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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, Patel, Aisha, Jenkins, Megan, Robbins, Alexander, Khan, Sujoy, Simpson, Thomas, Jolles, Stephen, Underwood, Jonathan ORCID:, Savic, Sinisa, Richter, Alex, Shields, Adrian, Brown, Michael and Lowe, David M. 2022. Treatment of chronic or relapsing COVID-19 in immunodeficiency. Journal of Allergy and Clinical Immunology 149 (2) , pp. 557-561. 10.1016/j.jaci.2021.10.031

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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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Elsevier
ISSN: 0091-6749
Date of Acceptance: 22 October 2021
Last Modified: 29 Nov 2022 10:08

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