1. Successful treatment of severe COVID-19 pneumonia with clazakizumab in a heart transplant recipient: case report
- Author
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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, and Evan P. Kransdorf
- Subjects
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 - Abstract
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.
- Published
- 2020