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Treatment of Infants and Children With SARS-CoV-2 Monoclonal Antibodies: A European Case Series
Cornelius Rau1, Lorenz Auer-Hackenberg2, Hedwig E Deubzer3
1From the Department of Neonatology and Paediatric Intensive Care, University Children's Hospital, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Insights
Monoclonal antibody (mAb) treatment for SARS-CoV-2 infection in children was well tolerated and effective, with a high survival rate observed in this European study. This antiviral therapy shows promise for pediatric patients with pre-existing conditions.
Area of Science:
- Pediatric Infectious Diseases
- Antiviral Therapies
- Immunology
Background:
- Severe COVID-19 is rare in children but poses a higher risk for those with pre-existing health conditions.
- Monoclonal antibodies (mAbs) are effective antiviral treatments for SARS-CoV-2 in adults but are often not approved for pediatric use.
- Limited data exists on the safety and efficacy of mAbs in children with SARS-CoV-2 infection.
Purpose of the Study:
- To evaluate the safety and tolerability of monoclonal antibody (mAb) treatment in pediatric patients with SARS-CoV-2 infection.
- To assess the clinical outcomes of mAb treatment in children with varying pre-existing conditions.
- To analyze the types of mAbs used and their associated side effects in a pediatric cohort.
Main Methods:
- Retrospective evaluation of 53 pediatric patients (<12 years or <40kg) treated with mAbs for SARS-CoV-2 infection.
- Data collected from 12 tertiary care centers across 3 European countries between January 2021 and March 2022.
- Analysis of patient demographics, pre-existing conditions, mAb type, clinical outcomes, and adverse events.
Main Results:
- The study included 53 children with a median age of 5.4 years and median weight of 20kg, many with pre-existing conditions.
- Sotrovimab was the most frequently administered mAb (79%), followed by casirivimab/imdevimab (17%).
- All but one patient survived, with a median hospital stay of 3 days; 11% experienced mild side effects like neutropenia.
Conclusions:
- Monoclonal antibody treatment was well-tolerated in this cohort of pediatric patients with SARS-CoV-2 infection.
- The observed high survival rate and manageable side effects suggest mAbs are a viable treatment option for children.
- Further research is warranted to expand the use of mAbs in pediatric populations.
Background:
Although severe COVID-19 in children is rare, those with certain pre-existing health conditions are more prone to severe disease. Monoclonal antibodies (mAbs) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are potent antiviral agents that reduce adverse clinical outcomes in adults, but are commonly not approved for use in pediatric patients.
Methods:
We retrospectively evaluated mAb treatment in children <12 years of age or <40kg with SARS-CoV-2 infection between January 1, 2021, and March 7, 2022, in 12 tertiary care centers in 3 European countries.
Results:
We received data from 53 patients from Austria, Denmark and Germany. Median age was 5.4 years [0-13.8, interquartile range (IQR) = 6.2], and median body weight was 20 kg (3-50.1, IQR = 13). The most frequent SARS-CoV-2 variant in this study, if known, was Omicron, followed by Delta and Alpha. Pre-existing conditions included immunodeficiency, malignancy, hematologic disease, cardiac disease, chronic lung disease, chronic liver disease, kidney disease and diabetes. Forty-two patients received sotrovimab (79%), 9 casirivimab/imdevimab (17%) and 2 bamlanivimab (4%). All but 1 patient survived. Median duration of hospital stay was 3 days (0-56, IQR = 6). Seven patients required treatment in an intensive care unit, and 5 required high-flow nasal cannula treatment. Potential side effects included neutropenia (6/53, 11%), lymphopenia (3/53, 6%), nausea or vomiting (2/53, 4%), rise of alanine transaminase (1/53, 2%) and hypotonia (1/53, 2%).
Conclusions:
MAb treatment was well tolerated by children in this cohort.
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