Frontiers in Medicine (Aug 2022)

Neutralizing monoclonal antibodies against SARS-CoV-2 for COVID-19 pneumonia in a rituximab treated patient with systemic sclerosis—A case report and literature review

  • Melek Yalcin Mutlu,
  • Melek Yalcin Mutlu,
  • Jule Taubmann,
  • Jule Taubmann,
  • Jochen Wacker,
  • Jochen Wacker,
  • Koray Tascilar,
  • Koray Tascilar,
  • Filippo Fagni,
  • Filippo Fagni,
  • Maximilian Gerner,
  • Maximilian Gerner,
  • Daniel Klett,
  • Daniel Klett,
  • Georg Schett,
  • Georg Schett,
  • Bernhard Manger,
  • Bernhard Manger,
  • David Simon,
  • David Simon

DOI
https://doi.org/10.3389/fmed.2022.934169
Journal volume & issue
Vol. 9

Abstract

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Patients with immune-mediated diseases (IMID) such as systemic sclerosis (SSc), who are treated with B cell depleting treatments, are at risk for developing severe COVID-19 due to inadequate humoral immune response. During B cell depletion, therapeutic substitution of neutralizing monoclonal antibodies against the SARS-CoV-2 spike protein (mAbs) might be helpful to prevent severe COVID-19. It has been shown, that in non-IMID patients mABs reduce SARS-CoV-2 viral load and lower the risk of COVID-19 associated hospitalization or death. However, there are limited data on the effect of mAbs in IMID patients after exposure, especially in patients treated with B cell depleting agents. Herein, we report a case of a rituximab treated SSc patient who developed COVID-19 and was successfully treated with a combination of mAbs (casirivimab/imdevimab). With this case we show that IMID patients may benefit from post-exposure administration of mAbs. In our case treatment with neutralizing autoantibodies was safe and a possible contributor in protecting the patient from mechanical ventilation and eventually death. We frame this case within the current evidence from the literature and provide a perspective on the future potential role of mAbs for treating IMID patients suffering from COVID-19.

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