Real-World Effectiveness of Tixagevimab and Cilgavimab (Evusheld) in Patients With Hematological Malignancies

Background: Immunocompromised individuals with hematological malignancy have increased risk for poor outcomes and death from se-vere acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This special population may mount a suboptimal response to vaccination. We assessed the effectiveness of tixagevimab and cilgavimab (Evush-eld), a monoclonal antibody combination against SARS-CoV-2, in conjunction with standard preventative measures, at preventing symptomatic incident infection.Methods: Patients aged 18 years and older with hematological ma-lignancy consented to receive Evusheld. Patients were followed lon-gitudinally for development of symptomatic incident SARS-CoV-2 infections. Adverse events were monitored.Results: Two hundred and three patients (94 female) with hematologi-cal malignancies and mean age 72 +/- 10 years were included. Of the patients, 99.5% had received at least one mRNA vaccination against SARS-CoV-2. Average time of follow-up was 151 +/- 50 days. Nine-teen patients (9.3%) developed incident symptomatic SARS-CoV-2 infection, with only one (0.5%) requiring hospitalization. During the same follow-up period, local incident rate of infection was 84,123 cases (11.3% of population). Of those, 3,386 cases (4%) of SARS-CoV-2 re-quired hospital admission. The incidence rate ratio was 0.79. No seri-ous adverse events occurred following administration of Evusheld.Conclusion: Patients with hematological malignancy who received Evusheld infrequently developed symptomatic infections or require hospitalization. The high-risk cohort incidence was at least as com-parable to the average risk general population. Evusheld appears ef-fective and is well tolerated, and may be administered in conjunction with vaccination and standard prevention measures, at decreasing in-cident SARS-Co-V2 cases in this high-risk population.

Automated summary

This study assessed the effectiveness of tixagevimab and cilgavimab in preventing symptomatic infection in immunocompromised patients with hematological malignancy. The results showed that these patients had a low incidence of symptomatic infection or hospitalization, suggesting the potential efficacy of the antibody combination in this high-risk population.