(1200) Evusheld Protects Against SARS-CoV-2 in Lung Transplant Recipients

PURPOSE: Evusheld (tixagevimab/cilgavimab), a combination of two monoclonal antibodies against SARS-CoV-2, was authorized in January 2022 as prophylaxis in immunocompromised patients. Data on Evusheld efficacy in lung transplant patients is lacking. This study aimed to determine if Evusheld reduces SARS-CoV-2 infection or is associated with improved clinical outcomes in lung transplant recipients. METHODS: We performed a single-center retrospective study of lung transplant recipients at our institution who were alive in 2022. SARS-CoV-2 diagnoses from 1/1/2022 to 6/30/22 were recorded. Demographics, number of COVID vaccine doses, Evusheld administration, and COVID-19 clinical outcomes were recorded. The primary outcome was rate of SARS-CoV-2 infection between patients who received Evusheld and those who did not. Secondary outcomes included death, hospitalization, hospital length of stay, and decline in FEV1. Data were analyzed using Fisher's exact test or logistic regression controlling for age and vaccine doses. RESULTS: 336 patients were included in the study (57% male, 84% double lung transplants, 51% prior interstitial lung disease, median of 3 years post-transplant, median of 3 COVID vaccine doses). 136 (40%) received Evusheld 600mg. Among patients who received Evusheld, 7 (5%) were diagnosed with SARS-CoV-2 infection, compared to 30 (15%) of patients without Evusheld (p=0.005, Figure). After controlling for age and COVID vaccine doses received, Evusheld reduced the risk of SARS-CoV-2 by 92% (OR 0.084, 95%CI 0.02-0.29, p<0.001). There were no significant differences between groups in symptom development (86% with Evusheld vs 93%, p=0.47), hospitalization rate (14% vs 23%, p=1.0), hospital length of stay (1 vs 9 days, p=0.29), >10% decline in FEV1 (18% vs 29%, p=0.61), or death (0% vs 13%, p=0.57). CONCLUSION: After controlling for age and COVID vaccine doses received, Evusheld substantially lowered the risk of SARS-CoV-2 infection, with limited impact on clinical outcomes once infected.