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Compassionate use of REGN-COV2 in the treatment of COVID-19 in a patient with impaired humoral immunity.
Nguyen, Hanna; Salkeld, Jo; Agarwal, Sangita; Goodman, Anna.
  • Nguyen H; Department of Infectious Diseases, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK.
  • Salkeld J; Department of Infectious Diseases, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK.
  • Agarwal S; Interstitial Lung Disease Unit, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK.
  • Goodman A; Department of Infectious Diseases, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK.
Clin Infect Pract ; 12: 100089, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1363932
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.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report Topics: Long Covid Language: English Journal: Clin Infect Pract Year: 2021 Document Type: Article Affiliation country: J.clinpr.2021.100089

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report Topics: Long Covid Language: English Journal: Clin Infect Pract Year: 2021 Document Type: Article Affiliation country: J.clinpr.2021.100089