Real-world efficacy, roll-out and uptake of intramuscular tixagevimab/cilgavimab as COVID-19 pre-exposure prophylaxis in people with multiple sclerosis and neuroimmunological conditions during the COVID-19 pandemic

Louise Rath; Wei Zhen Yeh; Angie Roldan; Robb Wesselingh; Michael Zhong; Tracie Tan; Nabil Seery; Francesca Bridge; YiChao Foong; Olga Skibina; Cassie Nesbitt; Helmut Butzkueven; Mastura Monif; Anneke van der Walt

doi:10.1136/bmjno-2024-000667

Real-world efficacy, roll-out and uptake of intramuscular tixagevimab/cilgavimab as COVID-19 pre-exposure prophylaxis in people with multiple sclerosis and neuroimmunological conditions during the COVID-19 pandemic

BMJ Neurol Open. 2024 Apr 30;6(1):e000667. doi: 10.1136/bmjno-2024-000667. eCollection 2024.

Authors

Louise Rath¹, Wei Zhen Yeh^{1

2}, Angie Roldan¹, Robb Wesselingh^{1

2}, Michael Zhong^{1

2}, Tracie Tan^{1

2}, Nabil Seery^{1

2}, Francesca Bridge^{1

2}, YiChao Foong^{1

2}, Olga Skibina¹, Cassie Nesbitt¹, Helmut Butzkueven^{1

2}, Mastura Monif^{1

2}, Anneke van der Walt^{1

2}

Affiliations

¹ Clinical Neurosciences, Alfred Health, Melbourne, Victoria, Australia.
² Department of Neurosciences, Central Clinical School, Monash University, Clayton, Victoria, Australia.

Abstract

Background: In Australia, tixagevimab/cilgavimab 150 mg/150 mg was a government-funded pre-exposure prophylaxis for COVID-19 people with multiple sclerosis (pwMS) and other neuroimmunological conditions (pwNIc) treated with anti-CD20 antibodies or sphingosine-1-phosphate receptor modulators were eligible.

Objective: To analyse the roll-out, uptake and real-world efficacy of tixagevimab/cilgavimab in the prevention and severity of COVID-19. To assess compliance with uptake depending on the location of delivery.

Methods: We undertook a single-centre study. 440 pwMS and pwNIc were eligible. Logistic regression was used to assess predictors of COVID-19 during follow-up and to assess predictors of uptake among those who consented.

Results: Of the eligible pwMS and pwNIc in our service, 52.7% (233/440) requested a consultation and were included in this study. Consultation resulted in 71.7% of people (167/233) receiving the treatment. Of these, 94.0% (157/167) had received three or more COVID-19 vaccines. Among those who received a single dose of tixagevimab/cilgavimab, 19.16% (32/167) tested positive for COVID-19 during the observational window. The majority of these were on ocrelizumab (68.8% (22/32)). None of those with COVID-19 required hospitalisation or supplemental oxygen. There was no difference in odds of COVID-19 during the observation period between those who received and did not receive tixagevimab/cilgavimab (adjusted OR, aOR 2.16 (95% CI 0.82 to 6.85), p=0.43). Uptake of tixagevimab/cilgavimab was highest when offered at the hospital infusion centre (aOR 3.09 (95% CI 1.08 to 9.94) relative to referral to the local pharmacy, p=0.04).

Conclusion: Tixagevimab/cilgavimab administration did not protect against subsequent COVID-19 in our cohort. Compliance with uptake was influenced by administration location.

Keywords: COVID-19; HEALTH POLICY & PRACTICE; MULTIPLE SCLEROSIS.