Successful treatment of severe COVID-19 pneumonia with clazakizumab in a heart transplant recipient: case report

Autor: R. Zabner, Jignesh Patel, Anuja Shikhare, Michelle M. Kittleson, Stanley C. Jordan, Hai Tran, Noriko Ammerman, David Chang, Gaurang Vaidya, Lawrence S.C. Czer, Ashley Vo, Jon A. Kobashigawa, Edmund Huang, Evan P. Kransdorf
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
CRP
C reactive protein
NYU
New York University
medicine.medical_treatment
uL
microliter
coronavirus
F
Fahrenheit
mg
milligram
mycophenolate mofetil
ng: nanogram
chemistry.chemical_compound
PCR
polymerase chain reaction
LVEF
left ventricular ejection fraction
pg
picogram
Respiratory system
COVID-19
coronavirus disease 2019
Heart transplantation
Leukopenia
Ejection fraction
Hg
mercury
Antibodies
Monoclonal
dL
deciliter
Middle Aged
IL-6
interleukin 6
Monoclonal
cytokine storm
mm: millimeter
MMF
Heart transplant
medicine.symptom
Coronavirus Infections
WBC
white blood cell
mcg
microgram
medicine.medical_specialty
ATP
adenosine triphosphate
HTx
heart transplant
Pneumonia
Viral
Antibodies
Monoclonal
Humanized
Article
Betacoronavirus
Immunocompromised Host
Tocilizumab
Internal medicine
BID
twice daily
L
liter
medicine
Humans
SARS
severe acute respiratory syndrome
Pandemics
Transplantation
business.industry
SARS-CoV-2
interleukin-6
clazakizumab
COVID-19
SARS-CoV-2
SARS coronavirus 2
qPM
each evening
medicine.disease
Receptors
Interleukin-6
FDA
Food and Drug Administration
COVID-19 Drug Treatment
Clinical trial
Pneumonia
chemistry
g
gram
U
unit
Surgery
qAM
each morning
business
Zdroj: Transplantation Proceedings
ISSN: 1873-2623
0041-1345
Popis: Background Severe Acute Respiratory Syndrome caused by coronavirus 2 (SARS-CoV-2) is characterized by an overwhelming cytokine response. Various treatment strategies have been attempted. Methods and Results A 61-year-old male with heart transplantation in 2017 presented with fever, cough, and dyspnea, and confirmed positive for the SARS-CoV-2 disease (COVID-19). Laboratory tests showed significant elevations in C-reactive protein and interleukin-6 (IL-6). Echocardiogram showed LVEF 58% (with EF 57% 6 months prior). Given the lack of clear management guidelines, the patient was initially managed symptomatically. However, the patient subsequently had a rapid respiratory deterioration with worsening inflammatory markers on day 5 of admission. Tocilizumab (anti-IL-6R) was in low supply in the hospital. The patient was offered clazakizumab (anti-IL-6) for compassionate use. Patient received 25 mg intravenously x1 dose. Within 24 hours, he noted significant improvement in symptoms, oxygen requirements, radiological findings and inflammatory markers. There was a transient leukopenia which improved in 4 days. He was discharged home on day 11, with negative nasopharyngeal SARS-CoV-2 PCR as an outpatient on day 35, development of positive serum COVID-19 IgG antibody, and he continued to do well on day 60, with no heart-related symptoms. Conclusion Clazakizumab is a monoclonal antibody against human IL-6, which may be helpful in inhibiting the cytokine response to SARS-CoV-2 in COVID-19. Although not yet FDA approved, it is being investigated for treatment of renal antibody-mediated rejection. Clinical trials of clazakizumab for treatment of COVID-19 are underway worldwide.
Highlights • Severe Acute Respiratory Syndrome caused by coronavirus 2 (SARS-CoV-2) is characterized by an overwhelming cytokine response. • A 61-year-old male with heart transplantation in 2017 presented with fever, cough, and dyspnea, and confirmed positive for the SARS-CoV-2 disease (COVID-19). Laboratory tests showed significant elevations in C-reactive protein, interleukin-6 (IL-6), and other inflammatory markers. Echocardiogram showed normal LV function. • The patient received clazakizumab (anti-IL-6 monoclonal antibody) 25 mg as a single dose, with significant improvement in symptoms, oxygen requirements, radiological findings and inflammatory markers within 24 hours, and discharge to home on day 11. He had a negative nasopharyngeal SARS-CoV-2 PCR as an outpatient on day 35, developed a positive serum COVID-19 IgG antibody, and was continuing to do well clinically on day 60. • Clazakizumab is a monoclonal antibody against human IL-6, which may be helpful in inhibiting the cytokine response to SARS-CoV-2 in COVID-19.
Databáze: OpenAIRE
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