Noemie1
  • Martin-Blondel, Guillaume2, 3, 5
  • Delobel, Pierre2, 3, 5
  • Kamar, Nassim2, 3, 4
  • Izopet, Jacques1, 2, 3
  • 1 CHU de Toulouse, Laboratoire de Virologie, Toulouse , (France)
  • 2 INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse , (France)
  • 3 Université, Toulouse III Paul Sabatier, Toulouse , (France)
  • 4 CHU de Toulouse, Département de Néphrologie, Dialyse et Transplantation d’Organes, Toulouse , (France)
  • 5 CHU de Toulouse, Service des Maladies Infectieuses et Tropicales, Toulouse , (France)
Type
Published Article
Journal
Open Forum Infectious Diseases
Publisher
Oxford University Press
Publication Date
Feb 21, 2022
Volume
9
Issue
4
Identifiers
DOI: 10.1093/ofid/ofac093
PMID: 35299988
PMCID: PMC8903465
Source
PubMed Central
Keywords
Disciplines
  • AcademicSubjects/MED00290
License
Unknown

Abstract

Background The increasing use of monoclonal antibodies (mAbs) to treat coronavirus disease 2019 raises questions about their impact on the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mAb-resistant variants. We assessed the impact of Casirivimab-Imdevimab on SARS-CoV-2 mutations associated with reduced mAb activity in treated patients. Methods We measured the nasopharyngeal (NP) viral load and sequenced the haplotypes of spike gene of 50 patients infected with the SARS-CoV-2 delta variant and treated with Casirivimab-Imdevimab using single-molecule real-time sequencing. Results The NP SARS-CoV-2 viral load of patients treated with Casirivimab-Imdevimab decreased from 8.13 (interquartile range [IQR], 7.06–8.59) log10 copies/mL pretreatment to 3.67 (IQR, 3.07–5.15) log10 copies/mL 7 days later ( P < .001). Of the 36 patients for whom follow-up timepoints Spike sequencing were available, none of the Spike mutations that reduced mAb activity were detected. Conclusions Casirivimab-Imdevimab is an effective treatment for patients infected with the SARS-CoV-2 delta variant. Despite selective pressure on SARS-CoV-2 Spike quasispecies, we detected no key mutations that reduced mAb activity in our patients.

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