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
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,
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,
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
(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)
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.
On April 2011

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
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : February | Volume : 17 | Issue : 2 | Page : OC05 - OC09 Full Version

Efficacy of Antibody Cocktail Drug in COVID-19 Positive Patients: A Retrospective Single-centered Study

Published: February 1, 2023 | DOI:
Manoranjan Dash, Nursingha Charan Dash, Arun Kumar, Smrutirekha Swain, Swetaleena Ashe, Jyoti Patnaik

1. Associate Professor, Department of Pulmonary Medicine, SCB Medical College, Cuttack, Odisha, India. 2. Assistant Professor, Department of Pulmonary Medicine, SCB Medical College, Cuttack, Odisha, India. 3. Associate Professor, Department of Anaesthesiology, SCB Medical College, Cuttack, Odisha, India. 4. Assistant Professor, Department of Pulmonary Medicine, PGIMER and Capital Hospital, Bhubaneswar, Odisha, India. 5. Senior Resident, Department of Community Medicine, SCB Medical College, Cuttack, Odisha, India. 6. Professor, Department of Pulmonary Medicine, SCB Medical College, Cuttack, Odisha, India.

Correspondence Address :
Dr. Smrutirekha Swain,
Plot No. 5F/857, CDA Sector-9, Cuttack, Odisha, India.


Introduction: Neutralising monoclonal antibodies (mABs) have been proposed and developed for the treatment of Coronavirus Disease-2019 (COVID-19) patients with mild to moderate diseases and to prevent further progression. The combination of Casirivimab and Imdevimab blocks the entry of virus into cells by attaching to receptor binding domain of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) spike glycoprotein. The mABs are utilised as a pre-emptive strategy in certain high-risk groups such as those suffering from chronic liver, kidney and respiratory disease, malignancies and other immunocompromised states where efficacy of vaccines may be suboptimal.

Aim: To evaluate the clinical outcomes in COVID-19 patients who were treated with Antibody Cocktail drug (casirivimab and imdevimab).

Materials and Methods: A retrospective observational study was conducted in patients confirmed positive for SARS-CoV-2 from June 2021 to January 2022 and subsequently, the collected data was analysed from May 2022 to June 2022. The study was conducted in a tertiary care referral hospital in eastern India. All eligible patient subsequently received casirivimab and imdevimab at COVID-19 facility. Monitoring of patients was done upto 12 hour postinfusion. Demographic parameters, routine investigations and clinical outcomes were assessed. Data entry was done using Microsoft excel. Data was entered, coded and analysed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 21.0. All analysis was done at a preset alpha error of 5% and results expressed at confidence levels of 95%.

Results: Total 104 eligible cases were taken in present study. Nearly, 93% of those patients who had not been vaccinated were at higher risk for having severely elevated levels of C-Reactive Protein (CRP) as compared to 48% of those with COVID-19 vaccination. Nearly, 9 out of 10 patients with moderate-severe CRP levels were at nine times more risk for longer duration of hospitalisation as compared to normal levels of CRP. All patients having moderate-severe CRP levels required mechanical ventilation in comparison to mild CRP levels. Patients with co-morbidities were more likely to get severe COVID-19 infections (p-value ≤0.05). Unvaccinated subjects were more likely to have severe infections than vaccinated subjects. (p-value ≤0.05). Prolonged hospitalisation (>7 days) was statistically significant in severe COVID-19. Unvaccinated subjects had a statistically significant rise in CRP over vaccinated subjects. The majority of the patients receiving antibody cocktail did not require prolonged hospitalisation while a minor fraction required invasive ventilation. Antibody cocktail was safe, well tolerated and had good efficacy and low mortality rate as compared to other modalities of treatment in this study.

Conclusion: The duration of hospitalisation and outcomes were superior in patients having mild to moderate COVID-19 who received antibody cocktail without any serious side-effects.


Casirivimab, Clinical profile, Coronavirus disease-2019, Imdevimab, Monoclonal antibodies, Outcomes

On March 11, 2020, the World Health Organisation (WHO) declared that COVID-19 caused by SARS-CoV-2 as a global pandemic (1). As of August 12, 2021, there have been more than 203 million confirmed cases of COVID-19, including more than 4.3 million deaths globally (2). Although the newly developed vaccines can provide effective protection against SARS-CoV-2 infection (3), many new COVID-19 cases have been reported in mid 2021 and early 2022 because of new and emerging variants of the SARS-CoV-2 virus. Therefore, the increasing number of COVID-19 patients remains a critical public health concern. The clinical spectrum of COVID-19 can range from asymptomatic, Severe Acute Respiratory Illness (SARI), pneumonia to Acute Respiratory Distress Syndrome (ARDS) (4),(5),(6). Currently, the recommended treatment options for COVID-19 patients depend on the stage and severity of the disease (5),(6),(7). For hospitalised COVID-19 patients, antiviral agents such as remdesivir is suggested, however anti-inflammatory agents such as corticosteroids and Interleukin-6 antagonist are recommended for patients requiring high-flow oxygen/non invasive ventilatory therapy with evidence of clinical progression or increased biomarkers of inflammation (7),(8),(9).

In addition to this, patients with severe to critical COVID-19 infection, a significant number of patients are classified as having mild or moderate illness. Some patients having mild to moderate illness may progress to severe illness or require hospitalisation, particularly those with older age, multiple co-morbidities, obesity and/or immunocompromised status (6). Therefore, disease progression or hospitalisation in patients with mild or moderate COVID-19 is another important issue. To address this issue, neutralising mABs have been proposed and developed for the treatment of patients with mild to moderate diseases and to prevent further progression (10).

An antibody cocktail is defined as a combination of two SARS-CoV-2 non competing neutralising or monoclonal human Immunoglobulin G1 (IgG1) antibodies that target the receptor-binding domain of the SARS-CoV-2 spike protein. The mABs have been found to be safe and effective in treating viral infections by blocking virus entry into the host cells thereby preventing complications (11). Antibody cocktail the receptor-binding domain of the spike glycoprotein of SARS-CoV-2 virus is the main target for neutralising antibodies (12). Casirivimab and Imdevimab are two IgG1 anti-SARS-CoV-2 mABs, for ceasing progression of COVID-19 (7). A combination of antibodies that bind to non overlapping epitopes, rather than a single antibody, is intended to minimise the likelihood of loss of antiviral activity due to naturally circulating viral variants or development of escape mutants under drug pressure (3). In a clinical study in adult outpatients with SARS-CoV-2 infection and risk factors for severe COVID-19, the combination of casirivimab and imdevimab was well tolerated with reduced viral load in the upper airway, shortened the time to symptom resolution and reduced the composite outcome of COVID-19 related admission to hospital or all-cause mortality (4),(5). The combination of casirivimab and imdevimab has also been shown to prevent SARS-CoV-2 infection in previously uninfected household contacts of infected individuals (6). In this study, authors report the outcomes of casirivimab-imdevimab among high-risk population with mild to moderate COVID-19. There have been various studies in the western part of world on antibody cocktail (casirivimab and imdevimab) for the prevention, and its safety and efficacy in COVID-19 (13),(14),(15),(16).

Despite recording one of the highest COVID-19 cases in the world very few studies have been done in Indian population regarding safety, efficacy, and outcomes of the antibody cocktail in COVID-19. This study aims to evaluate the clinical outcome in COVID-19 patients admitted to dedicated COVID-19 hospital-4 of SCB MCH, Cuttack, a tertiary referral medical institution of Odisha, India who were treated with casirivimab and imdevimab. This study is one of the largest retrospective studies evaluating outcomes of patients treated with antibody cocktail.

Material and Methods

This retrospective observational study was conducted on 104 COVID-19 positive patients admitted to dedicated COVID-19 hospital-4 of SCB MCH, Cuttack between June 2021 to January 2022 after getting approval from Institutional Ethics Committee (IEC) stated by letter no. 1047. Data of the patients were collected by past records and telephonically in some cases and the collected data was analysed between May 2022 to June 2022. All consenting patient received Inj. casirivimab (600-mg dose) and Inj. imdevimab (600 mg dose) in 250 mL 0.9% saline infused intravenously over one-hour at our COVID-19 facility. Monitoring of patients vitals was done for 12 hour postinfusion.

Inclusion criteria:

• Age ≥18 years
• Patients diagnosed with COVID-19 from nasopharyngeal swab (both by antigen and Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test).
• High-risk group patients (Age ≥65 years, Body Mass Index (BMI) ≥35 kg/m2, diabetes mellitus, chronic kidney disease, hypertension, cardiovascular disease, chronic lung disease, immunosuppressive medication use, or an immunocompromising condition).
• Should be hospitalised within seven days of onset of COVID-19 symptoms.
• Mild to moderate in severity.

Exclusion criteria:

• Age <18 years.
• Severe COVID-19 infection.
• >7 days of onset of COVID-19 symptoms.
• Pregnant and lactating women.

Study Procedure

All participants of the study who fulfilled the eligibility criteria were explained the objectives and protocols of the study. Informed written consent was taken from the patient or legal guardian of the patient (those unable to give consent due to sickness). In this study, six-basic principle of medical ethics like; beneficence, 6non maleficence, autonomy, justice, dignity and truthfulness and honest was followed. Patient data were collected from their past medical records, prescriptions, investigation reports and telephonic conversations. Proper care was taken for those patients developing any form of reaction from the treatment. The study protocol was approved by IEC. All eligible patients of COVID-19 were approached for counselling and consenting. Demographic parameters (age, sex, BMI), other characteristics (co-morbidity, disease severity and vaccination status) were obtained from the past medical records and by questioning. All routine investigations including CRP-Quantitative, D-Dimer done during initiation of treatment were recorded. Clinical outcomes (duration of hospitalisation, discharge and mortality) were assessed from the medical records. Values of D-Dimer were expressed quantitatively in mg/L FEU (Fibrinogen equivalent units). Patients were stratified into two groups (>1 mg/L FEU n=79) and <1 mg/L;(n=26) FEU) based on quantitative D-DIMER values (17). Based on elevation of CRP levels expressed in mg/L patients were classified into normal, mild, moderate and severe group {mild (n=54), moderate-severe(50)} (18).

Statistical Analysis

Data entry was done using Microsoft excel. Data was entered, coded and analysed using IBM SPSS version 21.0. Proportions were calculated for categorical variables and compared using Chi-square test. Mean and standard deviations were estimated for continuous variables as the measures of central tendency and dispersion, respectively. All analysis was done at a preset alpha error of 5% and results expressed at confidence levels of 95%.


Total 104 eligible cases were taken in the study. The mean age of patients in this study was 53.55±13.92 years. Elderly subjects (>60 years) were 40 (38.5%) in this study while 64 (61.5%) were non elderly (Table/Fig 1). Majority of the subjects were males 68 (65.4%) while females constituted around 36 (34.6%). Majority of the patients of the study group were vaccinated 90 (86.5%). This is explainable due to the massive vaccination drive launched by Government of India. Majority of the cases were classified as mild 94 (90.4%) and rest were moderate 10 (9.6%). Few patients required Low flow oxygen 5 (4.8%) and non invasive ventilation 4 (3.8%) while most of them were at room air 95 (91.4%). Majority of the patients had shorter duration of hospital stay i.e., <1 week 94 (90.4%) and some required prolonged hospitalisation 10 (9.6%) indicating the effects of antibody cocktail in reducing duration of hospitalisation. CRP levels were mildly elevated in 51 (49%) patients, while severe elevation was found in 3 (2.9%) of cases. Majority of the patients had mild elevation of D-dimer 79 (76%) while moderate to severe elevation was found in approximately one quarter of the cases (Table/Fig 2). There were four deaths (3.8%) who are having high titre of CRP demonstrating it as an adverse prognostication marker. Adverse effects of the drugs were recorded in two subjects (1.92%). Vaccinated group had more severe elevation in CRP as compared to unvaccinated group. Subjects with elevated CRP levels were more likely to have prolonged hospitalisation than with normal CRP levels. All patients having moderate-severe elevation of CRP levels required mechanical ventilation in comparison to mild CRP levels. Patients with co-morbidities are more likely to get severe COVID-19 infections than those not having co-morbidties (p-value ≤0.05). Unvaccinated subjects had more likely to have severe infections than vaccinated subjects (p-value ≤0.05). Prolonged hospitalisation (>7 days) was statistically significant in severe COVID-19. Unvaccinated subjects had a statistically significant rise in CRP over vaccinated subjects (Table/Fig 3). To summarise the duration of hospitalisation, and outcomes were superior in patients having mild to moderate elevation of CRP as compared to severe elevation of CRP. Most of the patients did not have any co-morbidites while Type 2 DM combined with hypertension was the single largest co-morbidity found. Malignancies both solid and haematolymphoid malignancies comprised the next major group (Table/Fig 4).


This retrospective study evaluated the outcomes of casirivimab and imdevimab in symptomatic COVID-19 patients and those with co-morbidities. Wood SN reported that COVID-19 fatality has been lowered drastically and are far away from its benign phase (19). Seasonal resurgence of various mutant strains has been a matter of concern especially those elderly and with co-morbidities. The dose recommended varies between 1200 mg-8000 mg (600 mg-4000 mg each antibody) (20),(21). The agents are preferred for mild to moderate COVID-19 patients. In present study population had Type 2 DM and hypertension as the most common morbidities which was also found in similar study by Wang Z et al., which showed hypertension (severe: 33.4%, 95% CI: 25.4%-41.4%; non severe 21.6%, 95% CI: 9.9%-33.3%), followed by diabetes (severe: 14.4%, 95% CI: 11.5%-17.3%; non severe: 8.5%, 95% CI: 6.1%-11.0%) as the major co-morbidity in a systematic review of 4881 cases of COVID-19 (22). Further vaccination status was an important predictor of severity in this study where majority of the patients were vaccinated. This is explainable due to the massive vaccination drive launched by Government of India. This has been also established in other studies done by Freund O et al., which concluded that subjects in the vaccinated group had a significantly low severity, significantly decreased ICU admission and significantly decreased oxygen requirement as compared to the unvaccinated subjects while death and hospital stay were not significantly different in between vaccinated and unvaccinated subjects in a series of 349 patients while Li M et al., in a large retrospective observational study concluded that COVID-19 vaccines were associated with 50-60% reduced risk of severe pneumonia and 70-80% lower risk of severe COVID-19 infection (23),(24).

In a study by Joy AP et al., patients did not showed significant difference of rate of hospitalisation between monoclonal antibody treated group and control group (25). Present study did not have a control group however the majority of subjects on monoclonal antibody did not required prolonged hospitalisation (90.4%). Few patients required Low flow oxygen (4.8%) and NIV (3.8%) while most of them were at room air (91.4%). In the study by Joy AP et al., 6.3% required mechanical ventilation while another study by Bhagyanath T et al., in a series of 201 patients (control group (n=101), test group (n=100) having diabetes with a 10 days follow-up period from India demonstrated a significantly less requirement of oxygen in the test group receiving monoclonal antibody cocktail as compared to standard treatment (26). Joy AP et al., in a comparative observational study of 152 patients (test; casirivimab and imdevimab treated patients, n=79) and control (non casirivimab and imdevimab treated individuals, n=73) observed noticed lesser requisite for mechanical ventilation (6.3%; p-value <0.001), high flow oxygen (5.1%; p-value <0.001) and no death during casirivimab and imdevimab therapy (25),(26). From these two studies one can infer that the requirement of invasive ventilation requirements is much less in the casirivimab and imdevimab treated patients as compared to the general population. The WHO guidelines recommend the antibody cocktail in those group who are likely to have a high rate of hospitalisation and in selective group of patients including elderly age and those suffering from chronic diseases, and unvaccinated subjects (21). The panel also recommends offering antibody cocktail if no detectable SARS-CoV-2 antibodies are detected. (seronegative status). NICE guidelines (UK) recommend against using antibody cocktail against Omicron variant (24).

Evidence gathered from one of the largest randomised clinical trial (recovery) suggest a significant reduction in progression to non invasive ventilation in the seronegative group receiving antibody cocktail as compared to other group receiving standard treatments while no difference was observed in the seropositive group (27),(28). The mortality rate in present group was 4% which was higher as compared to similar study conducted by Razonable RR et al., which compared 696 subjects having mild to moderate COVID-19 with high risk features (hypertension (52.4%), BMI ≥35 (31.0%), diabetes mellitus (24.6%), chronic lung disease (22.1%), chronic renal disease (11.4%), congestive heart failure (6.6%), and compromised immune function (6.7%) ) receiving antibody cocktail to a propensity matched control of equal number of cases and concluded that patients who received casirivimab imdevimab had significantly lower all-cause hospitalisation rates at day 14 (1.3% vs 3.3%; absolute difference: 2.0%; 95% Confidence Interval (CI):0.53.7%), day 21 (1.3% vs 4.2%; absolute difference: 2.9%; 95% CI: 1.24.7%), and day 28 (1.6% vs 4.8%; absolute difference: 3.2%; 95% CI: 1.45.1%). Rates of intensive care unit admission and mortality at days 14, 21 and 28 were similarly low for antibody-treated and untreated groups (12). This could be explained due to larger number of patients having elevated CRP at baseline. No case of anaphylaxis or serious adverse effects was observed. On the contrary, casirivimab and imdevimab are not recommended for COVID-19 patients with hypoxia (29). Overall with monoclonal antibody cocktail, the duration of hospitalisation and overall outcome were superior as compared to general population. Vaccination status was an important predictor of severity of disease requiring prolonged hospitalisation and mechanical ventilation.


Limitations of the study include absence of control group, retrospective nature of the study, limited sample size and heterogenous nature of the population.


The sudden arrival and devastating spread of the COVID-19 pandemic has stimulated an accelerated programme of international research to identify effective ways to limit the spread of infection and to reduce the morbidity and mortality associated with COVID-19. Neutralising mAbs, particularly in combination with other medications, are an attractive approach with potential utility in both prophylactic and treatment settings in high-risk population. Present study demonstrated superior outcomes with antibody cocktail with regards to hospitalisation, requirement of non invasive ventilation or invasive ventilation. On evaluating the post COVID-19 status of each patient in the study, majority of those on the antibody cocktail were healthy and were quite satisfied with the treatment. It will also be important to determine the optimum timing for administration of neutralising mAbs on the basis of viral load, serology and other potential clinical factors. More randomised studies with a greater sample size are required to confirm the findings and prove the efficacy of casirivimab-imdevimab combination.


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DOI and Others

DOI: 10.7860/JCDR/2023/59143.17392

Date of Submission: Jul 18, 2022
Date of Peer Review: Aug 20, 2022
Date of Acceptance: Nov 02, 2022
Date of Publishing: Feb 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• 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 X-checker: Jul 20, 2022
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