PROLONGED COVID-19 IN PATIENTS TREATED WITH RITUXIMAB

Abstract

TOPIC: Chest Infections TYPE: Fellow Case Reports INTRODUCTION: Patients with COVID-19 who have been prescribed rituximab prior to SARS-CoV-2 infection may be susceptible to an alternative disease course compared to the general population. These patients can develop chronic fatigue, dyspnea, fevers, and persistent radiographic abnormalities after appearing to convalesce from their index infection. CASE PRESENTATION: We report a case series of 3 patients with prolonged COVID-19 infections who had received rituximab prior to their index SARS-CoV-2 infection. They were all successfully treated with a combination of remdesivir and antibody therapy. This report demonstrates and replicates successful application of anti-viral therapy with remdesivir, and the provision of convalescent plasma/monoclonal antibodies to thwart B-cell depletion to treat patients with prolonged COVID-19 symptoms. DISCUSSION: Rituximab can cause B-cell depletion, impairment in humoral immunity, and delayed viral clearance with persistent viremia. Intact humoral and innate immunity appear necessary to eradicate SARS-CoV-2 in some individuals being treated with rituximab. The American Society of Hematology reports on 17 B-cell depleted patients with prolonged COVID-19 who were treated with convalescent plasma. All but 1 patient had symptom improvement within 48 hours. These findings support our experience and suggest that combination antiviral and antibody therapy is a promising treatment strategy. The reporting of successful and safe treatment strategies are crucial to guide clinicians as it is unlikely that there will be large, randomized control trials examining optimal therapeutic strategies for patients with a lack of humoral protection. CONCLUSIONS: Patients with COVID-19 who had been prescribed rituximab prior to infection may be susceptible to chronic symptoms with persistent radiographic features. Combination antiviral and antibody therapy is a promising treatment strategy in this cohort. REFERENCE #1: Hueso T, Pouderoux C, Pere H, et al. Convalescent plasma therapy for B-cell-depleted patients with protracted COVID-19. Blood 2020;136:2290-5 REFERENCE #2: Helleberg M, Niemann CU, Moestrup KS, et al. Persistent COVID-19 in an Immunocompromised Patient Temporarily Responsive to Two Courses of Remdesivir Therapy. J Infect Dis 2020;222:1103-7 DISCLOSURES: No relevant relationships by Rachel Aviv, source=Web Response No relevant relationships by Effie Singas, source=Admin input No relevant relationships by Andrew Weber, source=Web Response