(516) Evaluation of allergic reactions from different monoclonal antibodies used for COVID-19 in pregnancy

Objective: To compare the incidence of allergic reactions between different types of monoclonal antibodies (MAB) used for treatment of mild to moderate COVID-19 in pregnancy.

Study Design: This is a retrospective cohort analysis of SARS-COV-2 positive pregnant women who received Bamlanivimab-Etesevimab (BE), Casirivimab-Imdevimab (CI), or Sotrovimab (S) at a teaching community hospital were performed from August 2021 to January 2022. Positive patients received treatment if they met criteria for mild to moderate disease, defined according to CDC/SMFM guidelines. Allergic reactions were identified and patients were treated with diphenhydramine, epinephrine, and/or methylprednisolone.

Results: A total of 199 pregnant patients received 1 of the 3 monoclonal antibodies based on the availability and recommendations by the CDC. 23 (11.6%) of these patients had allergic reactions to MAB infusions. Allergic reactions were identified in 18 patients (18%) of the 100 patients who received BE, in 5 patients (7.6%) of the 65 patients who received CI, and in 0 patients (0%) of the 34 patients who received S. The OR of having a reaction to BE in comparison to CI and S was significant at 4.13 ((CI 95% [1.47-11.6])p=0.007). The OR of reactions to CI was 0.53 ((CI 95% [0.19-1.52])p=0.24). The OR of reactions to S was 0.09 ((CI 95% [0.19-1.52])p=0.09).

Conclusion: Our results show an increased odds of developing an allergic reaction with the use of BE in treatment of mild to moderate COVID-19 in pregnant patients in comparison to CI and S.