Review: Casirivimab-Imdevimab antibody Cocktail in Patients Amidst and Post COVID-19 Treatment

Written By : Dr. Kamal Kant Kohli Published On 2022-03-28T12:15:00+05:30 | Updated On 28 March 2022 12:15 PM IST

Casirivimab and Imdevimab are two IgG1 anti-SARS-CoV-2 monoclonal antibodies, given emergency use authorization by the US FDA, European Medical Agency, and Central Drug Standard Control Organization for ceasing the progression of COVID-19. Monoclonal antibodies have gained attention in developing countries owing to their benefits portrayed by few clinical trials. However, no studies until now have been undergone in India.

Study Design:

• Through a data retrieval for 6 months, 152 samples were documented and sorted into test (Casirivimab and Imdevimab treated patients, n = 79) and control (Non- Casirivimab and Imdevimab treated individuals, n = 73) subsets.

• The research had two phases.

• Estimation of mechanical ventilation and high flow oxygen requirement and mortality in samples amidst the treatment.

• Post COVID-19 patients' feedback through validated (Cronbach's alpha coefficient = 0.7) questionnaire that evaluated their health and vaccination status, and treatment satisfaction.

Results:

Baseline Characteristics:

• 61.8% (n = 94) were males. More patients were pooled in test group with age >65 years (n = 37, 46.8%) and controlgroup with age <65 years (n = 47, 64.4%).

• In control group (n = 73, 100%) and 24.1% (n = 19) of the test samples underwent treatment as out-patient.

• Patients were sorted into COVID category based on symptomatology.;

• A(n = 0)

• B (test, n = 75, 95%; Control, n = 39, 53%)

• C (test, n = 1, 1.3%; Control, n = 34, 47%)

• Those within B and C (test, n = 3, 3.8%; Control, n = 0) [Likelihood ratio = 54.93, p < 0.001].

• COVID19 categoryB patients (n = 102, 81%) had <10 days of staythan those (n = 24, 19%) in categoryC (X = 18.8, p < 0.001)

• Test group had lesser CRP elevation than the control group, which was statistically significant (X = 18.29, p < 0.001). Nevertheless, there were no significant findings concerning other parameters across the study groups (p > 0.05).

• In the study population, 54.6% (n = 83) patients were suffering from a single disease or were non-diseased, while 40 patients (50.6%) of the test and 20 (39.7%) of control were observed to be multi-morbid. 2

• Most prevailing was diabetes that was in 60.8% (n = 48) in test and 53.4% (n = 39) in control, while 55.7% (n = 44) of test and 39.7% (n = 29) ofcontrolhad Hypertension.

• Health status in the study, 90.1% (n = 64) of the test samples were healthythan the control(n = 57, 87.9%).

• 13% (n = 9) and 43.7% (n = 29) in the test and control group to have had economic constraints on running 2 the treatment expenses (X = 16.68, p < 0.001).

• Incidence of death and invasion of Pneumonia (n = 5) in the control group have lowered their attitude (Likelihood ratio = 9.13, p = 0.28).

• Re-hospitalization for other than COVID 19 was prominent in the control (n = 14, 21.2%) than in the test (n 2 = 6, 8.5%) group (X = 4.47, p = 0.03).

• Hematemesis (n = 1), cough (n = 1), pneumonia (n = 1) and shortness of breath (n = 4) and hair loss (n = 1), dyspnea (n = 2) and weakness (n = 2) were the post COVID-19 difficulties faced by the test and control samples.

• There were no noticeable adverse drug reactions reported in our patients.

Impact of Casirivimab and Imdevimab Antibody Cocktails

• Lesser requisite for mechanical ventilation (6.3%; p < 0.001), high flow oxygen (5.1%; p <0.001) and no death during Casirivimab and Imdevimab therapy.

• The control group had a greater essentiality of mechanical ventilation (n = 25, 34%) than the test (n = 5, 6.3%).

• Category C COVID-19 patients were the top utilizer of mechanical ventilation (n = 20, 66.7%) than categoryB (n = 8, 26.7%) [Likelihood ratio = 41.45, p < 0.001].

• Fully immunized had diminished requirement of mechanical ventilation (test, n = 2, 4.2%; control, n = 8, 25.8%) [likelihood ratio = 7.98, p < 0.01].

• Presence of co-morbidities was a factor for mechanical ventilation and was prominent among the 2 control group with more than a chronic disease condition (>1, n = 18, 62.1%; <1, n = 7, 15.9%; X = 16.54, p < 0.001)

• The control samples with multiple co-morbidities showed essentiality of high flow oxygen (>1, n = 16, 2 55.2%; <1, N = 12, 27.3%; X = 5.75, p = 0.01).

• Two patients in the control group died during theirCOVID treatment and two post-COVID

• Those in the test group had better life expectancy, with none dying during treatment (p < 0.05, Likelihood ratio = 5.98).

Clinical Implication
• The Casirivimab and Imdevimab treated community had lesser requisite for mechanical ventilation, high flow oxygen and there was no death reported.
• The post-COVID-19 status of each patient in the study, the majority of those on the antibody cocktail were healthy and were quite satisfied with the treatment.
Hence, Casirivimab and Imdevimab regimen is beneficial and can be recommended for high-risk COVID-19 patients.

For more details about the prescribing information, click here

Reference:JoyAP, Augustine AT, Karattuthodi MS, et al. The impact of casirivimab-imdevimab antibody cocktail in patients amidst and post COVID 19 treatment: A retro-prospective comparative study in India. Clin Epidemiol

This article has been published under MD Brand Connect Initiative.

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Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751