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Case Reports
. 2023 Jan 9:9:1062450.
doi: 10.3389/fmed.2022.1062450. eCollection 2022.

Case report: Sotrovimab, remdesivir and nirmatrelvir/ritonavir combination as salvage treatment option in two immunocompromised patients hospitalized for COVID-19

Federico Baldi  1   2 , Chiara Dentone  2 , Malgorzata Mikulska  1   2 , Daniela Fenoglio  3   4 , Michele Mirabella  2 , Federica Magnè  2 , Federica Portunato  2 , Tiziana Altosole  3 , Chiara Sepulcri  1   2 , Daniele Roberto Giacobbe  1   2 , Chiara Uras  3 , Graziana Scavone  4 , Lucia Taramasso  2 , Andrea Orsi  1   5 , Giuseppe Cittadini  6 , Gilberto Filaci  3   4 , Matteo Bassetti  1   2
Affiliations
Case Reports

Case report: Sotrovimab, remdesivir and nirmatrelvir/ritonavir combination as salvage treatment option in two immunocompromised patients hospitalized for COVID-19

Federico Baldi et al. Front Med (Lausanne). .

Abstract

COVID-19 in immunocompromised patients is difficult to treat. SARS-CoV-2 interaction with the host immune system and the role of therapy still remains only partly understood. There are no data regarding the use of monoclonal antibodies and the combination of two antivirals in fighting viral replication and disease progression. We report the cases of two patients, both treated with rituximab for non-Hodgkin lymphoma and granulomatosis with polyangiitis, respectively, and both hospitalized for COVID-19 with positive SARS-CoV-2 RNAemia, who were successfully treated with a salvage combination therapy with sotrovimab, remdesivir and nirmatrelvir/ritonavir.

Keywords: COVID-19; immunocompromised; monoclonal antibodies; nirmatrelvir/ritonavir; remdesivir; salvage therapy; sotrovimab.

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Conflict of interest statement

Outside the submitted work, DG reports investigator-initiated grants from Pfizer, Shionogi, and Gilead Italia and speaker fees and/or advisor fees from Pfizer and Tillotts Pharma. Outside the submitted work, MB reports research grants and/or personal fees for advisor/consultant and/or speaker/chairman from Bayer, BioMérieux, Cidara, Cipla, Gilead, Menarini, MSD, Pfizer, and Shionogi. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
(A) Bilateral ground-glass opacities with crazy-paving aspects and more consolidated components, greater at right lower lobe. (B) Extension of pulmonary opacities at the left basal lobe compared to the previous imaging.
FIGURE 2
FIGURE 2
(A) Interstitial pneumonia with peripheral small nodules. Postero-basal and para-scissural opacities. (B) Ground-glass opacities at the bases of the upper lobes dorsally, with partial periscissural consolidative area. Moderate bilateral pleural effusion with associated disventilatory area.
FIGURE 3
FIGURE 3
Immunofluorescence analyses of two patients with RT-PCR SARS-CoV-2 positive viremia and bronchoalveolar lavage fluid. (A,B) Representative examples of CD4+ and CD8+ T subset percentages on peripheral CD3+ T cells derived from before and after therapies (A) and frequency of circulating CD4+ Treg (CD4 + FoxP3 + CD25 +) on circulating CD4+ T population derived from before and after therapies (B). (C–G) Multidimensional data reduction analysis. t-SNE analysis of maturation, senescence, exhaustion, effector and activation markers of circulating CD4+ and CD8+ T cells on merged samples derived before (red clusters) and after (bleu clusters) therapies. In particular: the analysis of maturation and exhaustion marker expression in CD4+ (C) and CD8+ (D) T subsets; the analysis of maturation, senescence and granzyme effector molecule in CD8+ T cells (E); the evaluation of cycling cells by ki-67 marker in CD8+ (F) and CD4+ (G) T subsets.
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