Monoclonal antibodies to treat COVID-19 in rheumatoid arthritis: A case report and a clinical appraisal of selected drug trials

Abstract

The current report describes successful treatment of a rapidly progressive severe breakthrough COVID-19 in a female physician, a known case of rheumatoid arthritis (RA). She received monoclonal antibody (Mab) combination cocktail (Casirivimab™ plus Imdevimab™) infusion on day 4 after the onset of symptoms. RA was in prolonged remission with tofacitinib. She had completed vaccination 6 weeks earlier and worked in a COVID hospital. Post infusion, there was substantial improvement, and she was discharged after 3 days. However, she required intermittent domiciliary oxygen for a fortnight. Fatigue and ageusia persisted for 5 weeks. Several Mabs were recently approved for emergency use in mild-to-moderate ambulant COVID-19 patients. Controlled drug trials confirmed excellent efficacy and safety. Selected data on clinical relevance and limitations are currently described. RA is susceptible to COVID-19, and some vaccines may be less effective. Intervention with Mabs ought to be judicious and timely.

Keywords

• breakthrough infections
• covid-19
• monoclonal antibodies
• rheumatoid arthritis
• vaccination