Use of REGEN-COV in Pediatric Patients After Heart Transplantation for Treatment and Post-Exposure Prophylaxis of COVID-19

PURPOSE: Pediatric heart transplant (HT) patients are vulnerable to severe COVID-19 disease. REGEN-COV is a recombinant human monoclonal antibody to the spike protein of SARS-CoV-2; comprising of Casirivimab and Indevimab. It recently received emergency use authorization by the U.S. FDA for use as post-exposure prophylaxis (PEP) for COVID-19 in adult and pediatric patients (≥12 years and ≥40 kg) at high risk for progression to severe COVID-19. It is also authorized for the treatment of mild-to-moderate COVID-19 with positive RT-PCR, in patients at high risk for progression to severe COVID-19. We sought to review our experience in use of REGEN-COV in pediatric HT patients. METHODS: A retrospective chart review was performed to identify patients who received REGEN-COV for PEP or to prevent progression to severe COVID-19. Detailed demographic and clinical data was collected. RESULTS: Six pediatric patients received REGEN-COV, 4 received after a positive RT-PCR and 2 received as PEP with a negative RT-PCR. Median age was 16.5 years (range: 15-19) and median time from transplant was 29 months (range: 2-140). There were equal number of males and females. Of those positive for COVID-19, 3 demonstrated mild symptoms (2 respiratory and 1 gastrointestinal) and 1 was asymptomatic. Both patients who received PEP were asymptomatic however were <1 year from transplant. All patients received REGEN-COV within 5 days of testing positive or exposure. Patients who received it for PEP continued to remain RT-PCR negative. None of the patients demonstrated changes on their echocardiogram after the infection and tolerated the infusion without any complications. Further details of immunosuppression, panel reactive antibodies and comorbidities are presented in Table 1. None of the patients required any modifications in their immunosuppression. CONCLUSION: REGEN-COV was tolerated without any complications in pediatric heart transplant patients and no modifications in immunosuppression were required.