Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case Series
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : UR01 - UR03 Full Version

Antibody Cocktail in Moderate to Severe COVID-19 Infection: A Series of 10 Cases


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/56151.16530
Rohit Hanmanta Bhandari, Sonali Gupta

1. Senior Registrar, Department of Neurotrauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India. 2. Registrar, Department of Critical Care Unit, Sahtyadri Superspeciality Hospital, Pune, Maharashtra, India.

Correspondence Address :
Sonali Gupta,
B3-504 Ganga Constella, Kharadi, Pune, Maharashtra, India.
E-mail: drsonaligupta88@gmail.com

Abstract

In the wake of the Coronavirus Disease 2019 (COVID-19) pandemic, scientists all over the world are in a relentless search for a cure. None of the therapies advised till date have shown significant benefit in treating COVID-19 infection. An antibody cocktail consisting of a combination of casirivimab and imdevimab is the newest weapon in the armamentarium against the disease. Currently, it has shown great promise in treating mild non hospitalized cases. The authors present the results of a series of 10 cases aged 18-70 years that demonstrate the efficacy of this cocktail in treating moderate to severe cases as well. All the patients received Roche’s Antibody cocktail© on admission and standard treatment protocol comprising of remdesivir, methylprednisolone and low molecular weight heparin was given. Oxygen supplementation was titrated to achieve a target SpO2 of 88-92%. Majority (70%) of the patients demonstrated an improvement in SpO2/FiO2 ratio and a decline in the inflammatory marker levels 3-5 days after receiving the cocktail. Eight out of the 10 patients could be discharged home after 10-14 days of admission. The remaining two had severe disease with Computed Tomography Severity Index (CTSI) >17/25 and died despite receiving all the available therapies. Antibody cocktail is an effective adjuvant therapy against moderate to severe COVID-19 pneumonitis, demonstrating rapid improvement in SpO2/FiO2 ratio, inflammatory markers and a shortened duration of hospital stay.

Keywords

Casirivimab, Coronavirus disease 2019, Imdevimab, Remdesivir, Roche’s antibody cocktail

Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), a novel coronavirus was first identified in November 2019. The large number of cases reported worldwide has put immense burden on the healthcare infrastructure. The spectrum of the disease encompasses a constellation of symptoms ranging from mild flu to potentially life-threatening Acute Respiratory Distress Syndrome (ARDS) and systemic complications. Seeing no definitive cure at hand, a fervent search began for an effective treatment. First use of immunotherapeutic strategies was seen in the form of convalescent plasma. However, it was not specific and demonstrated an unpredictable response due to variability in the sera from different patients. On the other hand, targeted monoclonal antibodies, which were tailored to specific sequences on the viral genome, have shown great promise as an adjunctive therapy by preventing viral attachment to the host cells and thus, reducing the viral load (1). An antibody cocktail consisting of a combination of Casirivimab and Imdevimab is an upcoming antiviral therapy in treating mild non hospitalized cases (2). The authors present a series of 10 cases demonstrating efficacy of Roche’s antibody cocktail© consisting of casirivimab and imdevimab in severe cases as well (3).

Case Report

A total of 10 cases admitted from September 2021 to October 2021 are included in this series, the details of which are listed in (Table/Fig 1). The patients were between 18 and 70 years of age, with a Male:Female ratio of 3:2. Half of them had significant co-morbidities such as diabetes mellitus, hypertension or cardiac disease. The most common symptoms were fever, cough, shortness of breath and body ache, lasting between 3 to 8 days. Consent was obtained from all patients for publication of clinical data.

On admission, baseline vital signs including SpO2 was recorded, and a High Resolution Computed Tomography (HRCT) chest was done. Arterial blood gas, complete blood count, kidney function test, serum electrolytes were done along with COVID-19 Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test. Testing for inflammatory markers included D-dimer, ferritin and C-Reactive Protein (CRP) levels, which were repeated on day 4. All the patients required Intensive Care Unit (ICU) admission as their SpO2/FiO2 ratio, respiratory rate and HRCT were suggestive of moderate to severe disease (4).

They received Roche’s Antibody cocktail© (Caserivimab 600 mg+ Imdevimab 600 mg i.v. diluted in 250 mL normal saline over 2 hours) on the day of admission after testing positive for COVID-19 along with a standard treatment protocol comprising of Inj. Remdesivir 200 mg i.v. loading followed by 100 mg i.v. once daily for 5 days and Inj Enoxaparin 0.6 mL SC 12 hourly. Inj. Methylprednisolone 40 mg i.v. 12 hourly was started for 5 days and then tapered-off. Adjuvant measures like prone positioning and chest physiotherapy were also instituted. Oxygen supplementation was titrated to achieve a target SpO2 of >92%. Drop in SpO2 <90% or increase in respiratory rate >35/min were used as targets to step up the oxygen therapy. Conversely, SpO2 >95% and RR <25/min were used to de-escalate the oxygen support. Serial chest X-rays and blood investigations were done to monitor the progress of the patients. SpO2/FiO2 ratio was monitored daily, and D-dimer and other inflammatory markers were sent every 4th day. Blood glucose was maintained between 140-180 mg/dL.

All but two patients were shifted to the ward once oxygen requirement was less than 2 L/min with a SpO2 >92%. They were then discharged home without any oxygen support. Telephonic follow-up was done up to a period of two weeks for the possibility of recurrence of respiratory distress.

Discussion

Coronaviruses are enveloped, positive-sense, single-stranded Ribonucleic Acid (RNA) viruses. They are largely divided into four genera; α, β, γ, and δ based on their genomic structure. The α and β coronaviruses infect only mammals. Human coronaviruses responsible for common cold and croup belong to α coronavirus. In contrast, SARS-CoV-2, Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and SARS-CoV-2 are classified to β coronaviruses (5).

Angiotensin Converting Enzyme 2 (ACE-2) has been identified as a functional receptor for SARS-CoV and is highly expressed on the pulmonary epithelial cells. It is through this host receptor that the Spike (S) protein binds initially to start the host cell invasion by the virus. The virus invades the type 2 alveolar epithelial cells, to undergo replication. The virus-laden pneumocytes then release cytokines and inflammatory markers. This ‘cytokine storm’ acts as a chemo attractant for neutrophils and T-cells which are responsible for fighting-off the virus, but in doing result in inflammation and lung injury (6). Symptoms typically appear 7-10 days after infection and IgM antibodies develop by 8-12 days after the onset of symptoms. Spectrum of clinical disease comprises of asymptomatic cases; mild disease with fever, sore throat, dry cough, malaise and body aches or Gastrointestinal (GI) symptoms; moderate disease with involvement of lower respiratory tract without hypoxemia and severe disease where hypoxemia and complications like ARDS, heart failure, shock, etc. are prominent. Risk factors for developing severe disease include diabetes mellitus, age >60 years, cardiovascular diseases like hypertension and coronary artery disease, immunocompromised state and cerebrovascular disease (3).

Since its emergence in November 2019, SARS-CoV-2, has evolved into an even stronger and superior variant as compared to other coronaviruses. Its more virulent, transmissible and mutates rapidly making effective antiviral treatment available herculean task. Current treatment strategies are divided into antivirals (remdesivir) and immunotherapy (dexamethasone, tocilizumab, baricitanib, convalescent plasma and monoclonal antibodies) but none except dexamethasone have produced significant mortality reduction in severe cases (7). Convalescent plasma from recovered individuals was first used to provide short term, passive immunity to susceptible individuals. Benefits included ready availability, antibody mediated viral suppression, resolution of lung consolidation and excellent safety profile. However, it was non specific and only provided short-term immunity (1). Other strategies include use of specific monoclonal antibodies against Vascular Endothelial-derived Growth Factor (VEGF) and IL6 receptor (tocilizumab, siltuximab). These, too, failed to prove effective and some were associated with severe side-effects (8).

Roche’s antibody cocktail© consists of casirivimab and imdevimab, which belong to IgG1 class of immunoglobulins, that targets the spike protein of the virus and was effective in mild, non-hospitalized cases. Upto 1000 times higher neutralizing antibody titres are achieved with the cocktail as compared to convalescent plasma. It prevents virus attachment to the host via the ACE2 receptors and acts as an interim defense till the time the host is able to mount its own antibody response against the virus. It is particularly effective in patients in whom an endogenous immune response has not been initiated. It demonstrates a reduction in the viral load, rate of hospitalization and progression to severe disease in patients infected with SARS-CoV-2 (2). The cocktail appears to be effective in reducing the rate of symptomatic infection and risk of transmission in household contacts of COVID-19 infected patients (9). It has an excellent safety profile and is devoid of any major adverse effects with the exception of hypersensitivity reaction. While data on its use in inpatients or severe disease is limited, cases have been reported demonstrating its efficacy in the same (10). Studies have also shown that the combination of two monoclonal antibodies is more effective than a single one as it prevents escape mutations (11). This is particularly important in determining the future course of viral evolution and subsequent susceptibility to treatment.

The 10 patients analyzed included five patients over 60 years old, six males and five with co-morbidities like diabetes and hypertension, putting them at a higher risk for developing moderate or severe disease (12). Five patients had a SpO2/FiO2 ratio <100 on admission and required Non Invasive Ventilation (NIV). Based on the CT severity score, seven patients had moderate disease while three had severe disease. Clinical experience has shown that patients with CT severity score >10/25 required enhanced oxygen supplementation in the form of NIV or High Flow Nasal Cannula (HFNC) for a prolonged duration and also had a longer hospital stay (4).

There was clinical improvement within 3-5 days after administration of the cocktail. Those on NIV or HFNC could be weaned off positive pressure ventilation with improvement in SpO2/FiO2 ratios. Most of them (70%) had declining D-dimer levels. Improvement in these parameters corresponded with a subjective feeling of well-being. Eight patients were discharged home on room air within 10-14 days of admission.

Two patients died despite all interventions. Both were >60 years age, presented on day 6 and 8 of illness respectively, had HRCT score >18/25 and raised inflammatory markers with rising D- dimer levels. Previous studies have demonstrated that old age, raised inflammatory markers and high CT severity score are all predictors for poor clinical outcome (12),(13).

One of the limitations of this case series is that it was done during the 2nd wave of COVID-19 pandemic in India, where the delta variant was the predominant one. Whether the cocktail is equally effective against the other variants remains to be seen.

Conclusion

Monoclonal antibody cocktail is an effective adjuvant antiviral therapy even in severe cases of COVID-19 infection.

References

1.
Sharun K, Tiwari R, IqbalYatoo M, Patel SK, Natesan S, Dhama J, et al. Antibody-based immunotherapeutics and use of convalescent plasma to counter COVID-19: advances and prospects. Expert Opin Biol Ther. 2020;20(9):1033-46. [crossref] [PubMed]
2.
Weinreich DM, Sivapalasingam S, Norton T, Ali S, Gao H, Bhore R, et al. REGN-COV2, a Neutralizing Antibody Cocktail, in Outpatients with COVID-19. N Engl J Med. 2021;384(3):238-51. [crossref] [PubMed]
3.
MOHFW Clinical Management Protocol for COVID-19 (Adults).pdf. Version 6 (24.05.21).
4.
Saeed GA, Gaba W, Shah A, Al Helali AA, Raidullah E, Al Ali AB, et al. Correlation between Chest CT Severity Scores and the Clinical Parameters of Adult Patients with COVID-19 Pneumonia. Radiol Res Pract. 2021;2021:6697677. [crossref] [PubMed]
5.
Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A review. Clin Immunol. 2020;215:108427. [crossref] [PubMed]
6.
Parasher A. COVID-19: Current understanding of its pathophysiology, clinical presentation and treatment. Postgrad Med J. 2021;97(1147):312-20. [crossref] [PubMed]
7.
Recovery Collaborative Group. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med. 2021;384(8):693-04. [crossref] [PubMed]
8.
Cortegiani A, Ippolito M, Greco M, Granone V, Protti A, Gregoretti C, et al. Rationale and evidence on the use of tocilizumab in COVID-19: A systematic review. Pulmonology. 2021;27(1):52-66. [crossref] [PubMed]
9.
O’Brien M, Neto E, Chen K, Isa F, Heirman I, Sarkar N, et al. Casirivimab with imdevimab antibody cocktail for COVID-19 prevention: Interim results. Top Antivir Med. 2021;29(1):33-34.
10.
Phan AT, Gukasyan J, Arabian S, Wang S, Neeki MM. Emergent inpatient administration of casirivimab and imdevimab antibody cocktail for the treatment of COVID-19 pneumonia. Cureus. 2021;13(5). [crossref]
11.
Baum A, Fulton BO, Wloga E, Copin R, Pascal KE, Russo V, et al. Antibody cocktail to SARS-CoV-2 spike protein prevents rapid mutational escape seen with individual antibodies. Science. 2020;369(6506):1014-18. [crossref] [PubMed]
12.
Rahman A, Sathi NJ. Risk factors of the severity of COVID-19: A meta-analysis. Int J Clin Pract. 2021;75(7). [crossref]
13.
Yao Y, Cao J, Wang Q, Shi Q, Liu K, Luo Z, et al. D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: A case control study. J Intensive Care. 2020;8(1):49. [crossref] [PubMed]

Tables and Figures
[Table / Fig - 1]
DOI and Others

DOI: 10.7860/JCDR/2022/56151.16530

Date of Submission: Mar 06, 2022
Date of Peer Review: Apr 05, 2022
Date of Acceptance: Apr 18, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 17, 2022
• Manual Googling: Apr 14, 2022
• iThenticate Software: May 30, 2022 (11%)

ETYMOLOGY: Author Origin

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  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com