Remission of severe forms of long COVID following monoclonal antibody (MCA) infusions: A report of signal index cases and call for targeted research

• Published in: The American journal of emergency medicine Vol. 75; pp. 122 - 127
• Main Authors: Scheppke, Kenneth A, Pepe, Paul E, Jui, Jonathan, Crowe, Remle P, Scheppke, Eric K, Klimas, Nancy G, Marty, Aileen M
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.01.2024
• Subjects: Antibodies, Monoclonal - therapeutic use; Chronic fatigue syndrome; Chronic illnesses; Chronic infection; Cognitive ability; Complications; COVID-19; COVID-19 vaccines; Cytomegalovirus; Debilitation; Dyspnea; Emergency medical care; Epstein-Barr virus; Exercise; Female; Fever; Humans; Immunological tolerance; Infections; Male; Middle Aged; Monoclonal antibodies; Patients; Physical fitness; Post-Acute COVID-19 Syndrome; Remission; Remission (Medicine); SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Vaccination; United States > US; COVID-19; Monoclonal antibody treatment; Long COVID; Immune response imbalance; SARS-CoV-2 complications; Post-acute sequelae SARS-CoV-2 infection
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2023.09.051

Long COVID has afflicted tens of millions globally leaving many previously-healthy persons severely and indefinitely debilitated. The objective here was to report cases of complete, rapid remission of severe forms of long COVID following certain monoclonal antibody (MCA) infusions and review the corresponding pathophysiological implications. Case histories of the first three index events (among others) are presented. Unaware of others with similar remissions, each subject independently completed personal narratives and standardized surveys regarding demographics/occupation, past history, and the presence and respective severity grading of 33 signs/symptoms associated with long COVID, comparing the presence/severity of those symptoms during the pre-COVID, long-COVID, post-vaccination, and post-MCA phases. Patient interviews, e-mails and telephone conversations. Three previously healthy, middle-aged, highly-functioning persons, two women and one man (ages 60, 43, and 63 years respectively) who, post-acute COVID-19 infection, developed chronic, unrelenting fatigue and cognitive impairment along with other severe, disabling symptoms. Each then independently reported incidental and unanticipated complete remissions within days of MCA treatment. The casirivimab/imdevimab cocktail. Irrespective of sex, age, medical history, vaccination status, or illness duration (18, 8 and 5 months, respectively), each subject experienced the same complete remission of their persistent disabling disease within a week of MCA infusion. Each rapidly returned to normal health and previous lifestyles/occupations with normalized exercise tolerance, still sustained to date over two years later. These index cases provide compelling clinical signals that MCA infusions may be capable of treating long COVID in certain cases, including those with severe debilitation. While the complete and sustained remissions observed here may only apply to long COVID resulting from pre-Delta variants and the specific MCA infused, the striking rapid and complete remissions observed in these cases also provide mechanistic implications for treating/managing other post-viral chronic conditions and long COVID from other variants.