Early Use of Sotrovimab in Children: A Case Report of an 11-Year-Old Kidney Transplant Recipient Infected with SARS-CoV-2

Abstract

Background: The use of virus-neutralizing monoclonal antibodies has been approved in fragile populations, including kidney transplant recipients, who are at risk of developing severe COVID-19. Sotrovimab is the only currently available anti-SARS-CoV-2 neutralizing monoclonal antibody with activity against the new Omicron variant of concern. While sotrovimab has been approved in adolescents and adults, studies regarding its efficacy and safety in children aged less than 12 years old and weighing less than 40 kg are still lacking. Here, we report a first case of a child, who was treated early with sotrovimab after a kidney transplant. Case Report: At the end of January 2022, a 11-year-old male child underwent a deceased-donor kidney transplant and became infected with SARS-CoV-2 during the first day after surgery. Due to the increased risk of developing severe COVID-19, based on the predominance of Omicron and the patient’s renal function, the child was treated with sotrovimab. The clinical course was successful and no adverse reactions were reported. Conclusions: For the first time, we report the well-tolerated use of sotrovimab in children under 12 years old. As the pandemic affects children across the globe, urgent data on sotrovimab dosing in children with a higher risk of developing severe COVID-19 are needed.

Early Treatments of Fragile Children with COVID-19—Results of CLEVER (Children COVID Early Treatment), a Retrospective, Observational Study

“…This background may have supported the use of other MAbs in children, even off-label and without well-established safety data [ 20 ]. Among available evidence, data from a recent study by Romani et al already reported the safety of MAbs in children at high risk of developing severe COVID-19, along with a case report on the use of sotrovimab in patients under 12 years [ 21 , 22 ].…”

Prevention and treatment strategies for kidney transplant recipients in the context of long-term existence of COVID-19

“…Although sotrovimab has been approved for adolescents and adults, its effectiveness and safety in KTRs under 12 years of age are unclear. Chiara et al ( 39 ) described the case of an 11-year-old male KTR who got COVID-19 after a kidney transplant. Due to the patient’s kidney function, sotrovimab was administered, and the treatment was deemed successful without adverse effects.…”

Monoclonal antibodies for the early treatment of paediatric COVID-19 patients: a tangible contribution from hospital pharmacists in the lack of evidence

“…This re-adaptation was first applied to treat an 11 year old transplant recipient with sotrovimab, and it has been demonstrated as successful on both effectiveness and safety profiles 5…”