Nguyen, H;
Salkeld, J;
Agarwal, S;
Goodman, A;
(2021)
Compassionate use of REGN-COV2 in the treatment of COVID-19 in a patient with impaired humoral immunity.
Clinical Infection in Practice
, 12
, Article 100089. 10.1016/j.clinpr.2021.100089.
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Abstract
Background: The role of antibodies in coronavirus disease 2019 (COVID-19) in patients with X-linked agammaglobulinaemia (XLA) has yet to be characterised and clinical courses observed in this cohort of patients have been heterogeneous. Whilst some exhibit spontaneous recovery, others have experienced a more protracted disease length. Previous reports have described successful use of convalescent plasma, however there is a paucity of information around the use of the REGN-COV2 antibody cocktail in these patients. Case report: A patient with XLA was admitted to hospital with COVID-19 and remained persistently symptomatic with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swab positivity despite treatment with Remdesivir and dexamethasone. Attempts at modulating the immune response with anakinra were unsuccessful. Consent for compassionate use of REGN-COV2 was obtained with administration taking place on day 87 of his illness. This was followed by a period of convalescence and SARS-CoV-2 nasopharyngeal swab negativity. As a consequence of prolonged immunosuppression, the patient developed pneumocystis pneumonia. Conclusion: This case highlights the role of antibodies in clearing SARS-CoV-2 in a hypogammaglobulinaemic host and demonstrates the consequences of prolonged immunosuppression and delayed treatment. We propose that this may be of particular significance given the capacity of SARS-CoV-2 to develop advantageous mutations in a chronically infected host.
| Type: | Article |
|---|---|
| Title: | Compassionate use of REGN-COV2 in the treatment of COVID-19 in a patient with impaired humoral immunity |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.clinpr.2021.100089 |
| Publisher version: | https://doi.org/10.1016/j.clinpr.2021.100089 |
| Language: | English |
| Additional information: | © 2021 The Author(s). Published by Elsevier Ltd on behalf of British Infection Association. This is an open access article under the CC BY-NC-ND. |
| Keywords: | Agammaglobulinemia, COVID-19, REGN-COV2, Remdesivir, SARS-CoV2 |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10184141 |
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