Treatment of persistent COVID-19 in two B-cell-depleted patients with the monoclonal antibody Sotrovimab

David Totschnig; Daniel Doberer; Renate Haberl; Christoph Wenisch; Arschang Valipour

doi:10.1016/j.idcr.2022.e01528

Treatment of persistent COVID-19 in two B-cell-depleted patients with the monoclonal antibody Sotrovimab

IDCases. 2022:29:e01528. doi: 10.1016/j.idcr.2022.e01528. Epub 2022 Jun 7.

Authors

David Totschnig¹, Daniel Doberer², Renate Haberl³, Christoph Wenisch¹, Arschang Valipour²

Affiliations

¹ Department of Medicine IV, Klinik Favoriten, Vienna Healthcare Group, Kundratstraße 3, 1100 Vienna, Austria.
² Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Health Care Group, Bruenner Straße 68, 1210 Vienna, Austria.
³ Consultant of Infectious Diseases, Klinik Floridsdorf, Bruenner Straße 68, 1210 Vienna, Austria.

Abstract

Background: Patients having undergone B-cell-depletion with anti-CD20-antibodies have a higher risk of mortality, delayed viral clearance and prolonged infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report two cases of patients with persistent coronavirus disease 2019 (COVID-19) in association with B-cell-depletion that were treated with the monoclonal antibody Sotrovimab.

Case presentation: Both patients presented with chronic symptoms of COVID-19 such as dyspnea, fatigue, and chest pain. Nasopharyngeal swabs remained positive months after the initial infection with fluctuating cycle threshold (Ct) values around 30. Both patients received a single infusion with the monoclonal SARS-CoV-2 antibody Sotrovimab, which resulted in a rapid improvement of symptoms and inflammation markers as well as negative SARS-CoV-2 swabs. A follow-up after a month showed ongoing improvement of symptoms, persistent negative SARS-CoV-2 swabs, and positive serum antibodies.

Conclusion: Infusion with the monoclonal SARS-CoV-2 antibody led to rapid improvement in two patients with persistent COVID-19 after B-cell depletion.

Keywords: Anti-CD20-antibody; B-cell depletion; COVID-19; COVID-19, Coronavirus disease 2019; CoV-2-S-AB, SARS-CoV-2 S protein antibodies; Ct, Cycle threshold; LTOT, Long term oxygen therapy; Monoclonal antibody; PCR, polymerase chain reaction; Persistent COVID-19; SARS-CoV-2; SARS-CoV-2, Severe acute respiratory syndrome coronavirus type2; Sotrovimab; mABs, monoclonal antibodies.

Publication types

Case Reports