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COVID Antivirals Immunosuppressed AAV — ESENeph MCQ

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ModerateRenal VasculitisCOVID Antivirals Immunosuppressed AAVESENeph

A 50-year-old man with ANCA vasculitis on Rituximab develops COVID-19 pneumonia requiring hospitalisation. He has undetectable anti-spike antibodies despite full vaccination. What therapeutic option should be considered early?

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Correct answer: D — Early antiviral therapy (Nirmatrelvir/Ritonavir or Remdesivir) is particularly important in immunosuppressed patients with poor vaccine response – they are at high risk of severe disease and prolonged viral shedding

Immunosuppressed patients (particularly those on Rituximab with B-cell depletion) are at high risk of severe COVID-19 and prolonged viral shedding due to impaired humoral immunity. Early antiviral therapy is particularly important in this population. Nirmatrelvir/Ritonavir (Paxlovid) has a critical drug interaction with Tacrolimus (CYP3A4 inhibition) but this is less relevant for non-transplant patients on Rituximab. Remdesivir (3-day IV course) is an alternative. Convalescent plasma or anti-spike monoclonal antibodies may be considered if available and effective against circulating variants.

Reference: NICE – COVID Therapeutics; UKKA 2023 – COVID in CKD