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Comparative effectiveness of neutralising monoclonal antibodies in high risk COVID-19 patients: a Bayesian network meta-analysis.
McConnell, David; Harte, Marie; Walsh, Cathal; Murphy, Desmond; Nichol, Alistair; Barry, Michael; Adams, Roisin.
  • McConnell D; National Centre for Pharmacoeconomics, St James's Hospital, Dublin, Ireland. dmcconnell@stjames.ie.
  • Harte M; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland. dmcconnell@stjames.ie.
  • Walsh C; National Centre for Pharmacoeconomics, St James's Hospital, Dublin, Ireland.
  • Murphy D; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland.
  • Nichol A; National Centre for Pharmacoeconomics, St James's Hospital, Dublin, Ireland.
  • Barry M; Health Research Institute and MACSI, University of Limerick, Limerick, Ireland.
  • Adams R; Cork University Hospital, Cork, Ireland.
Sci Rep ; 12(1): 17561, 2022 Oct 20.
Article in English | MEDLINE | ID: covidwho-2077116
ABSTRACT
The purpose of this work was to review and synthesise the evidence on the comparative effectiveness of neutralising monoclonal antibody (nMAB) therapies in individuals exposed to or infected with SARS-CoV-2 and at high risk of developing severe COVID-19. Outcomes of interest were mortality, healthcare utilisation, and safety. A rapid systematic review was undertaken to identify and synthesise relevant RCT evidence using a Bayesian Network Meta-Analysis. Relative treatment effects for individual nMABs (compared with placebo and one another) were estimated. Pooled effects for the nMAB class compared with placebo were estimated. Relative effects were combined with baseline natural history models to predict the expected risk reductions per 1000 patients treated. Eight articles investigating four nMABs (bamlanivimab, bamlanivimab/etesevimab, casirivimab/imdevimab, sotrovimab) were identified. All four therapies were associated with a statistically significant reduction in hospitalisation (70-80% reduction in relative risk; absolute reduction of 35-40 hospitalisations per 1000 patients). For mortality, ICU admission, and invasive ventilation, the risk was lower for all nMABs compared with placebo with moderate to high uncertainty due to small event numbers. Rates of serious AEs and infusion reactions were comparable between nMABs and placebo. Pairwise comparisons between nMABs were typically uncertain, with broadly comparable efficacy. In conclusion, nMABs are effective at reducing hospitalisation among infected individuals at high-risk of severe COVID-19, and are likely to reduce mortality, ICU admission, and invasive ventilation rates; the effect on these latter outcomes is more uncertain. Widespread vaccination and the emergence of nMAB-resistant variants make the generalisability of these results to current patient populations difficult.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Antineoplastic Agents, Immunological / COVID-19 Type of study: Experimental Studies / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Vaccines / Variants Limits: Humans Language: English Journal: Sci Rep Year: 2022 Document Type: Article Affiliation country: S41598-022-22431-6

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Antineoplastic Agents, Immunological / COVID-19 Type of study: Experimental Studies / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Vaccines / Variants Limits: Humans Language: English Journal: Sci Rep Year: 2022 Document Type: Article Affiliation country: S41598-022-22431-6