Mild Clinical Course of COVID-19 in 3 Patients Receiving Therapeutic Monoclonal Antibodies Targeting C5 Complement for Hematologic Disorders

• Published in: The American journal of case reports 2020-09, Vol.21, p.e927418-e927418
• Main Authors: Araten, David J, Belmont, H Michael, Schaefer-Cutillo, Julia, Iyengar, Arjun, Mattoo, Aprajita, Reddy, Ramachandra
• Format: Article
• Language: English
• Subjects: Adult; Antibodies, Monoclonal, Humanized - therapeutic use; Betacoronavirus; Complement C5 - drug effects; Complement C5 - immunology; Complement C5 - metabolism; Complement Inactivating Agents - therapeutic use; Coronavirus Infections - complications; Coronavirus Infections - epidemiology; COVID-19; Female; Hemoglobinuria, Paroxysmal - complications; Hemoglobinuria, Paroxysmal - drug therapy; Hemoglobinuria, Paroxysmal - immunology; Humans; Middle Aged; Pandemics; Pneumonia, Viral - complications; Pneumonia, Viral - epidemiology; SARS-CoV-2; Thrombotic Microangiopathies - complications; Thrombotic Microangiopathies - drug therapy; Thrombotic Microangiopathies - immunology
• ISSN: 1941-5923; 1941-5923
• DOI: 10.12659/AJCR.927418

BACKGROUND Patients receiving immunosuppressive therapies might be more susceptible to COVID-19. Conversely, an exaggerated inflammatory response to the SARS-CoV-2 infection might be blunted by certain forms of immunosuppression, which could be protective. Indeed, there are data from animal models demonstrating that complement may be a part of the pathophysiology of coronavirus infections. There is also evidence from an autopsy series demonstrating complement deposition in the lungs of patients with COVID-19. This raises the question of whether patients on anti-complement therapy could be protected from COVID-19. CASE REPORT Case 1 is a 39-year-old woman with an approximately 20-year history of paroxysmal nocturnal hemoglobinuria (PNH), who had recently been switched from treatment with eculizumab to ravulizumab prior to SARS-CoV-2 infection. Case 2 is a 54-year-old woman with a cadaveric renal transplant for lupus nephritis, complicated by thrombotic microangiopathy, who was maintained on eculizumab, which she started several months before she developed the SARS-CoV-2 infection. Case 3 is a 60-year-old woman with a 14-year history of PNH, who had been treated with eculizumab since 2012, and was diagnosed with COVID-19 at the time of her scheduled infusion. All 3 patients had a relatively mild course of COVID-19. CONCLUSIONS We see no evidence of increased susceptibility to SARS-CoV-2 in these patients on anti-complement therapy, which might actually have accounted for the mild course of infection. The effect of anti-complement therapy on COVID-19 disease needs to be determined in clinical trials.