Antiviral combination treatment of SARS-CoV-2 after repeated treatment failures of remdesivir monotherapy: A case report
Anne Cathrine Bay,
Michael R. Clausen,
Birgit Thorup Røge,
Thomas V. Sydenham,
Kat Steinke,
Rune Micha Pedersen,
Line L. Bang,
Thomas E. Andersen,
Anders Jensen,
Lone W. Madsen
Affiliations
Anne Cathrine Bay
Department of Internal Medicine, Kolding Hospital, Kolding, Denmark
Michael R. Clausen
Department of Hematology, Vejle Hospital, Vejle, Denmark
Birgit Thorup Røge
Department of Internal Medicine, Kolding Hospital, Kolding, Denmark
Thomas V. Sydenham
Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit for Clinical Microbiology, University of Southern Denmark, Odense, Denmark
Kat Steinke
Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit for Clinical Microbiology, University of Southern Denmark, Odense, Denmark
Rune Micha Pedersen
Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit for Clinical Microbiology, University of Southern Denmark, Odense, Denmark
Line L. Bang
Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit for Clinical Microbiology, University of Southern Denmark, Odense, Denmark
Thomas E. Andersen
Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit for Clinical Microbiology, University of Southern Denmark, Odense, Denmark
Anders Jensen
Department of Clinical Microbiology, Vejle Hospital, Vejle, Denmark
Lone W. Madsen
Department of Internal Medicine, Kolding Hospital, Kolding, Denmark; Department of Infectious Diseases, Odense University Hospital, Odense, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark; Correspondence to: Department of Internal Medicine, Kolding Hospital, Sygehusvej 24, 6000 Kolding, Denmark.
Immunocompromised patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can have a longer duration of viral shedding and persistence of symptoms. The optimal treatment strategy for these patients remains to be established. This case describes a male in his late sixties with follicular lymphoma and persistent symptoms of infection with SARS-CoV-2 variant BA.2 who was treated with remdesivir five times over a period of six months. The clinical effect of remdesivir treatment decreased over time, and further viral sequencing revealed the emergence of mutations across the SARS-CoV-2 genome. Due to the lack of other treatment options, the patient was treated with a combination of remdesivir and molnupiravir for 10 days, and epcoritamab was discontinued, which led to the cessation of symptoms. This case illustrates the risk of a diminished effect of remdesivir with prolonged use and the need for treatment guidelines for immunocompromised patients with persistent COVID-19.
