Effects of bamlanivimab alone or in combination with etesevimab on subsequent hospitalization and mortality in outpatients with COVID-19: a systematic review and meta-analysis

• Published in: PeerJ (San Francisco, CA) Vol. 11; p. e15344
• Main Authors: Tai, Yu-Lin, Lee, Ming-Dar, Chi, Hsin, Chiu, Nan-Chang, Lei, Wei-Te, Weng, Shun-Long, Liu, Lawrence Yu-Min, Chen, Chung-Chu, Huang, Shih-Yu, Huang, Ya-Ning, Lin, Chien-Yu
• Format: Journal Article
• Language: English
• Published: United States PeerJ. Ltd 08.05.2023; PeerJ Inc
• Subjects: Analysis; Anti-viral treatment; Antibodies, Monoclonal - adverse effects; Bamlanivimab; Coronaviruses; COVID-19; Drugs and Devices; Etesevimab; Hospitalization; Humans; Infectious Diseases; Iran; Monoclonal antibody; Mortality; Outpatients; Patient outcomes; Pharmacology; Respiratory Medicine; SARS-CoV-2; Severe acute respiratory syndrome; Iran; COVID-19; Anti-viral treatment; Bamlanivimab; Etesevimab; Monoclonal antibody
• ISSN: 2167-8359; 2167-8359
• DOI: 10.7717/peerj.15344

Coronavirus disease 2019 (COVID-19) has caused an enormous loss of life worldwide. The spike protein of the severe acute respiratory syndrome coronavirus 2 is the cause of its virulence. Bamlanivimab, a recombinant monoclonal antibody, has been used alone or in combination with etesevimab to provide passive immunity and improve clinical outcomes. A systematic review and meta-analysis was conducted to investigate the therapeutic effects of bamlanivimab with or without etesevimab (BAM/ETE) treatment. Our study was registered in PROSPERO (registry number CRD42021270206). We searched the following electronic databases, without language restrictions, until January 2023: PubMed, Embase, medRxiv, and the Cochrane database. A systematic review and meta-analysis was conducted based on the search results. Eighteen publications with a total of 28,577 patients were identified. Non-hospitalized patients given bamlanivimab with or without etesevimab had a significantly lower risk of subsequent hospitalization (18 trials, odds ratio (OR): 0.37, 95% confidence interval (CI): [0.29-0.49], : 69%; < 0.01) and mortality (15 trials, OR: 0.27, 95% CI [0.17-0.43], : 0%; = 0.85). Bamlanivimab monotherapy also reduced the subsequent risk of hospitalization (16 trials, OR: 0.43, 95% CI [0.34-0.54], : 57%; = 0.01) and mortality (14 trials, OR: 0.28, 95% CI [0.17-0.46], : 0%; = 0.9). Adverse events from these medications were uncommon and tolerable. In this meta-analysis, we found the use of bamlanivimab with or without etesevimab contributed to a significantly-reduced risk of subsequent hospitalization and mortality in non-hospitalized COVID-19 patients. However, resistance to monoclonal antibodies was observed in COVID-19 variants, resulting in the halting of the clinical use of BAM/ETE. Clinicians' experiences with BAM/ETE indicate the importance of genomic surveillance. BAM/ETE may be repurposed as a potential component of a cocktail regimen in treating future COVID variants.