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Treatment of chronic or relapsing COVID-19 in immunodeficiency
- Source :
- The Journal of Allergy and Clinical Immunology
- Publication Year :
- 2021
- Publisher :
- Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology., 2021.
-
Abstract
- 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.Our aim was to characterize a cohort of patients with chronic or relapsing COVID-19 disease and record treatment response.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.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.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.
- Subjects :
- Adult
Male
medicine.medical_specialty
Recombinant Fusion Proteins
Immunology
Population
X-linked agammaglobulinemia
remdesivir
Disease
Antiviral Agents
Article
Recurrence
Internal medicine
medicine
Immunology and Allergy
Humans
Lymphocyte Count
Treatment Failure
education
Immunodeficiency
COVID-19 Serotherapy
Aged
Aged, 80 and over
education.field_of_study
B-Lymphocytes
Alanine
biology
business.industry
SARS-CoV-2
Common variable immunodeficiency
C-reactive protein
Immunization, Passive
Immunologic Deficiency Syndromes
Antibodies, Monoclonal
COVID-19
therapeutic monoclonal
Middle Aged
medicine.disease
Adenosine Monophosphate
Cohort
Chronic Disease
biology.protein
Female
Antibody
business
immunodeficiency
Subjects
Details
- Language :
- English
- ISSN :
- 10976825 and 00916749
- Database :
- OpenAIRE
- Journal :
- The Journal of Allergy and Clinical Immunology
- Accession number :
- edsair.doi.dedup.....9449abb2d35d1eb28d128161379312cf