Impact of Casirivimab-Imdevimab on SARS-CoV-2 delta variant nasopharyngeal virus load and Spike quasispecies

ABSTRACT

Objectives The increasing use of monoclonal antibodies (mAbs) to treat COVID-19 raises questions about their impact on the emergence of 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. Patients and 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 (SMRT). Results The NP SARS-CoV-2 viral load of patients treated with Casirivimab-Imdevimab decreased from 8.13 [IQR, 7.06-8.59] log10 copies/ml pre-treatment to 3.67 [IQR, 3.07-5.15] log10 copies/ml seven days later (p<0.001). Of the 36 patients for whom follow-up time-points Spike sequencing were available, none of the Spike mutations that reduced mAb activity were detected. Conclusion 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.