Successful management of persistent COVID-19 using combination antiviral therapy (nirmatrelvir/ritonavir and remdesivir) and intravenous immunoglobulin transfusion in an immunocompromised host who had received CD20 depleting therapy for follicular lymphoma

Taketomo Maruki; Hidetoshi Nomoto; Noriko Iwamoto; Kei Yamamoto; Masami Kurokawa; Kiyoko Iwatsuki-Horimoto; Seiya Yamayoshi; Yutaka Suzuki; Yoshihiro Kawaoka; Norio Ohmagari

doi:10.1016/j.jiac.2024.01.008

Successful management of persistent COVID-19 using combination antiviral therapy (nirmatrelvir/ritonavir and remdesivir) and intravenous immunoglobulin transfusion in an immunocompromised host who had received CD20 depleting therapy for follicular lymphoma

J Infect Chemother. 2024 Aug;30(8):793-795. doi: 10.1016/j.jiac.2024.01.008. Epub 2024 Jan 17.

Affiliations

¹ Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
² Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan. Electronic address: hnomoto@hosp.ncgm.go.jp.
³ Laboratory Testing Department, National Center for Global Health and Medicine, Tokyo, Japan.
⁴ Division of Virology, Institute of Medical Science, University of Tokyo, Tokyo, Japan.
⁵ Department of Computational Biology and Medical Sciences, The University of Tokyo, Tokyo, Japan.
⁶ Division of Virology, Institute of Medical Science, University of Tokyo, Tokyo, Japan; Pandemic Preparedness, Infection and Advanced Research Center, The University of Tokyo, Tokyo, Japan; Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA.

PMID: 38242284
DOI: 10.1016/j.jiac.2024.01.008

Abstract

The management of persistent symptomatic coronavirus disease 2019 (COVID-19) infections in immunocompromised patients remains unclear. Here, we present the first case of successful antiviral therapy (nirmatrelvir/ritonavir and remdesivir) in combination with intravenous immunoglobulin (IVIg) in a patient who had received CD20 depleting therapy for follicular lymphoma and experienced recurrent COVID-19 relapses. After the patient received IVIg treatment, the viral load decreased without recurrence. Subsequently, it was found that the anti-spike antibody titer in the administered immunoglobulin was high at 9528.0 binding antibody units/mL. Our case highlights the potential of combination therapy with selective IVIg and antiviral drugs for relapsed immunocompromised COVID-19 patients who have received CD20 depleting therapy.

Keywords: CH 1.1; COVID-19; Immunocompromised host; Immunoglobulin; SARS-CoV-2.

Copyright © 2024 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.

Publication types

Case Reports

MeSH terms

Adenosine Monophosphate* / administration & dosage
Adenosine Monophosphate* / analogs & derivatives
Adenosine Monophosphate* / therapeutic use
Alanine* / analogs & derivatives
Alanine* / therapeutic use
Antibodies, Monoclonal, Humanized
Antigens, CD20 / immunology
Antiviral Agents* / therapeutic use
COVID-19 Drug Treatment*
COVID-19* / immunology
Drug Therapy, Combination / methods
Humans
Immunocompromised Host*
Immunoglobulins, Intravenous* / therapeutic use
Lymphoma, Follicular* / drug therapy
Lymphoma, Follicular* / immunology
Male
Middle Aged
Ritonavir* / therapeutic use
Rituximab / administration & dosage
Rituximab / therapeutic use
SARS-CoV-2* / immunology
Treatment Outcome
Viral Load / drug effects

Substances

remdesivir
Alanine
Adenosine Monophosphate
Ritonavir
Antiviral Agents
Immunoglobulins, Intravenous
Antigens, CD20
obinutuzumab
Rituximab
Antibodies, Monoclonal, Humanized