Treatment of chronic or relapsing COVID-19 in immunodeficiency - 22/11/21
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Abstract |
Background |
Patients with some types of immunodeficiency can experience chronic or relapsing infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This leads to morbidity and mortality, infection control challenges, and the risk of evolution of novel viral variants. The optimal treatment for chronic coronavirus disease 2019 (COVID-19) is unknown.
Objective |
Our aim was to characterize a cohort of patients with chronic or relapsing COVID-19 disease and record treatment response.
Methods |
We conducted a UK physician survey to collect data on underlying diagnosis and demographics, clinical features, and treatment response of immunodeficient patients with chronic (lasting ≥21 days) or relapsing (≥2 episodes) of COVID-19.
Results |
We identified 31 patients (median age 49 years). Their underlying immunodeficiency was most commonly characterized by antibody deficiency with absent or profoundly reduced peripheral B-cell levels; prior anti-CD20 therapy, and X-linked agammaglobulinemia. Their clinical features of COVID-19 were similar to those of the general population, but their median duration of symptomatic disease was 64 days (maximum 300 days) and individual patients experienced up to 5 episodes of illness. Remdesivir monotherapy (including when given for prolonged courses of ≤20 days) was associated with sustained viral clearance in 7 of 23 clinical episodes (30.4%), whereas the combination of remdesivir with convalescent plasma or anti-SARS-CoV-2 mAbs resulted in viral clearance in 13 of 14 episodes (92.8%). Patients receiving no therapy did not clear SARS-CoV-2.
Conclusions |
COVID-19 can present as a chronic or relapsing disease in patients with antibody deficiency. Remdesivir monotherapy is frequently associated with treatment failure, but the combination of remdesivir with antibody-based therapeutics holds promise.
Le texte complet de cet article est disponible en PDF.Key words : COVID-19, SARS-CoV-2, immunodeficiency, therapeutic monoclonal, remdesivir
Abbreviations used : COVID-19, CRP, CVID, SARS-CoV-2, XLA
Plan
| Disclosure of potential conflict of interest: T. Simpson has received speakers’ fees from Gilead. S. Jolles reports advisory board, speaker, conference, drug safety monitoring board, and project support from CSL Behring, Shire, Takeda, BioCryst Pharmaceuticals, Swedish Orphan Biovitrum, Biotest, Binding Site, LFB, Octapharma, Grifols, UCB Pharma, Sanofi, Pharming, Weatherden, and Zarodex Therapeutics, Limited, and he is a member of the IPOPI SAFE Taskforce and COVIC19 Trial Group. M. Brown is the UK chief investigator for a Gilead remdesivir trial (GS-US-540-9012), local principal investigator for a Gilead remdesivir trial (GS-US-540-5773/5774), and local coinvestigator for the AstraZeneca PROVENT trial. D. Lowe has received travel and subsistence costs for consultancy work for CSL Behring and fees for roundtable discussion from Merck; in addition, he is chief investigator for the COVID-19 antiviral FLARE trial (NCT04499677), and he holds research grants from LifeArc, the UK Medical Research Council, Blood Cancer UK, Bristol-Myers Squibb and the British Society for Antimicrobial Chemotherapy. The rest of the authors declare that they have no relevant conflicts of interest. |
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