First Case of COVID-19 Treated with Monoclonal Anti-Spike Antibodies in a Patient with Cystic Fibrosis in Romania

Abstract

Patients with chronic lung conditions, including cystic fibrosis, may be prone to severe COVID-19. Therefore, therapeutic intervention should be prompt and tailored to all associated comorbidities. We report the case of a 17-year-old male adolescent with cystic fibrosis and multiple chronic conditions (bronchiectasis, exocrine pancreatic insufficiency, chronic multidrug resistant Pseudomonas aeruginosa colonization, nasal polyposis, chronic sinusitis, ventricular extrasystoles and multiple drug allergies), who presented with an acute episode of productive cough, and was confirmed with moderate COVID-19 based on positive RT-PCR for SARS-CoV-2 and lung imaging showing isolated foci of interstitial pneumonia. Intravenous treatment with the monoclonal antibody cocktail casirivimab and imdevimab was administered. The evolution was favorable, with rapid remission of the inflammatory syndrome and gradual decrease of cough, without progression to severe or critical COVID-19, but with complications such as repeated hemoptysis, which was due to the patient’s underlying conditions, and which required close monitoring for timely adjustment of the patient’s chronic treatment.

Epidemiological Profile of Hospitalized Patients with Cystic Fibrosis in Brazil Due to Severe Acute Respiratory Infection during the COVID-19 Pandemic and a Systematic Review of Worldwide COVID-19 in Those with Cystic Fibrosis

“…A total of 31 papers published as observational studies reported an association of COVID-19 in patients with CF [ 18 , 19 , 20 , 21 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ] ( Table 1 ). These studies comprised 661,386 patients in total, including children, adults, and elderly age groups.…”

“…However, only 19,150 (2.9%) patients were diagnosed with CF and, from these patients, 2523 (0.4%) were diagnosed with both CF and COVID-19. Regarding patients with CF and COVID-19, the sex proportion was (female/male) 1207/1167 [ 24 , 25 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 41 , 42 , 43 , 45 , 47 , 48 , 49 , 50 ]. Some publications [ 21 , 26 , 35 , 40 , 46 ] did not report the sex of the patients.…”

“…Regarding the CFTR genotype, the most common pathogenic variant was the p.Phe508del. In the studies, 623 patients were p.Phe580del heterozygous, then 486 patients were p.Phe580del homozygous, and, also, 496 patients presented other pathogenic variants [ 19 , 20 , 21 , 25 , 30 , 31 , 33 , 34 , 38 , 39 , 40 , 41 , 45 , 47 , 48 , 49 , 50 ]. A total of 300 patients with CF were lung transplanted; the remaining individuals were non-transplanted patients or did not have their organ transplantation specified [ 18 , 20 , 21 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 49 , 50 ].…”

Seroprevalence of SARS-CoV-2 IgG in people with cystic fibrosis

“…antigen presenting cells, lymphocytes, myeloid cells, etc. ), it does represent an arm of the complex protection system so heavily relied upon in this pandemic; and, indeed, infusion of spike Ab (casirivimab, imdevimab, regdanvimab) only has proven effective treatment for people with CF [ 29 ]. Our data show persistent IgG after vaccination or natural infection in pwCF is detectable for up to 13 months.…”

Therapeutic developments for SARS-CoV-2 infection—Molecular mechanisms of action of antivirals and strategies for mitigating resistance in emerging variants in clinical practice

“…To reduce the burden on the hospitals, outpatient departments, also called "infusion clinics," as well as mobile units were created (Ton et al, 2021;Tulledge-Scheitel et al, 2021). Here, patients at high-risk for progression to severe COVID-19 were treated with NAbs as early as possible after symptom onset, with good clinical response and lower rates of hospitalization or requirement for supplemental oxygen (Al-Obaidi et al, 2022;Kwak et al, 2022;Stan et al, 2022). At that point in the pandemic, antivirals were considered "rescue therapy" and used only in cases where NAbs had either not been administered, or in cases of progression to pneumonia despite NAb treatment.…”