298 - Outcomes of pediatric monoclonal antibody therapy for Coronavirus Disease 2019 (COVID-19)

Poster Number: 298
Publication Number: 298.215

Gilad Sherman, Boston Children's Hospital, Boston, MA, United States; Gabriella S. Lamb, Boston Children's Hospital, Boston, MA, United States; Tanvi S. Sharma, Boston Children's Hospital, Boston, MA, United States; Elizabeth C. Lloyd, University of Michigan Medical School, Ann Arbor, MI, United States; Jerod Nagel, University of Michigan Medical School, Ann Arbor, MI, United States; Carlos R. Oliveira, Yale University School of Medicine, New Haven, CT, United States; Hassan S. Sheikha, Yale School of Medicine, New Haven, CT, United States; Brenda I. Anosike, Albert Einstein College of Medicine/Montefiore Medical Center - - New York, NY, Bronx, NY, United States; Philip Lee, The Children's Hospital at Montefiore, Bronx, NY, United States; Surabhi B. Vora, Seattle Children's, Seattle, WA, United States; Karisma Patel, Children's Health, Dallas, TX, United States; Paul K. Sue, UT Southwestern Medical Center, Dallas, TX, United States; April M. Yarbrough, Children's of Alabama, Birmingham, AL, United States; Lakshmi Ganapathi, Boston Children's Hospital, Boston, MA, United States; Mari M. Nakamura, Boston Children's Hospital/Harvard Medical School, Jamaica Plain, MA, United States

Background: Although monoclonal antibodies (mAbs) for COVID-19 are authorized in high-risk patients ≥12 years of age, evidence in pediatric patients is very limited. We conducted a case series of mAb recipients at 7 pediatric academic hospitals.

Objective: We assessed patient characteristics, treatment-emergent adverse events (TEAEs), and outcomes following mAb therapy.

Design/Methods: Patients treated from 12/1/20-7/31/21 were eligible. All ages were included since some patients < 12 years of age received mAbs via "compassionate use," and some centers accepted adults with underlying childhood-onset conditions. We collected data via retrospective chart review on demographic characteristics, Social Vulnerability Index (SVI) of home census tract, chronic conditions, TEAEs during and within 7 days of mAb therapy, and COVID-19-related ED visits and hospitalizations at the index hospital within 30 days.

Results: Among 164 mAb recipients, the median age was 17 years (IQR 15-19), and 50% were female (Table 1). Most identified as Black (22%), Latinx (24%), or White (54%). The median SVI was 0.36 (IQR 0.16-0.77). 52 patients (32%) had immunocompromising conditions. The most common individual conditions were obesity (57, 34%), neurodevelopmental disorder (14, 9%), and respiratory disease (13, 8%). The median number of days from symptom onset to initial positive COVID-19 polymerase chain reaction (PCR) was 1 (IQR 0-3) and from PCR to mAb therapy was 2 (IQR 1-4). TEAEs occurred in 9 patients (6%) during mAb therapy and 6 (4%) in the subsequent week (Table 2). 5 (3%) patients had COVID-19-related ED visits within 30 days, 3 of whom were hospitalized. Including those 3 admissions, 11 total patients (7%) were admitted to the index hospital for COVID-19 within 30 days: 6 were immunocompromised, 2 had neurodevelopmental disorders, and 1 each had obesity, sickle cell disease, and respiratory disease. The median stay was 3 days (IQR 2-6). 1 patient required supplemental oxygen, and none required non-invasive or invasive ventilation. COVID-19-directed therapies included intravenous immune globulin (IVIG) and tocilizumab in 1 patient and IVIG in another; none received remdesivir or anakinra.Conclusion(s): COVID-19 mAb therapy was generally well-tolerated among pediatric patients. Subsequent COVID-19-related ED visits and hospitalizations were uncommon.
Demographic and clinical characteristics
Treatment-emergent adverse events