Table 1 Patient characteristics receiving sotrovimab for treatment of mild to moderate COVID-19 infection
From: Monoclonal antibody treatment of COVID-19 in a pregnant woman with common variable immunodeficiency
Identification | Medical history | Immunodeficiency history and treatment | Clinical presentation | Indication for monoclonal antibody treatment | Dose/route/frequency | Clinical effects |
|---|---|---|---|---|---|---|
31-year-old 24 weeks pregnant G3P2 woman | • CVID • Inguinal hernia repair • Appendectomy • Right inguinal lymphadenitis | • Diagnosed at the age of 9 in the context of recurrent sinopulmonary infections • Initial blood work at time of diagnosis: - IgG 5.1 (ref 5.7–14.7 g/L) - IgA < 0.1 (ref 0.3–3.1 g/L) - IgM 0.4 (ref 0.3–2.1 g/L) - IgG1 = 4.18 g/L (ref 3.82–9.29 g/L) - IgG2 = 0.10 g/L (2.42–7.00 g/L) - IgG3 = 0.20 g/L (0.22–1.76 g/) - IgG4 = undetectable (0.039–0.864 g/L) - Measles virus IgG – reactive - Mumps virus IgG – non-reactive - Rubella virus IgG – reactive •Repeat immunization with MMR vaccine at time of diagnosis: - Measles virus IgG by EIA – positive - Mumps virus IgG by EIA – negative - Rubella virus IgG by EIA – negative • Initially on IVIG until age of 17, but switched to ScIg due to flu-like side-effects encountered with IVIG Had an adverse reaction with ScIg with syncope and seizure-like activity • Due to compliance issues and concern about developing side-effects she could not revert back to IVIG at the time • Restarted on ScIg in August 2020, cutaquig 10 g (0.14 g/kg) subQ qweekly, ↑to 12 g (0.15 g/kg) subQ qweekly in December 2021 due to weight gain in pregnancy • Blood work prior to stating ScIg in March 2020: - IgG 3.91 g/L (ref 6–16 g/L), - IgA < 0.1 g/L (ref 0.54–4.17 g/L) - IgM 0.35 g/L (ref 0.30–2.30 g/L) • Blood work from November 2021 - IgG 7.03 g/L (ref 6–16 g/L), - IgA < 0.10 g/L (ref 0.54–4.17 g/L) - IgM 0.25 g/L (ref 0.30–2.30 g/L) • Blood work from February 2022 (post sotrovimab treatment): - IgG 6.77 g/L (ref 6–16 g/L), - IgA < 0.10 g/L (ref 0.54–4.17 g/L) - IgM 0.23 g/L (ref 0.30–2.30 g/L) | • She presented January 18, 2022 to the ED with a two-day history of pharyngitis that progressed to include nasal and chest congestion, non-productive cough and shortness of breath. • She was diagnosed with COVID-19 confirmed with PCR testing | • ≥ 12 years of age with mild to moderate symptomatic COVID-19 on a background of IEI • Consideration given pregnant | • She received a single dose of sotrovimab 500 mg IV over one hour on the same date of testing positive for SARS-CoV-2 | • Post treatment her symptoms did not progress • Symptoms of pharyngitis, nasal and chest congestion, and non-productive cough resolved within two days post treatment • Shortness of breath resolved after three days post treatment • She did not require hospitalization • She went on to have an uneventful pregnancy months later at 37 weeks |