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Early use of anti-SARS-CoV-2 monoclonal antibodies has shown to be a safe option to reduce hospitalization and death in solid organ transplant recipients with COVID-19. Real world data regarding sotrovimab in heart transplant (HT) recipients is scarce. We aim to describe our experience in terms of safety and outcomes in this group. Consecutive HT recipients from our center with confirmed SARS-CoV-2 Omicron variant who received intravenous sotrovimab infusion between January and April 2022 were enrolled in this observational study. Clinical data was recorded including the first 24 hours post infusion, as well as 1-month and 3-month follow-ups. A total of 29 HT recipients with SARS-CoV-2 infection who received sotrovimab were enrolled [median age 53 (IQR 36, 62), 52% female]. Baseline characteristics are shown in Table 1. The median time since symptom onset was 2 (1,3) days, and 86% of patients had previously received ≥3 doses of COVID-19 vaccine. No acute infusion-related reactions were reported. A total of five patients were admitted (17%), 3 of them with COVID-19 pneumonitis, receiving high-dose steroids. Bacterial superinfection was reported in 4 patients. Neither invasive mechanical ventilation nor ICU care were required, and no in-hospital deaths were recorded. Hospitalized patients had more comorbidities [diabetes (40 vs 13%, p 0.13), hyperlipidemia (80 vs 29%, p 0.03), advanced chronic kidney disease (100 vs 38%, p 0.01), leucopenia (40 vs 4%, p 0.02), and anemia (100 vs 46%, 0.03)], compared to non-hospitalized patients. Over a median follow-up of 111 (86, 131) days, there were 2 cases of COVID-19 reinfection and 6 non-COVID-19-related readmissions. No episodes of acute rejection, new onset graft dysfunction or death were registered. In our series, the early use of sotrovimab in HT recipients with COVID-19 was safe. No COVID-19-related deaths were recorded, hospitalization rate was low and more frequent in patients with prior chronic comorbidities. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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As of April 2022, the Mater Hospital serves 190 patients who have been the recipient of a lung transplant in Ireland. During the COVID-19 pandemic, solid organ transplant was recognised as a risk factor for progression to severe disease. In January 2022, the European Medicines Agency (EMA) approved the use of Sotrovimab for high risk patients. Sotrovimab is a monoclonal antibody which neutralises SARS-CoV-2 with recent data showing efficacy in reducing the risk of progression to severe disease in high risk patients . We aim to describe our patient cohort and the rates of COVID-19 infection seen before and after the introduction of monoclonal antibody therapy. While likely reflecting emerging variants resulting in less severe disease, we observe variation in morbidity and mortality in this time. From March 2020 to April 2022, 116 post-lung transplant patients tested positive for COVID-19 infection. This represents 61% of our overall population. Since January 2022, coinciding with the surge of the omicron variant, 57 patients contracted COVID-19. 47 were deemed to be suitable for treatment with 10 presenting outside the window for therapeutic intervention. 3.5% (n=2) required ICU admission and 2 died directly as a result of COVID-19. Prior to this, 58 patients contracted COVID-19, 31 of which (53.5%) required hospital admission with 18 (58%) requiring ICU admission. Overall we saw 13 deaths representing 22.4% of this group and 6.8% of the overall population.
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Background: Specialty disease modifying anti-rheumatic drugs (DMARDs) used to treat rheumatologic conditions result in immunosuppression. The American College of Rheumatology and the European League Against Rheumatism recommend vaccination in patients initiating specialty DMARDs to prevent infections, including influenza, pneumonia, and herpes zoster. At an integrated health-system specialty pharmacy, clinical rheumatology pharmacists identified an opportunity to improve vaccine screening during the pre-treatment counseling process. Prior to screening protocol implementation, specialty pharmacists provided general vaccine counseling to all patients initiating specialty DMARD therapy and documented counseling completion in the electronic health record (EHR) with no standard format. Objective(s): This quality improvement project aimed to standardize and expand the vaccine screening process in patients initiating specialty DMARDs at an outpatient rheumatology clinic. Method(s): A specialty resident pharmacist developed a vaccine screening protocol for patients initiating new specialty DMARDs at an outpatient rheumatology clinic serviced by a health-system specialty pharmacy. Screening was completed in clinic by specialty pharmacists and individualized vaccination recommendations were provided during each new drug counseling. Patient vaccine eligibility criteria from package inserts and guideline recommendations were summarized and provided to pharmacists as a counseling reference. An EHR form was created and embedded in standardized counseling notes for specialty pharmacists to document specific vaccine recommendations. Mixed methods were used to assess the impact of implementing the standardized vaccine screening tool from 9/1/2021 through 10/19/2021. The primary outcome was the percentage of eligible patients with documented vaccination screening under the new protocol. Eligible patients prescribed a new specialty DMARD were identified through the specialty pharmacy management system, Atlas, and patients who received vaccine screening were identified by completion of the screening form in Epic. Secondary outcomes included the number and type of vaccines recommended and efficiency of the vaccine screening protocol as reported by specialty pharmacists. Specialty pharmacists provided feedback through surveys completed before and after vaccine screening protocol implementation and rated screening efficiency on a scale of 0 (not efficient) to 10 (highly efficient). Result(s): During the evaluation period, 108 patients initiated specialty DMARDs and were identified as eligible for vaccine screening. Of those, 76 patients (71.7%) had a vaccine screening form completed in Epic within the initial counseling note. Specific vaccine recommendations were provided to 72 patients (94.7%) during initial counseling. Recommended vaccines included influenza (n=59;49%), zoster (n=33;28%), and pneumonia (n=28;23%). In the pre-implementation survey, specialty pharmacists rated the existing vaccine screening process efficiency as a 4.2 out of 10. In the postimplementation survey, specialty pharmacists rated the new vaccine screening process efficiency as an 8 out of 10. Conclusion(s): Implementation of a vaccine screening protocol led to successful screening in most eligible patients and encouraged specialty pharmacists to provide patient-specific vaccine recommendations. The new screening protocol created a more efficient vaccine screening process. Future directions include implementing the screening protocol in other clinics that use specialty DMARDs, creating vaccine handouts for patients, adding COVID- 19 vaccines into the screening form, and following up with patients to verify vaccine reception.
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28 Figure 1a) Frequency of a detectable antibody response after each vaccination for 80 heart transplant recipients, b) Interval change in anti-spike antibody titres between the 2nd ChAdOx1 nCoV-19 vaccine and the 3rd dose mRNA (BNT162b2) booster vaccine.[Figure omitted. See PDF]Conclusions/ImplicationsHeart transplant recipients who received 2 doses of the ChAdOx1 nCoV-19 viral vector vaccine and a mRNA booster vaccine failed to develop a detectable antibody response in 44% of cases. These findings highlight the importance of maintaining protective measures for transplant recipients, particularly those on more intensive immunosuppressive regimens, both at a personal and public health level, as well as investigating additional strategies to protect this vulnerable patient cohort.