Monoclonal Antibodies to Treat COVID-19 in Rheumatoid Arthritis: A Case Report and a Clinical Appraisal of Selected Drug Trials

ABSTRACT

The current report describes successful treatment of a rapidly progressive severe breakthrough COVID-19 in a female physician, a known case of rheumatoid arthritis (RA). She received monoclonal antibody (Mab) combination cocktail (Casirivimab (TM) plus Imdevimab (TM)) infusion on day 4 after the onset of symptoms. RA was in prolonged remission with tofacitinib. She had completed vaccination 6 weeks earlier and worked in a COVID hospital. Post infusion, there was substantial improvement, and she was discharged after 3 days. However, she required intermittent domiciliary oxygen for a fortnight. Fatigue and ageusia persisted for 5 weeks. Several Mabs were recently approved for emergency use in mild-to-moderate ambulant COVID-19 patients. Controlled drug trials confirmed excellent efficacy and safety. Selected data on clinical relevance and limitations are currently described. RA is susceptible to COVID-19, and some vaccines may be less effective. Intervention with Mabs ought to be judicious and timely.