Coronavirus Disease-2019 in the Immunocompromised Host

Bertini, Christopher D.; Khawaja, Fareed; Sheshadri, Ajay

doi:10.1016/j.ccm.2022.11.012

Cited by 14 publications

(11 citation statements)

References 73 publications

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“…The differences in treatment between patients with and without immunocompromised status are also summarized in Table 1. For more details of the therapeutic management differences, please refer to sections “Therapeutic Management of Nonhospitalized Adults With COVID‐19”, “Therapeutic Management of Hospitalized Adults With COVID‐19” in reference 3, and section “Management of Patients With COVID‐19 Who Are Immunocompromised” in reference 5. For more strategies regarding ICP including prevention of COVID‐19, adjusting chronic immunosuppressive therapies, and therapeutic management of nonhospitalized and hospitalized immunocompromised patients with COVID‐19, please refer to the “Special Considerations in People Who Are Immunocompromised” section of COVID‐19 Treatment Guidelines proposed by COVID‐19 Treatment Guidelines Panel at the U.S. National Institutes of Health 9,11…”

Section: Considerations For Covid‐19 Patients In Immunocompromised Po...mentioning

confidence: 99%

“…About 3% of the population have immunosuppressed conditions, 4 including people with primary immunodeficiencies and secondary immunodeficiencies, consisting of people with solid‐organ transplants, metastatic cancers, hematologic malignancies, advanced or untreated HIV (human immunodeficiency virus) infection, those receiving cancer chemotherapy, and patients with autoimmune diseases receiving immunosuppressive biologics and medications 5 . Patients in this heterogenous group had a higher risk of COVID‐19‐related hospitalization, severe COVID‐19, or death 6 and tend to have higher risk for opportunistic infections 7 .…”

Section: Considerations For Covid‐19 Patients In Immunocompromised Po...mentioning

confidence: 99%

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Unveiling COVID‐19 treatment strategies for immunocompromised individuals: Therapeutic innovations and latest findings

Liu,

Tsai

2024

Int J of Rheum Dis

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In the past 3 years, targets for therapeutics and strategies for prevention against coronavirus disease 2019 (COVID-19) were identified and developed based on the pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and clinical outcomes of infection. Therapeutics for COVID-19 regarding disease time course, symptoms and interventions, different stages of the SARS-CoV-2 lifecycle, and COVID-19-associated immunomodulatory effects were discussed by Toussi et al. 1 Drug treatment of COVID-19 infection regarding mild-to-moderate COVID-19 disease in the outpatient setting, patients hospitalized with mildto-moderate disease, patients hospitalized with the severe and critical disease were recently reviewed by Lui and Guaraldi. 2 EDITO RIA L

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Section: Considerations For Covid‐19 Patients In Immunocompromised Po...mentioning

confidence: 99%

Section: Considerations For Covid‐19 Patients In Immunocompromised Po...mentioning

confidence: 99%

Unveiling COVID‐19 treatment strategies for immunocompromised individuals: Therapeutic innovations and latest findings

Liu,

Tsai

2024

Int J of Rheum Dis

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“…The World Health Organization (WHO) declared the end of the COVID-19 pandemic ( 1 ) on 5 May 2023, but the SARS-CoV-2 infection remains an ongoing problem in certain settings, especially in immunocompromised (IC) patients ( 2 ). These patients, particularly those with hematologic malignancies, are at an increased risk of SARS-CoV-2-associated morbidity and mortality due to the immunologic deficits that limit primary prevention, treatment, and clearance of the virus ( 3 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

B-cell-depleted patients with persistent SARS-CoV-2 infection: combination therapy or monotherapy? A real-world experience

D’Abramo,

Vita,

Beccacece

et al. 2024

Front. Med.

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ObjectivesThe aim of the study was to describe a cohort of B-cell-depleted immunocompromised (IC) patients with prolonged or relapsing COVID-19 treated with monotherapy or combination therapy.MethodsThis is a multicenter observational retrospective study conducted on IC patients consecutively hospitalized with a prolonged or relapsing SARS-CoV-2 infection from November 2020 to January 2023. IC COVID-19 subjects were stratified according to the monotherapy or combination anti-SARS-CoV-2 therapy received.ResultsEighty-eight patients were enrolled, 19 under monotherapy and 69 under combination therapy. The study population had a history of immunosuppression (median of 2 B-cells/mm3, IQR 1–24 cells), and residual hypogammaglobulinemia was observed in 55 patients. A reduced length of hospitalization and time to negative SARS-CoV-2 molecular nasopharyngeal swab (NPS) in the combination versus monotherapy group was observed. In the univariable and multivariable analyses, the percentage change in the rate of days to NPS negativity showed a significant reduction in patients receiving combination therapy compared to those receiving monotherapy.ConclusionIn IC persistent COVID-19 patients, it is essential to explore new therapeutic strategies such as combination multi-target therapy (antiviral or double antiviral plus antibody-based therapies) to avoid persistent viral shedding and/or severe SARS-CoV-2 infection.

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“…The detrimental effect of rituximab on vaccine immunogenicity has already been established for numerous vaccines 4–6 . In addition, the infection with SARS‐CoV‐2 has been shown to be more severe in immunocompromised patients treated with rituximab 7–9 . Due to this heightened risk, vaccination against SARS‐CoV‐2 has been prioritized for this vulnerable population according to national and international recommendations 10,11…”

Section: Introductionmentioning

confidence: 99%

Rituximab‐to‐vaccine interval on SARS‐CoV‐2 immunogenicity in children: The potential role of prior natural infection

Gualtieri,

Yerly,

Garcia‐Tarodo

et al. 2024

Pediatric Allergy Immunology

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BackgroundTreatment with anti‐CD20 antibodies (rituximab) is used in both adults and children to treat various autoimmune and oncological diseases. Rituximab depletes B CD20+ cells and, thereby, antibody response to vaccines. This study aimed to examine the antibody response to mRNA‐based COVID‐19 vaccines in children aged 5–18 years undergoing rituximab treatment compared to healthy matched children.MethodsBetween 31 January and 18 July 2022, we conducted a prospective observational study at the Geneva University Hospitals, enrolling children aged 5–18 years under rituximab treatment who had received two mRNA‐based SARS‐CoV‐2 vaccine doses. Controls were healthy volunteers with no significant medical conditions. Exclusion criteria included a recent SARS‐CoV‐2 infection. Blood samples were collected at day 60 (±30) and day 270 (±90) after the second vaccination.ResultsThe rituximab‐treated group exhibited significantly lower levels of antibodies specific to the anti‐receptor binding domain (RBD) of the SARS‐CoV‐2 spike (S) protein than healthy controls at 60 (±30) days after the second vaccine dose (geometric mean concentration: 868.3 IU/mL in patients and 11,393 IU/mL in controls; p = .008). However, patients with a rituximab‐to‐vaccine interval shorter than 6 months and with evidence of a past infection (based on positive anti‐N antibody levels) had a high level of anti‐RBD antibodies.ConclusionA past infection with SARS‐CoV‐2 may induce anti‐RBD‐specific memory B cells that can be re‐activated by SARS‐CoV‐2 vaccination, even after rituximab‐induced B‐cell depletion. This suggests that it is possible to vaccinate earlier than 6 months after rituximab to develop a good antibody response, especially in the case of past SARS‐CoV‐2 infection.

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Coronavirus Disease-2019 in the Immunocompromised Host

Cited by 14 publications

References 73 publications

Unveiling COVID‐19 treatment strategies for immunocompromised individuals: Therapeutic innovations and latest findings

Unveiling COVID‐19 treatment strategies for immunocompromised individuals: Therapeutic innovations and latest findings

B-cell-depleted patients with persistent SARS-CoV-2 infection: combination therapy or monotherapy? A real-world experience

Rituximab‐to‐vaccine interval on SARS‐CoV‐2 immunogenicity in children: The potential role of prior natural infection

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