Abstract: TH-PO1110
COVID-19 Vaccination Implications for Individuals Receiving Anti-Complement Therapy During the SARS-CoV-2 Pandemic
Session Information
- COVID-19 - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Srivastava, Tanya, Dr. D.Y Patil Medical College, Hospital and Research Centre, Pune, India
- Gnasigamany, Jason Gnanaraj, CHRISTUS Good Shepherd Health System, Longview, Texas, United States
- Shrivastava, Snehal, East Texas Kidney Specialist, Longview, Texas, United States
Introduction
Treatment of complement mediated thrombotic microangiopathy (CM-TMA) with anti-complement agents such as Eculizumab during the COVID-19 Pandemic posed unique clinical decision making challenges in the area for COVID vaccination.
Case Description
A 36 year old African American lady, presented to the obstetric ER for hypertension and underwent emergency C-section due to fetal distress. Postoperative course was complicated by blood loss and oliguric acute renal failure. Based on lab data and clinical findings, diagnosis of CM-TMA was made. Genetic testing revealed heterozygosity for c.989-78G>A (rs1962149) variant of MCP/CD46 haplotype. Patient received transient hemodialysis for uremia and definitive treatment with anti-complement therapy- Eculizumab which resulted in complete renal recovery and remission for a 15 month follow up period. Due to ongoing COVID-19 pandemic, patient expressed interest in obtaining COVID vaccine for protection of herself and her newborn infant. After review of literature and observing her clinical progression, patient received 2 doses of mRNA vaccines: first dose administered 15 days after the final eculizumab infusion; and the second dose, three weeks after 1st dose. Her renal function and CM-TMA parameters were closely monitored post vaccination without event. The antibody response to vaccination could not be tested.
Discussion
Concurrent administration of COVID-19 vaccine with anti complement therapy poses special clinical challenges due to lack of conclusive data and guidance. SARS-CoV-2 virus, mRNA and adenovirus vaccines have shown to trigger Microangiopathic Hemolytic anemia (MAHA) and CM-TMA. Additionally, inconclusive data exists regarding the use of Eculizumab in the treatment of COVID-19. Data regarding strength of immune response after vaccination while on therapy is also limited.
Due to increasing use of anti-complement therapies, we call for further research to aid development of guidelines for timing of covid vaccination. Such data will not only be useful in timely administration of preventive vaccination but also guide further management of complement mediated disorders.