TY - JOUR T1 - Early experience with tixagevimab/cilgavimab pre-exposure prophylaxis in patients with immune-mediated inflammatory disease undergoing B cell depleting therapy and those with inborn errors of humoral immunity JF - RMD Open JO - RMD Open DO - 10.1136/rmdopen-2022-002557 VL - 8 IS - 2 SP - e002557 AU - Cassandra Calabrese AU - Elizabeth Kirchner AU - Alexandra Villa-Forte AU - Rula A Hajj-Ali AU - Brandon P Moss AU - James P Fernandez AU - Leonard Calabrese Y1 - 2022/09/01 UR - http://rmdopen.bmj.com/content/8/2/e002557.abstract N2 - Among immunocompromised patients, those with immune-mediated inflammatory diseases (IMIDs) treated with B cell depleting therapies (BCDTs) and those with inborn errors of humoral immunity (IEI) are among the poorest responders to vaccination1 against SARS-CoV-2. These patients are also more likely to experience severe COVID-19 outcomes, regardless of vaccination status.2 Although vaccination has not proven to be as efficacious as hoped in this population, the December 2021 emergency use authorisation of tixagevimab/cilgavimab has been greeted with cautious optimism by those providing care for immunocompromised patients. Tixagevimab/cilgavimab consists of two Fc-modified fully human monoclonal antibodies administered by intramuscular injection; it is effective for the prevention of COVID-19 in patients with moderate-to-severe immune compromise who are unlikely to mount an adequate immune response to COVID-19 vaccination (Levin et al3 #2781). In the pivotal trial,3 however, only 3.3% of patients were receiving immunosuppressive drugs at baseline and no details as to class of agents were provided. It is becoming more and more evident that multiple strategies are required to prevent and treat outpatient COVID-19 in immunosuppressed patients; this includes the use of monoclonal antibodies and antiviral therapies when prevention strategies fail. The practical effectiveness of this multipronged approach in terms of safety, tolerability and effectiveness has yet to be described.To … ER -