Successful Treatment of Severe COVID-19 Pneumonia With Clazakizumab in a Heart Transplant Recipient: A Case Report

  • Transplant Proc. 2020 Nov;52(9):2711-2714. doi: 10.1016/j.transproceed.2020.06.003.
Gaurang Vaidya  1 ,  Lawrence S C Czer  2 ,  Jon Kobashigawa  1 ,  Michelle Kittleson  1 ,  Jignesh Patel  1 ,  David Chang  1 ,  Evan Kransdorf  1 ,  Anuja Shikhare  3 ,  Hai Tran  4 ,  Ashley Vo  5 ,  Noriko Ammerman  5 ,  Edmund Huang  5 ,  Rachel Zabner  6 ,  Stanley Jordan  5
Affiliations
  • 1. Cedars-Sinai Smidt Heart Institute, Heart Transplant Program, Cedars Sinai Medical Center, Los Angeles, California.
  • 2. Cedars-Sinai Smidt Heart Institute, Heart Transplant Program, Cedars Sinai Medical Center, Los Angeles, California. Electronic address: [email protected].
  • 3. Department of Medicine, William Beaumont Hospital, Royal Oak, Michigan.
  • 4. Department of Pharmacy Services, Cedars Sinai Medical Center, Los Angeles, California.
  • 5. Comprehensive Transplant Center, Transplant Immunotherapy Program, Cedars Sinai Medical Center, Los Angeles, California.
  • 6. Division of Infectious Diseases, Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California.
PMID: 32563584 DOI: 10.1016/j.transproceed.2020.06.003
Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Infection is characterized by an overwhelming cytokine response. Various treatment strategies have been attempted.

Methods and results: A 61-year-old man with heart transplantation in 2017 presented with fever, cough, and dyspnea, and was confirmed positive for coronavirus disease 2019 (COVID-19). Laboratory tests showed significant elevations in C-reactive protein and interleukin-6 (IL-6). Echocardiogram showed left ventricular ejection fraction 58% (with ejection fraction 57% 6 months prior). Given the lack of clear management guidelines, the patient was initially managed symptomatically. However, the patient subsequently had a rapid respiratory deterioration with worsening inflammatory markers on day 5 of admission. Tocilizumab (anti-IL-6R) was in low supply in the hospital. The patient was offered clazakizumab (anti-IL-6) for compassionate use. Patient received 25 mg intravenously × 1 dose. Within 24 hours, he showed significant improvement in symptoms, oxygen requirements, radiological findings, and inflammatory markers. There was a transient leukopenia that improved in 4 days. He was discharged home on day 11, with negative nasopharyngeal SARS-CoV-2 PCR as an outpatient on day 35, development of positive serum COVID-19 IgG antibody, and he continued to do well on day 60, with no heart-related symptoms.

Conclusion: Clazakizumab is a monoclonal antibody against human IL-6, which may be helpful in inhibiting the cytokine response to SARS-CoV-2 in COVID-19. Although not yet FDA approved, it is being investigated for treatment of renal antibody-mediated rejection. Clinical trials of clazakizumab for treatment of COVID-19 are underway worldwide.

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