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

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.