Treatment of chronic or relapsing COVID-19 in immunodeficiency.
Brown, Li-An K Moran, Ed Goodman, Anna Baxendale, Helen Bermingham, William Buckland, Matthew AbdulKhaliq, Iman Jarvis, Hannah Hunter, Michael Karanam, Surendra
Brown, Li-An K
Moran, Ed
Goodman, Anna
Baxendale, Helen
Bermingham, William
Buckland, Matthew
AbdulKhaliq, Iman
Jarvis, Hannah
Hunter, Michael
Karanam, Surendra
Citations
Altmetric:
Affiliation
Sandwell and West Birmingham NHS Trust; University College London; North Bristol NHS Trust
Other Contributors
Publication date
2021-11-12
Subject
Collections
Research Projects
Organizational Units
Journal Issue
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.
Citation
Brown LK, Moran E, Goodman A, Baxendale H, Bermingham W, Buckland M, AbdulKhaliq I, Jarvis H, Hunter M, Karanam S, Patel A, Jenkins M, Robbins A, Khan S, Simpson T, Jolles S, Underwood J, Savic S, Richter A, Shields A, Brown M, Lowe DM. Treatment of chronic or relapsing COVID-19 in immunodeficiency. J Allergy Clin Immunol. 2022 Feb;149(2):557-561.e1.
Type
Article
Other
Other