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Monoclonal Antibody Therapy of Breastfeeding Patient Infected with SARS-CoV-2: A Case Report

Nicole E Marshall1, Madison B Blanton2,3, Brianna M Doratt2

  • 1Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA.

Breastfeeding Medicine : the Official Journal of the Academy of Breastfeeding Medicine
|August 24, 2023
PubMed

Insights

This study reports on a breastfeeding individual with a breakthrough SARS-CoV-2 infection who received monoclonal antibody treatment. The treatment favorably increased SARS-CoV-2 antibody levels in plasma and breast milk.

Area of Science:

  • Immunology
  • Infectious Diseases
  • Maternal-Fetal Medicine

Background:

  • Optimal treatment for symptomatic pregnant and lactating individuals with SARS-CoV-2 is not fully defined.
  • Vaccination against SARS-CoV-2 is safe and effective for pregnant and breastfeeding individuals.
  • Breakthrough infections can occur even in vaccinated individuals.

Observation:

  • A vaccinated breastfeeding woman with a symptomatic SARS-CoV-2 infection received casirivimab-imdevimab treatment.
  • The patient exhibited a minimal maternal antibody response to vaccinations, including SARS-CoV-2 and Tdap.
  • No obvious defects in innate or adaptive cellular subsets were noted.

Findings:

  • Monoclonal antibody treatment led to a favorable outcome.
  • Casirivimab-imdevimab transiently increased SARS-CoV-2 antibody titers in both plasma and human milk.
  • This suggests a potential therapeutic benefit for breastfeeding individuals with SARS-CoV-2.

Implications:

  • Monoclonal antibodies may be a viable treatment option for symptomatic, vaccinated, breastfeeding individuals with SARS-CoV-2.
  • Further research is needed to define optimal treatment courses for this population.
  • Understanding antibody dynamics in maternal milk is crucial for infant protection.

Keywords:
SARS-CoV-2 infectionimmune responselactationmonoclonal antibody therapy

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