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Ischaemic Stroke Occurring in a Patient Treated with Monoclonal Antibodies for COVID-19
Antonio Lobasso1, Ciro di Gennaro1, Maria Rita Poggiano1
1UOC Medicina, P.O. A. Rizzoli, ASL Napoli 2 Nord, Lacco Ameno, 80076 Naples, Italy.
Insights
A rare case of ischemic stroke occurred shortly after sotrovimab treatment for COVID-19 in an immunocompromised patient. This potential side effect of sotrovimab, an antiviral drug, was not previously reported in clinical trials.
Area of Science:
- Neurology
- Infectious Diseases
- Pharmacology
Background:
- COVID-19 is associated with an increased risk of thrombotic events, including ischemic stroke.
- While vaccination reduced SARS-CoV-2 incidence, severe infections persist in frail individuals.
- Sotrovimab, a monoclonal antibody, is used to treat mild-to-moderate COVID-19 in high-risk patients.
Observation:
- A frail patient with chronic lymphocytic leukemia developed an ischemic stroke minutes after receiving sotrovimab for COVID-19.
- Other potential causes of ischemic stroke were excluded.
- The Naranjo probability scale was used to assess the likelihood of sotrovimab as the cause.
Findings:
- Ischemic stroke is not a known side effect of sotrovimab treatment for COVID-19.
- This case presents the first reported instance of early ischemic stroke following sotrovimab administration.
- The patient was immunocompromised, a factor potentially influencing adverse events.
Implications:
- This case highlights a potential rare adverse event associated with sotrovimab.
- Further investigation is warranted to understand the mechanism and frequency of this association.
- Clinicians should remain vigilant for neurological complications in immunocompromised patients receiving sotrovimab for COVID-19.
Abstract:
Since the COVID-19 outbreak began, an association between COVID-19 and thrombotic diseases has been underlined. Although this association is more frequent with venous thromboembolism, ischaemic stroke has also been reported as a thrombotic complication in several cohorts of affected patients. Furthermore, the association between ischaemic stroke and COVID-19 has been considered a risk factor for early mortality. On the other hand, after the successful vaccination campaign, the incidence and the virulence of SARS-CoV-2 decreased, though it has been observed that COVID-19 may induce a severe infection in specific cohorts of frail subjects. For this reason, different drugs have been introduced of an antiviral action in order to improve the disease outcome of frail patients. In this field, with the arrival of a neutralizing monoclonal antibody against SARS-CoV-2, in particular, sotrovimab, a further chance to treat high-risk patients with mild-to-moderate COVID-19 arrived, achieving a concrete reduction in the risk of disease progression. We here report our clinical experience of an ischaemic stroke occurring a few minutes after the administration of sotrovimab for the treatment of moderate COVID-19 in a frail patient with chronic lymphocytic leukaemia. Other causes of ischaemic stroke were ruled out, and in order to evaluate the probability of a rare side effect, the Naranjo probability scale has also been utilized. In conclusion, among several side effects that have been described during the treatment of COVID-19 with sotrovimab, ischaemic stroke was not reported. Therefore, we here report a rare case of ischaemic stroke with early clinical manifestation after the administration of sotrovimab for the treatment of moderate COVID-19 in an immunocompromised patient for the first time.
