Effectiveness of Pre-exposure Prophylaxis with Tixagevimab–Cilgavimab for COVID-19 Hospitalization among Chronic Kidney Disease Patients in Thailand: A Retrospective Cohort Study, August 2022 to May 2023
DOI:
https://doi.org/10.59096/osir.v19i1.279468Keywords:
tixagevimab–cilgavimab, COVID-19, chronic kidney disease, dialysis, prophylaxis, effectivenessAbstract
Objectives: To evaluate the effectiveness of tixagevimab–cilgavimab in preventing COVID-19-related hospitalizations among chronic kidney disease (CKD) patients in Thailand from 1 Aug 2022 to 30 May 2023.
Methods: We conducted a retrospective cohort study using secondary data from Thailand’s national health databases among CKD patients aged ≥12 years under the Universal Coverage Scheme who were followed from 1 Aug 2022 to 30 May 2023. The primary outcome was time until COVID-19 hospitalization, analyzed using Cox regression, and adjusted for age, gender, vaccination status, and comorbidities. Receiving tixagevimab–cilgavimab at a dose of either 300 mg or 600 mg was the main explanatory variable. A stratified analysis was also conducted by history of dialysis.
Results: Among 1,018,175 CKD patients, tixagevimab–cilgavimab recipients had a higher hazard of hospitalization compared to non-recipients (adjusted hazard ratio 1.70; 95% confidence interval (CI) 1.40–2.06). Among dialysis patients, administration of tixagevimab–cilgavimab was associated with a non-significant reduction in the risk of hospitalization (effectiveness 18.15%; 95% CI: -12.82–40.62) while COVID-19 vaccination was strongly protective in both groups, with five doses showing an effectiveness of 79.18% (95% CI 61.28–88.80). Tixagevimab–cilgavimab did not significantly reduce the hazard of hospitalization overall but showed a non-significant trend toward a benefit among dialysis patients.
Public Health Recommendations: Tailored prophylaxis strategies are needed for immunocompromised populations during evolving waves of COVID-19 variants. Further studies should assess effectiveness by variant period and underlying risk profile to better identify subgroups most likely benefit from the interventions.
References
Khan MMA, Khan MN, Mustagir G, Rana J, Islam MS, Kabir MI. Effects of underlying morbidities on the occurrence of deaths in COVID-19 patients: A systematic review and meta-analysis. J Glob Health. 2020;10(2):1–14. doi: 10.7189/jogh.10.020503. DOI: https://doi.org/10.7189/jogh.10.020503
Martins-Filho PR, Tavares CSS, Santos VS. Factors associated with mortality in patients with COVID-19. A quantitative evidence synthesis of clinical and laboratory data. Eur J Intern Med. 2020;76:97. doi:10.1016/j.ejim.2020.04.043. DOI: https://doi.org/10.1016/j.ejim.2020.04.043
Kang SH, Kim SW, Kim AY, Cho KH, Park JW, Do JY. Association between Chronic Kidney Disease or Acute Kidney Injury and Clinical Outcomes in COVID-19 Patients. J Korean Med Sci [Internet]. 2020 Dec 28 [cited 2025 Apr 11];35(50):e434. <https://pmc.ncbi.nlm.nih.gov/articles/PMC7769703/>. doi:10.3346/jkms.2020.35.e434. DOI: https://doi.org/10.3346/jkms.2020.35.e434
Valeri AM, Robbins-Juarez SY, Stevens JS, Ahn W, Rao MK, Radhakrishnan J, et al. Presentation and outcomes of patients with ESKD and COVID-19. J Am Soc Nephrol [Internet]. 2020 Jul [cited 2025 Apr 11];31(7):1409–15. <https://pmc.ncbi.nlm.nih.gov/articles/PMC7350989/>. doi:10.1681/ASN.2020040470. DOI: https://doi.org/10.1681/ASN.2020040470
Booth A, Reed AB, Ponzo S, Yassaee A, Aral M, Plans D, et al. Population risk factors for severe disease and mortality in COVID-19: A global systematic review and meta-analysis. PLoS One [Internet]. 2021 Mar 4 [cited 2025 Apr 11];16(3):e0247461. <https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247461>. doi:10.1371/journal.pone.0247461. DOI: https://doi.org/10.1371/journal.pone.0247461
Evans RA, Dube S, Lu Y, Yates M, Arnetorp S, Barnes E, et al. Impact of COVID-19 on immunocompromised populations during the Omicron era: insights from the observational population-based INFORM study. Lancet Reg Health Eur [Internet]. 2023 Oct 13 [cited 2025 Apr 11];35:100747. <https://pmc.ncbi.nlm.nih.gov/articles/PMC10730312/>. doi:10.1016/j.lanepe.2023.100747. DOI: https://doi.org/10.1016/j.lanepe.2023.100747
Bruminhent J, Setthaudom C, Kitpermkiat R, Kiertiburanakul S, Malathum K, Assanatham M, et al. Immunogenicity of ChAdOx1 nCoV-19 vaccine after a two-dose inactivated SARS-CoV-2 vaccination of dialysis patients and kidney transplant recipients. Sci Rep [Internet]. 2022 [cited 2025 Apr 11];12(1):3587. <https://pmc.ncbi.nlm.nih.gov/articles/PMC8897448/>. doi:10.1038/s41598-022-07574-w. DOI: https://doi.org/10.1038/s41598-022-07574-w
Grupper A, Sharon N, Finn T, Cohen R, Israel M, Agbaria A, et al. Humoral Response to the Pfizer BNT162b2 Vaccine in Patients Undergoing Maintenance Hemodialysis. Clin J Am Soc Nephrol [Internet]. 2021 Jul [cited 2025 Apr 11];16(7):1037–42. <https://pmc.ncbi.nlm.nih.gov/articles/PMC8425628/>. doi:10.2215/CJN.03500321. DOI: https://doi.org/10.2215/CJN.03500321
Clarke CL, Prendecki M, Dhutia A, Gan J, Edwards C, Prout V, et al. Longevity of SARS-CoV-2 immune responses in hemodialysis patients and protection against reinfection. Kidney Int [Internet]. 2021 Jun [cited 2025 Apr 11];99(6):1470–7. <https://pmc.ncbi.nlm.nih.gov/articles/PMC7992297/>. doi:10.1016/j.kint.2021.03.009. DOI: https://doi.org/10.1016/j.kint.2021.03.009
Boongird S, Chuengsaman P, Setthaudom C, Nongnuch A, Assanatham M, Phanprasert S, et al. Short-Term Immunogenicity Profiles and Predictors for Suboptimal Immune Responses in Patients with End-Stage Kidney Disease Immunized with Inactivated SARS-CoV-2 Vaccine. Infect Dis Ther [Internet]. 2021 Feb [cited 2025 Apr 11];11(1):351. <https://pmc.ncbi.nlm.nih.gov/articles/PMC8639296/>. doi:10.1007/s40121-021-00574-9. DOI: https://doi.org/10.1007/s40121-021-00574-9
Boongird S, Setthaudom C, Kitpermkiat R, Prasongtanakij S, Srisala S, Chuengsaman P, et al. Durability of Humoral and Cellular Immunity after an Extended Primary Series with Heterologous Inactivated SARS-CoV-2 Prime-Boost and ChAdOx1 nCoV-19 in Dialysis Patients (ICON3). Vaccines (Basel) [Internet]. 2022 Jul 1 [cited 2025 Apr 11];10(7):1064. <https://pmc.ncbi.nlm.nih.gov/articles/PMC9323398/>. doi:10.3390/vaccines10071064. DOI: https://doi.org/10.3390/vaccines10071064
Bielopolski D, Libresco G, Barda N, Dagan N, Steinmetz T, Yahav D, et al. BNT162b2 vaccine effectiveness in chronic kidney disease patients—an observational study. Clin Kidney J [Internet]. 2022 [cited 2025 Apr 11];15(10):1838. <https://pmc.ncbi.nlm.nih.gov/articles/PMC9384353/>. doi:10.1093/ckj/sfac166. DOI: https://doi.org/10.1093/ckj/sfac166
Goggolidou P, Malik SA, Modarage K. A systematic review assessing the effectiveness of COVID-19 mRNA vaccines in chronic kidney disease (CKD) individuals. F1000Res [Internet]. 2022 Aug 8 [cited 2025 Apr 11];11:909. <https://pmc.ncbi.nlm.nih.gov/articles/PMC9732501/>. doi:10.12688/f1000research.122820.2. DOI: https://doi.org/10.12688/f1000research.122820.2
Cowan J, Amson A, Christofides A, Chagla Z. Monoclonal antibodies as COVID-19 prophylaxis therapy in immunocompromised patient populations. Int J Infect Dis [Internet]. 2023 Sep [cited 2025 Apr 11];134:228–38. <https://pubmed.ncbi.nlm.nih.gov/37400053/>. doi:10.1016/j.ijid.2023.06.021. DOI: https://doi.org/10.1016/j.ijid.2023.06.021
Huang AT, Garcia-Carreras B, Hitchings MDT, Yang B, Katzelnick LC, Rattigan SM, et al. A systematic review of antibody mediated immunity to coronaviruses: kinetics, correlates of protection, and association with severity. Nat Commun. 2020;11(1):4704. doi:10.1038/s41467-020-18450-4. DOI: https://doi.org/10.1038/s41467-020-18450-4
Loo YM, McTamney PM, Arends RH, Abram ME, Aksyuk AA, Diallo S, et al. The SARS-CoV-2 monoclonal antibody combination, AZD7442, is protective in non-human primates and has an extended half-life in humans. Sci Transl Med. 2022 Mar 9;14(635):eabl8124. doi:10.1126/scitranslmed.abl8124. DOI: https://doi.org/10.1126/scitranslmed.abg8900
Zost SJ, Gilchuk P, Case JB, Binshtein E, Chen RE, Nkolola JP, et al. Potently neutralizing and protective human antibodies against SARS-CoV-2. Nature. 2020;584(7821):443. doi:10.1038/s41586-020-2548-6. DOI: https://doi.org/10.1038/s41586-020-2548-6
Food and Drugs Administration, Ministry of Public Health (TH). Details of medicinal product: Evusheld [Internet]. Nonthaburi: Food and Drugs Administration; [cited 2025 Apr 11]. <https://pertento.fda.moph.go.th/FDA_SEARCH_DRUG/SEARCH_DRUG/pop-up_drug_ex.aspx?Newcode=U1DR2C1072650000511C>
Ministry of Public Health (TH). Long-acting antibody: LAAB national guideline [Internet]. Nonthaburi: Department of Disease Control; 2022 Sep [cited 2025 Apr 11]. 40 p. <https://ddc.moph.go.th/vaccine-covid19/getFiles/11/1669968711550.pdf>. Thai.
Ministry of Public Health (TH). Long-acting antibody: LAAB national guideline [Internet]. Nonthaburi: Department of Disease Control; 2023 Mar [cited 2025 Apr 11]. 4 p. <https://ddc.moph.go.th/uploads/publish/1402820230322130408.pdf>. Thai.
Soeroto AY, Yanto TA, Kurniawan A, Hariyanto TI. Efficacy and safety of tixagevimab-cilgavimab as pre-exposure prophylaxis for COVID-19: A systematic review and meta-analysis. Rev Med Virol. 2023 Mar;33(2):e2420. doi:10.1002/rmv.2420. DOI: https://doi.org/10.1002/rmv.2420
Levin MJ, Ustianowski A, De Wit S, Launay O, Avila M, Templeton A, et al. Intramuscular AZD7442 (tixagevimab–cilgavimab) for prevention of covid-19. N Engl J Med. 2022;386(23):2188–200. doi:10.1056/NEJMoa2116620. DOI: https://doi.org/10.1056/NEJMoa2116620
Bertrand D, Laurent C, Lemee V, Lebourg L, Hanoy M, Le Roy F, et al. Efficacy of anti–SARS-CoV-2 monoclonal antibody prophylaxis and vaccination on the Omicron variant of COVID-19 in kidney transplant recipients. Kidney Int. 2022 Aug;102(2):440–2. doi:10.1016/j.kint.2022.05.007. DOI: https://doi.org/10.1016/j.kint.2022.05.007
Pittayawonganon C, Pisitpayat N, Kripattanapong S, Doungngern P, Jitpeera C. Effectiveness and Safety of Long-acting Antibody (LAAB) to Prevent COVID-19 among High-risk Population in Thailand: a 6-month retro-prospective cohort study. OSIR. 2024 Sep;17(3):155–64. doi:10.59096/osir.v17i3.270829. DOI: https://doi.org/10.59096/osir.v17i3.270829
Boongird S, Srithongkul T, Sethakarun S, Bruminhent J, Kiertiburanakul S, Nongnuch A, et al. Tixagevimab–cilgavimab for preventing breakthrough COVID-19 in dialysis patients: a prospective study. Clin Kidney J. 2024;17(11):sfae309. doi:10.1093/ckj/sfae309. DOI: https://doi.org/10.1093/ckj/sfae309
Puenpa J, Chansaenroj J, Suwannakarn K, Poovorawan Y. Genomic epidemiology and evolutionary analysis during XBB.1.16-predominant periods of SARS-CoV-2 omicron variant in Bangkok, Thailand: December 2022–August 2023. Sci Rep. 2024;14(1):645. doi:10.1038/s41598-023-50856-0. DOI: https://doi.org/10.1038/s41598-023-50856-0
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Outbreak, Surveillance, Investigation & Response (OSIR) Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
