Successful management of persistent COVID-19 using combination antiviral therapy (nirmatrelvir/ritonavir and remdesivir) and intravenous immunoglobulin transfusion in an immunocompromised host who had received CD20 depleting therapy for follicular lymphoma

Taketomo Maruki; Hidetoshi Nomoto; Noriko Iwamoto; Kei Yamamoto; Masami Kurokawa; Kiyoko Iwatsuki-Horimoto; Seiya Yamayoshi; Yutaka Suzuki; Yoshihiro Kawaoka; Norio Ohmagari

doi:10.1016/j.jiac.2024.01.008

Successful management of persistent COVID-19 using combination antiviral therapy (nirmatrelvir/ritonavir and remdesivir) and intravenous immunoglobulin transfusion in an immunocompromised host who had received CD20 depleting therapy for follicular lymphoma

J Infect Chemother. 2024 Jan 17:S1341-321X(24)00012-6. doi: 10.1016/j.jiac.2024.01.008. Online ahead of print.

Affiliations

¹ Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
² Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan. Electronic address: hnomoto@hosp.ncgm.go.jp.
³ Laboratory Testing Department, National Center for Global Health and Medicine, Tokyo, Japan.
⁴ Division of Virology, Institute of Medical Science, University of Tokyo, Tokyo, Japan.
⁵ Department of Computational Biology and Medical Sciences, The University of Tokyo, Tokyo, Japan.
⁶ Division of Virology, Institute of Medical Science, University of Tokyo, Tokyo, Japan; Pandemic Preparedness, Infection and Advanced Research Center, The University of Tokyo, Tokyo, Japan; Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA.

PMID: 38242284
DOI: 10.1016/j.jiac.2024.01.008

Abstract

The management of persistent symptomatic coronavirus disease 2019 (COVID-19) infections in immunocompromised patients remains unclear. Here, we present the first case of successful antiviral therapy (nirmatrelvir/ritonavir and remdesivir) in combination with intravenous immunoglobulin (IVIg) in a patient who had received CD20 depleting therapy for follicular lymphoma and experienced recurrent COVID-19 relapses. After the patient received IVIg treatment, the viral load decreased without recurrence. Subsequently, it was found that the anti-spike antibody titer in the administered immunoglobulin was high at 9528.0 binding antibody units/mL. Our case highlights the potential of combination therapy with selective IVIg and antiviral drugs for relapsed immunocompromised COVID-19 patients who have received CD20 depleting therapy.

Keywords: CH 1.1; COVID-19; Immunocompromised host; Immunoglobulin; SARS-CoV-2.

Copyright © 2024 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.

Publication types

Case Reports