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

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Dr Mohan Z Mani

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Dr Mohan Z Mani,
Professor & Head,
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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.
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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 : OC10 - OC15 Full Version

Comparison of Monoclonal Antibody Cocktail (Casirivimab-Imdevimab) Treatment With Remdesivir and Favipiravir in Mild to Moderate COVID-19 Infection: A Retrospective Study

Published: February 1, 2023 | DOI:
Rahul Rajaram Tambe, Anupa Resham Ashok Hinduja, Harshad Limaye, Ashwini Jogade, Aishwarya Pillai, Astha Trivedi

1. Senior Consultant and Head, Department of Internal Medicine, Dr. Balabhai Nanavati Hospital, Mumbai, Maharashtra, India. 2. Clinical Associate, Department of Internal Medicine, Dr. Balabhai Nanavati Hospital, Mumbai, Maharashtra, India. 3. Senior Consultant, Department of Internal Medicine, Dr. Balabhai Nanavati Hospital, Mumbai, Maharashtra, India. 4. Medical Superintendent, Department of Medical Administration, Dr. Balabhai Nanavati Hospital, Mumbai, Maharashtra, India. 5. Resident Medical Officer, Department of Internal Medicine, Dr. Balabhai Nanavati Hospital, Mumbai, Maharashtra, India. 6. Resident Medical Officer, Department of Internal Medicine, Dr. Balabhai Nanavati Hospital, Mumbai, Maharashtra, India.

Correspondence Address :
Dr. Anupa Resham Ashok Hinduja,
106, Palm View, Opp. Akash Building, Sarojini Naidu Road, Santacruz West, Mumbai-400054, Maharashtra, India.


Introduction: Favipiravir and remdesivir are antiviral drugs being used in the COVID pandemic and were also used previously for other viral infections in the past. Monoclonal antibody (Mab) Casirivimab-Imdevimab is a Coronavirus Disease 2019 neutralising antibody approved in the last one year. Therefore, a clinical comparison with the existing treatment modalities is imperative.

Aim: To compare Mab with remdesivir and favipiravir for mild to moderate COVID-19 disease.

Materials and Methods: A retrospective, observational and single-centre study was conducted at a COVID-19 infection facility and private tertiary care hospital, Mumbai, Maharashtra, India. Data of patients admitted during the period of 1st June 2021 to 31st August 2021 was collected and analysed in the months of September 2021 and October 2021. Adults participants diagnosed to have COVID-19 infection, not requiring critical care or oxygen therapy were included in the study. Time to recovery from treatment onset and the need for treatment escalation were the primary outcome measures. Data was entered into Microsoft excel spreadsheet version 16 and analysed. Statistical analysis was carried out using Chi-square test for the significance of association between tabulated values of data for qualitative and categorical data. Two-tailed unpaired t-test and Analysis of Variance (ANOVA) was used for quantitative tabulated data.

Results: This study included 158 participants, grouped into remdesivir (n=63), favipiravir (n=30) and Mab (n=65) treatment groups. Gender distribution was comparable in all groups (p-value=0.08). The three groups were compared for need of treatment escalation and time of recovery. The Mab treatment group (on comparing with other treatment arms) had earlier symptom recovery when given to patients with mild COVID-19 disease (p-value=0.006 for major symptoms) or when treatment was started within five days of symptom onset (p-value <0.001). Patients in Mab treatment group with mild illness required no treatment escalation compared to other groups (p-value=0.011). However, time to recovery patients in all treatment groups was comparable in case of patients with moderate COVID-19 illness (p-value=0.7381). In patients with moderate COVID-19 illness Mab treatment group required more frequent treatment escalation compared to remdesivir treatment group (p-value=0.044), when treatment was started within 5 days of symptom onset remdesivir and mab were comparable for treatment escalation (p-value=0.144). Vaccination status of the three groups differed significantly (p-value=0.033) hence a further subanalysis was done. On further analysis, non vaccinated patients receiving Mab recovered from minor symptoms (p-value=0.0006) earlier than those receiving Remdesivir. Amongst the participants of the Mab treatment-group, vaccinated and non-vaccinated patients had comparable recovery time and need for treatment escalation (p-value=0.57 and p-value=0.76, respectively). Participants who received Mab-treatment within five days of symptom onset; recovered earlier compared to those who received Mab treatment after five days (p-value=0.019).

Conclusion: Monoclonal antibody treatment group compared to the other treatment groups had earlier recovery in non vaccinated patients, mild COVID-19 disease, and when treatment was started before or on the 5th day of symptom onset.


Antiviral, Coronavirus disease 2019, Recovered, Vaccination

Since the onset of the Coronavirus Disease 2019 (COVID-19) pandemic, several treatment modalities have been tried (1),(2). Drugs like remdesivir continue to be in use (2),(3). Whereas, other treatment modalities namely ivermectin and hydroxychloroquine were withdrawn (3). Various antibody treatments have been introduced, such as the two novel antibody (nAb) cocktails {Casirivimab-Imdevimab Monoclonal antibody (Mab) cocktail and Bamlanivimab-Etesevimab} and one nAb monotherapy (Bamlanivimab) (4). These treatment modalities have been granted Emergency Use Authorisation (EUA) by the United States (US) Food and Drug Administration (FDA) and the European Medicines Agency for the treatment of ambulatory patients who have a high-risk of progressing to severe disease (3),(4). As Mab is a neutralising therapy, the efficacy of Mab in patients with severe COVID-19 patients have been varied (4),(5). However, early data suggest a promising role for nAbs/Mab in preventing COVID-19 progression, and hence it has been incorporated in the Infectious Diseases Society of America (IDSA) guidelines for susceptible variants (3). The Monoclonal antibody (Mab) cocktail is suggested to prevent disease progression and reduce morbidity and mortality (4),(5).

Recent clinical data have demonstrated the clinical activity of remdesivir in terms of faster time to recovery in patients with severe COVID-19 and higher Odd’s ratio of improved clinical status in patients with moderate COVID-19 (6). Remdesivir is approved by IDSA for mild to moderate disease patients, who are at risk of progression to severe disease (7). Favipiravir, an antiviral drug has been used for treating COVID-19 in several countries including Japan, Russia, China and India, under emergency provisions for the initial wave of COVID-19 (8),(9),(10),(11).

As remdesivir and favipiravir are two common drugs used in the country for COVID-19 illness (11),(12); this study aimed to compare the effect of remdesivir and favipiravir with that of Mab treatment in terms of mortality, recovery time from onset of treatment, and progression to severe or critical disease.

Material and Methods

The present retrospective, observational and single-centre study was conducted at a COVID-19 infection facility, Dr. Balabhai Nanavati Hospital, a tertiary care hospital in Mumbai, Maharashtra, India. Data of patients admitted to the facility from 1st June 2021 to 31st August 2021 was accessed from institutional medical records from September 2021 to October 2021, after procuring ethical clearance from Institutional Ethical Committee (IEC No: BNH/90/2021).

Inclusion criteria: Adults (18 years and above) with mild to moderate COVID-19 disease with laboratory confirmed (Real time-polymerase chain reaction or rapid antigen test) COVID-19 infection, not requiring oxygen therapy at the time of admission were included in the study.

Exclusion criteria: Patients having an interval of more than 10 days between the onset of symptoms and onset of treatment and pregnant females were excluded from the study.

Study Procedure

The data was divided into three groups based on the choice of treatment given (remdesivir, Mab and favipiravir). Each group included mild and moderate severity patients. Subanalysis for each severity was done separately. Treatment choice was decided by the treating physician and the patient. Patients receiving Mab were admitted in the Inpatient Department for logistic reasons. As per state (11) and central government (12) treatment guidelines, favipiravir was used for mild to moderate cases until 10 days of symptom onset for those at low risk of progression to severe disease. Remdesivir was reserved for moderate severity COVID-19 illness as per guidelines (11). However, at the institutional level it was also used for mild patients with high-risk of progression to severe disease. Mab was introduced at the institutional level on 1st June 2021. As per international guidelines (IDSA) it was reserved for patients with mild to moderate severity COVID-19 with high-risk of progression to severe disease (7). As the cost of Mab was high, it was a factor that influenced the selection of treatment choice for patients.

Mortality, time to recovery from symptoms (absence of symptoms), and delayed recovery or worsening (reported through the need for treatment escalation) were the primary outcomes. Patients were defined as mild or moderate COVID-19 disease as per National Institute of Health guidelines (13).

For purposes of statistical analysis, patients in each treatment group were classified as those having mild symptoms and those having 11moderate symptoms (patients with severe symptoms were not included in the study). Cough, fever, breathlessness was counted as major symptoms. Malaise and weakness that lingered on for many days for a few patients were considered minor symptoms. Variables that were further evaluated included time to treatment from symptom onset (≤5 days vs >5 days) and status of vaccination (fully vaccinated vs not vaccinated).

Patients were defined as vaccinated, when vaccinated with two doses as per regional guidelines with either CovishieldR (adenovirus ChAdOx1) or CovaxinR (BBV152) COVID-19 vaccines (14). Vaccination status was taken into consideration only when 15 days had elapsed after the last dose of vaccination (15). A separate analysis was done for patients who had completed two doses of COVID-19 vaccination.

Missing data: Initially there were 64 participants in remdesivir group and 66 in Mab group. One patient from the remdesivir and Mab group, each was excluded due to insufficient data, making it 63 in remdesivir group and 65 in Mab group.

Sample size calculation: Alpha error was considered to be 0.05%, Power of the study was taken as 80%. As no previous data was available for comparison between remdesivir, favipiravir, and Mab, a pilot study was conducted, and mean values of time to recovery for symptom resolution from treatment onset for remdesivir and Mab treatment group, from the study were taken (Mean time to recovery from symptoms for Mab group with 10 patients 3±2.89, mean for remdesivir 5.3±3.13). The sample size was hence calculated as 25 minimum in each group (16).

Statistical Analysis

Data were recorded and tabulated in Microsoft excel spreadsheet version 16. Chi-square test was used to test the significance of association between tabulated values of data and qualitative, categorical data (17). Two-Tailed unpaired t-test and ANOVA analyses were used to compare differences between the mean of quantitative measurements [18,19]. A two-sided p-value of <0.05 was considered statistically significant.


The present retrospective study comprised a total of 158 participants. Data were grouped into three treatment groups; i.e. remdesivir (n=63), favipiravir (n=30) and Mab (n=65) treatment group. Gender distribution was comparable in all groups (p-value=0.08). Remdesivir group had more moderate severity patients and Mab treatment group had more mild severity COVID-19 patients when compared with other treatment groups (p-value <0.001). Patients of Mab treatment group were significantly older (p-value <0.0001) with more co-morbidities and favipiravir treatment group had younger participants (Table/Fig 1). All groups were comparable for major symptom distribution (p-value=0.062).

Mab treatment group recovered earlier when compared to other groups for major symptoms (p-value=0.0011). The number of patients requiring treatment escalation was higher in the favipiravir group when compared to the Mab and remdesivir groups (p-value=0.005). Prevalence of secondary infection during treatment for COVID-19 illness was comparable in all three groups (p-value=0.455) (Table/Fig 2).

Mab group had a statistically significant shorter time to recovery when treatment was started ≤5 days after symptoms onset (p-value <0.002). Favipiravir required a more frequent escalation of treatment compared to the other two groups when treatment was initiated on the 5th day from symptom onset or before (p-value=0.0033) (Table/Fig 3).

In the subgroup of patients with mild symptoms: Overall time to recovery was statistically better in the Mab group compared to the favipiravir and remdesivir groups (p-value=0.006). The number of patients requiring treatment escalation was higher in the favipiravir group. Compared to the Mab group, remdesivir groups had more requirement of treatment escalation (p-value=0.011).

Further analysis was done for mild COVID-19 subgroup for patients whose treatment was initiated ≤5th day of symptom onset. The lag between symptom onset and treatment onset was comparable in all three groups (p-value=0.18). Participants of Mab group recovered earlier than those of remdesivir and favipiravir group (Major symptoms: p-value <0.001, Minor symptoms p-value=00.014). Favipiravir required more frequent treatment escalation (p-value=0.011), whereas no participant of Mab and remdesivir required any escalation of treatment (Table/Fig 3).

In the subgroup of patients with moderate symptoms: Overall time of recovery was the same in all three treatment groups (Major symptoms, p-value=0.738, Minor symptoms, p-value=0.075, (Table/Fig 4)a, and this was not affected when the treatment was started earlier i.e., ≤5 days (major symptoms, p-value=0.59, minor symptoms, p-value=0.47, (Table/Fig 4)b.

Compared to remdesivir treatment group, Mab and favipiravir treatment group required more frequent treatment escalation (p-value=0.007), (Table/Fig 4). In moderate subgroup where treatment was initiated within 5 days of symptom onset escalation of treatment was less frequently required in remdesivir group. However, statistically requirement of escalation was comparable in Mab and remdesivir group but still significantly higher in favipiravir group (p-value=0.0017, (Table/Fig 4)b).

Subanalysis of the group Mab: No difference was found in vaccinated and non vaccinated patients of the Mab treatment group when compared for the need of treatment escalation and symptom recovery. Mab treatment group participants whose treatment started on the 5th day or before had earlier symptom recovery compared to Mab patients who received treatment later. Both groups were comparable for the need for escalation of treatment (Table/Fig 5).

Subanalysis of vaccinated vs non vaccinated participants: In the vaccinated subgroup, symptom recovery was comparable in all three treatment groups (p-value=0.199); however, treatment escalation was more likely to be needed in the favipiravir group compared to the other two groups (p-value=0.0017). In the non vaccinated subgroup, symptom recovery was earlier in the Mab-treatment group (Major symptoms: p-value=0.0001, Minor symptoms p-value=0.00016) (Table/Fig 6).


In this present study, a total of 158 participants were included and all had mild to moderate COVID-19 infection. All patients were admitted to the Inpatient Department, despite Casirivimab and imdevimab being authorised for Outpatient Department use due to logistic reasons and as per request of the participants. Participants of Mab group were significantly elder with more co-morbidities, as is the case in other Mab studies too (20). This is because the drug was initially authorised for adults ≥65 years or with co-morbidities or any other risk for progression to severe disease (21).

Casirivimab and imdevimab are human Immunoglobulin G-1 (IgG1) monoclonal antibodies and are explicitly directed against the spike protein of COVID-19. These prevent the virus from attaching to and entering human cells and thus affecting the progression of disease (22).

In the case of remdesivir, the Ribonucleic Acid (RNA)-dependent RNA polymerase of COVID-19 arrest of RNA synthesis occurs after the incorporation of three additional nucleotides (23). Remdesivir is classified as a direct-acting antiviral agent that works as a delayed chain terminator (23), arresting viral replication. To the best of authors knowledge there is no study that analyses and compares the three drugs; favipiravir, remdesivir and Mab. Since the ultimate purpose of these drugs is to arrest viral replication, it would be pertinent to compare them.

All participants of this study at the time of treatment onset were haemodynamically stable with no requirement for oxygen or non invasive ventilation (except in cases like Obstructive Sleep Apnea or those who required it even before infection with COVID-19). Mab and favipiravir-treatment group had more mild cases compared to remdesivir-treatment group. As per the Indian Ministry of Health and Family Welfare guidelines (12) guidelines, remdesivir is recommended for patients having some lung involvement or having moderate to severe disease, hence the group had a greater number of patients having moderate COVID-19 infection.

There were two cases of mortality in the Mab treatment group compared to none in the other treatment groups. Of these one of them died due to reasons other than COVID-19 disease. This particular patient had diabetic foot with sepsis along with COVID. The other patient had developed secondary infection during the course of COVID-19 treatment and thus succumbed. As the sample size is limited, it was hence difficult to compare the three groups for risk of mortality.

In the present study for the moderate COVID-19 subgroup, Mab and Remdesivir were comparable for symptom recovery and need for escalation when treatment was initiated within 5 days of symptom onset. Spinner CD et al., (2) randomised patients to a 5-day course of remdesivir, and found a statistically significant difference in clinical status compared with standard care for patients with moderate COVID-19 disease (2). In a Lancet study, among high-risk patients with mild to moderate COVID-19, Casirivimab–imdevimab treatment was associated with a significantly lower rate of hospitalisation and a thus lower rate of progression of the disease (24).

As per guidelines Mab and remdesivir, both are to be given within 10 days of symptom onset (25),(21). Hence, the present study compared if there was any benefit of starting treatment with Mab within the first five days, vs later. In the present study, Mab treatment group patients whose treatment started on the 5th day or before had earlier symptom recovery compared to Mab treatment group patients who received treatment later. When compared to the remdesivir treatment group, Mab-treatment group fared better than the remdesivir group for the duration/time to symptom recovery, when both had treatment onset within five days of symptoms. Patients with mild COVID-19 disease having received Mab treatment also fared better when compared to mild COVID-19 disease patients who received remdesivir in terms of recovery of symptoms as well as progression of disease. Another study also report that the antibody cocktail of Casirivimab and imdevimab significantly shortened the duration of symptoms by four days (with a median of 10 vs 14 days to clinical improvement (p-value <0.0001). The improvement was best seen among those having baseline negative COVID-19 antibodies (22).

There is very scarce data for comparison of COVID-19 treatment in those patients who have received the COVID-19 vaccination vs the non vaccinated patients. Non vaccinated patients receiving Mab or favipiravir treatment recovered earlier than the remdesivir group but the need for escalation was comparable in all three treatment groups. In the vaccinated subgroup, all three treatment groups had comparable symptom recovery, this could be because vaccination itself is said to reduce the disease severity (24). No difference was found in vaccinated and non vaccinated patients of the Mab group when compared for the need of treatment escalation and symptom recovery. No participant of this study had any adverse event related to any of the drugs used.

To the best of authors knowledge, this is the first study that compares Mab therapy with other treatment modalities. All the other previous studies compare each modality with a placebo therapy. Also, authors believe that the present study is the first study to include the subanalysis of COVID-19 vaccinated versus non vaccinated participants and compare the treatment response with various treatment modalities available.


The sample size was small and it was a retrospective study. The Mab treatment group had more elderly patients with co-morbidities. These could be confounding factors when analysing the response to treatment and progression of disease of COVID-19 patients. Larger sample size and randomisation of patients would make further subanalysis possible with age and individual co-morbidities and this would help to fully understand the benefit of this cocktail drug. As genomic sequencing was not possible, different variants of COVID-19 virus were not assessed.


As per the study findings, the recovery from symptoms was earlier when treated with Mab treatment therapy for patients with mild COVID-19 disease or when treatment onset was ≤5 days from symptom onset. Although the numbers were small no patient in the Mab treatment group required escalation of treatment in the mild group compared to the other treatment groups. Secondly, patients in the moderate COVID-19 disease subgroup receiving Mab vs remdesivir treatment had comparable recovery time and disease progression. Non vaccinated patients receiving Mab therapy recovered from minor symptoms earlier than the remdesivir treatment group. No difference was found in COVID-19 vaccinated and unvaccinated patients of the Mab-treatment group when compared for the need of treatment escalation and symptom recovery. Hence, authors recommend use of monoclonal antibody therapy for all patients with mild disease and when symptom duration is five days or less.


Authors would like to acknowledge a few colleagues and seniors without whom this study would not have been possible. First and foremost, authors would like to acknowledge, Dr. Deepak Patkar, who always encouraged at every step of this study. Authors would also like to thank the medical records department for being patient. Last but not the least authors would like to thank their family and friends who were patiently with them and helped to proofread the document.


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DOI and Others

DOI: 10.7860/JCDR/2023/57428.17402

Date of Submission: Apr 29, 2022
Date of Peer Review: Jun 24, 2022
Date of Acceptance: Sep 26, 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? No
• For any images presented appropriate consent has been obtained from the subjects. No

• Plagiarism X-checker: May 05, 2022
• Manual Googling: Sep 19, 2022
• iThenticate Software: Sep 23, 2022 (7%)

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