Viral clearance and escape during therapy of COVID-19 outpatients: A prospective cohort study
Year: 2025
Type: article
Study design: Observational Study
Abstract: The efficacy of neutralizing SARS-CoV-2 monoclonal antibodies (mAbs) in preventing severe COVID-19 has been hindered by the diversity of viral strains and the complexity of patient populations. In this prospective cohort study, we used regression analyses to identify virological, immunological, and clinical factors associated with viral clearance and emergence of escape mutations. We included 114 mainly immunocompromised high-risk patients with mild-to-moderate COVID-19 who received mAbs or direct antivirals to prevent COVID-19 progression. Nasopharyngeal SARS-CoV-2 RNA level at day 7 was independently associated with viral load at day 0, serum neutralization at day 7, and treatment received. The emergence of mutations within Spike was observed in 21.9% of patients, all being immunocompromised treated by Sotrovimab or Tixagevimab/Cilgavimab after Omicron emergence, and was independently associated with higher viral load and serum neutralization at day 7. Our data show that suboptimal neutralizing antibodies should be avoided in immunocompromised individuals, given the risk of emergence of viral escape mutations.
Source: iScience
Authors: Guillaume Martin-Blondel, Paul Burgat, Valentin Leducq, Françoise Porrot, Andrea Cottignies-Calamarte, Alejandro De Cruz, Céline Dorival, Raphaelle Romieu-Mourez, Camille Chaubet, Vincent Cazaentre, Xavier Boumaza, Quentin Richier, Benjamin Gaborit, Francois Coustilleres, Vincent Dubée, Florence Ader, Youri Yordanov, Olivier Schwartz, Anne-Geneviève Marcelin, Clovis Lusivika-Nzinga, Fabrice Carrat, Cathia Soulié, Roland Liblau, Timothée Bruel
Institutions: Centre National de la Recherche Scientifique, Université Toulouse III - Paul Sabatier, Inserm, Centre Hospitalier Universitaire de Toulouse, Institut Toulousain des Maladies Infectieuses et Inflammatoires, Sorbonne Université, Institut Pierre Louis d‘Épidémiologie et de Santé Publique, Assistance Publique – Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Institut Pasteur, Université Paris Cité, Hôpital Saint-Antoine, Centre Hospitalier Universitaire de Nantes, Centre d'Investigation Clinique de Nantes, Center for Research in Transplantation and Translational Immunology, Nantes Université, Centre Hospitalier Universitaire de Tours, Centre Hospitalier Universitaire d'Angers, Lyon 1 Université, École Normale Supérieure de Lyon, Hospices Civils de Lyon, Centre International de Recherche en Infectiologie, Hôpital Edouard Herriot, Institut de Recherche Vaccinale
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,240
Funders: Agence Nationale de la Recherche, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Toulouse, Centre Hospitalier Universitaire de Nantes, Centre Hospitalier Universitaire de Bordeaux, Ministère de l'Enseignement supérieur, de la Recherche et de l'Innovation, Ministère des Solidarités et de la Santé, Centre Hospitalier Universitaire de Poitiers, CHIST-ERA
OpenAlex ID: W4416702849