tetano
Editor, Senior Moderator
Transplant Proc
. 2020 Jun 7;S0041-1345(20)32575-6.
doi: 10.1016/j.transproceed.2020.06.003. Online ahead of print.
Successful Treatment of Severe COVID-19 Pneumonia With Clazakizumab in a Heart Transplant Recipient: A Case Report
Gaurang Vaidya[SUP] 1 [/SUP], Lawrence S C Czer[SUP] 2 [/SUP], Jon Kobashigawa[SUP] 1 [/SUP], Michelle Kittleson[SUP] 1 [/SUP], Jignesh Patel[SUP] 1 [/SUP], David Chang[SUP] 1 [/SUP], Evan Kransdorf[SUP] 1 [/SUP], Anuja Shikhare[SUP] 3 [/SUP], Hai Tran[SUP] 4 [/SUP], Ashley Vo[SUP] 5 [/SUP], Noriko Ammerman[SUP] 5 [/SUP], Edmund Huang[SUP] 5 [/SUP], Rachel Zabner[SUP] 6 [/SUP], Stanley Jordan[SUP] 5 [/SUP]
Affiliations
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is characterized by an overwhelming cytokine response. Various treatment strategies have been attempted.
Methods and results: A 61-year-old man with heart transplantation in 2017 presented with fever, cough, and dyspnea, and was confirmed positive for coronavirus disease 2019 (COVID-19). Laboratory tests showed significant elevations in C-reactive protein and interleukin-6 (IL-6). Echocardiogram showed left ventricular ejection fraction 58% (with ejection fraction 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 ? 1 dose. Within 24 hours, he showed significant improvement in symptoms, oxygen requirements, radiological findings, and inflammatory markers. There was a transient leukopenia that 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.
. 2020 Jun 7;S0041-1345(20)32575-6.
doi: 10.1016/j.transproceed.2020.06.003. Online ahead of print.
Successful Treatment of Severe COVID-19 Pneumonia With Clazakizumab in a Heart Transplant Recipient: A Case Report
Gaurang Vaidya[SUP] 1 [/SUP], Lawrence S C Czer[SUP] 2 [/SUP], Jon Kobashigawa[SUP] 1 [/SUP], Michelle Kittleson[SUP] 1 [/SUP], Jignesh Patel[SUP] 1 [/SUP], David Chang[SUP] 1 [/SUP], Evan Kransdorf[SUP] 1 [/SUP], Anuja Shikhare[SUP] 3 [/SUP], Hai Tran[SUP] 4 [/SUP], Ashley Vo[SUP] 5 [/SUP], Noriko Ammerman[SUP] 5 [/SUP], Edmund Huang[SUP] 5 [/SUP], Rachel Zabner[SUP] 6 [/SUP], Stanley Jordan[SUP] 5 [/SUP]
Affiliations
- PMID: 32563584
- PMCID: PMC7275980
- DOI: 10.1016/j.transproceed.2020.06.003
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is characterized by an overwhelming cytokine response. Various treatment strategies have been attempted.
Methods and results: A 61-year-old man with heart transplantation in 2017 presented with fever, cough, and dyspnea, and was confirmed positive for coronavirus disease 2019 (COVID-19). Laboratory tests showed significant elevations in C-reactive protein and interleukin-6 (IL-6). Echocardiogram showed left ventricular ejection fraction 58% (with ejection fraction 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 ? 1 dose. Within 24 hours, he showed significant improvement in symptoms, oxygen requirements, radiological findings, and inflammatory markers. There was a transient leukopenia that 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.