Real‐world experience with available, outpatient COVID‐19 therapies in solid organ transplant recipients during the omicron surge

Abstract

The SARS‐CoV‐2 pandemic continues to place a substantial burden on healthcare systems. Outpatient therapies for mild‐to‐moderate disease have reduced hospitalizations and deaths in clinical trials, but the real‐world effectiveness of monoclonal antibodies and oral antiviral agents in solid organ transplant recipients (SOTR) with coronavirus disease‐2019 (COVID‐19) is largely uncharacterized. We conducted a single‐center, retrospective review of 122 SOTR diagnosed with COVID‐19 in the outpatient setting during the Omicron surge to address this knowledge gap. The mean age was 54 years, 57% were males, and 67% were kidney transplant recipients. The mean time from transplant to COVID‐19 diagnosis was 75 months. Forty‐nine (40%) received molnupiravir, 24 (20%) received sotrovimab, and 1 (0.8%) received nirmatrelvir/ritonavir. No outpatient therapy was administered in 48 (39%). All 122 SOTR had >30 days follow‐up. Rates of hospitalization within 30 days of initiating therapy for molnupiravir, nirmatrelvir/ritonavir, and sotrovimab were 16% (8/49), 0% (0/1), and 8% (2/24), respectively, compared to 27% (13/48) in patients without outpatient therapy. There were no deaths in those who received any therapy versus 3 (6%) deaths in patients without outpatient therapy ( p = .002). Overall, our experience suggests a role for monoclonal antibodies and oral antiviral agents in reducing COVID‐19‐related morbidity and mortality in SOTR.