Anti-complement C5 Therapy with Eculizumab in Three Cases of Critical COVID-19

Overview

Journal Clin Immunol

Specialty Allergy & Immunology

Date 2020 Aug 11

PMID 32771488

Citations 73

Authors

Jeffrey Laurence

J Justin Mulvey

Madhav Seshadri

Alexandra Racanelli

Joanna Harp

Edward J Schenck

Dana Zappetti

Evelyn M Horn

Cynthia M Magro

Affiliations

Soon will be listed here.

Abstract

Respiratory failure and acute kidney injury (AKI) are associated with high mortality in SARS-CoV-2-associated Coronavirus disease 2019 (COVID-19). These manifestations are linked to a hypercoaguable, pro-inflammatory state with persistent, systemic complement activation. Three critical COVID-19 patients recalcitrant to multiple interventions had skin biopsies documenting deposition of the terminal complement component C5b-9, the lectin complement pathway enzyme MASP2, and C4d in microvascular endothelium. Administration of anti-C5 monoclonal antibody eculizumab led to a marked decline in D-dimers and neutrophil counts in all three cases, and normalization of liver functions and creatinine in two. One patient with severe heart failure and AKI had a complete remission. The other two individuals had partial remissions, one with resolution of his AKI but ultimately succumbing to respiratory failure, and another with a significant decline in FiO requirements, but persistent renal failure. In conclusion, anti-complement therapy may be beneficial in at least some patients with critical COVID-19.

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