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

Federico Baldi; Chiara Dentone; Malgorzata Mikulska; Daniela Fenoglio; Michele Mirabella; Federica Magnè; Federica Portunato; Tiziana Altosole; Chiara Sepulcri; Daniele Roberto Giacobbe; Chiara Uras; Graziana Scavone; Lucia Taramasso; Andrea Orsi; Giuseppe Cittadini; Gilberto Filaci; Matteo Bassetti

doi:10.3389/fmed.2022.1062450

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

Front Med (Lausanne). 2023 Jan 9:9:1062450. doi: 10.3389/fmed.2022.1062450. eCollection 2022.

Authors

Federico Baldi^{1

2}, Chiara Dentone², Malgorzata Mikulska^{1

2}, Daniela Fenoglio^{3

4}, Michele Mirabella², Federica Magnè², Federica Portunato², Tiziana Altosole³, Chiara Sepulcri^{1

2}, Daniele Roberto Giacobbe^{1

2}, Chiara Uras³, Graziana Scavone⁴, Lucia Taramasso², Andrea Orsi^{1

5}, Giuseppe Cittadini⁶, Gilberto Filaci^{3

4}, Matteo Bassetti^{1

2}

Affiliations

¹ Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
² Infectious Diseases Unit, Polyclinic San Martino Hospital (IRCCS), Genoa, Italy.
³ Department of Internal Medicine, Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy.
⁴ Biotherapy Unit, Polyclinic San Martino Hospital (IRCCS), Genoa, Italy.
⁵ Hygiene Unit, Polyclinic San Martino Hospital (IRCCS), Genoa, Italy.
⁶ General Radiology, Polyclinic San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.

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.

Publication types

Case Reports