Case report: Sotrovimab, remdesivir and nirmatrelvir/ritonavir combination as salvage treatment option in two immunocompromised patients hospitalized for COVID-19

COVID-19 in immunocompromised patients is difficult to treat. SARS-CoV-2 interaction with the host immune system and the role of therapy still remains only partly understood. There are no data regarding the use of monoclonal antibodies and the combination of two antivirals in fighting viral replication and disease progression. We report the cases of two patients, both treated with rituximab for non-Hodgkin lymphoma and granulomatosis with polyangiitis, respectively, and both hospitalized for COVID-19 with positive SARS-CoV-2 RNAemia, who were successfully treated with a salvage combination therapy with sotrovimab, remdesivir and nirmatrelvir/ritonavir.

Automated summary

COVID-19 in immunocompromised patients is difficult to treat, and the understanding of SARS-CoV-2 interaction with the host immune system and therapy role is limited. The use of monoclonal antibodies and antiviral combinations for viral replication and disease progression is lacking data. Here, we report successful treatment of two COVID-19 patients with positive SARS-CoV-2 RNAemia, who had undergone rituximab treatment for non-Hodgkin lymphoma and granulomatosis with polyangiitis, respectively, using a salvage combination therapy with sotrovimab, remdesivir, and nirmatrelvir/ritonavir.