TREATMENT OF COVID-19 WITH CASIRIVIMAB/INDEVIMAB IN A PATIENT WITH CERVICAL SPINE INJURY: A CASE REPORT

  • Miljana Vrhovac University Clinical Center of Serbia, COVID Hospital Batajnica, Belgrade, Serbia
  • Tijana Stanišić University Clinical Center of Serbia, COVID Hospital Batajnica, Belgrade, Serbia; University Clinical Center of Serbia, Centre for Physical Medicine and Rehabilitation, Belgrade, Serbia
  • Milan Mirković Institute for Orthopedic Surgery “Banjica”, Belgrade, Serbia
  • Jelena Veličković University Clinical Center of Serbia, COVID Hospital Batajnica, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia; University Clinical Center of Serbia, Centre for Anesthesiology and Reanimation, Belgrade, Serbia
  • Sead Dalifi University Clinical Center of Serbia, COVID Hospital Batajnica, Belgrade, Serbia; University Clinical Center of Serbia, Clinic for Pulmonology, Belgrade, Serbia
  • Danilo Jeremić Univerzitet u Beogradu, Medicinski fakultet, Beograd, Srbija; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Filip Pilipović Institute for Orthopedic Surgery “Banjica”, Belgrade, Serbia
  • Tatjana Adžić-Vukičević University Clinical Center of Serbia, COVID Hospital Batajnica, Belgrade, Serbia; University Clinical Center of Serbia, Centre for Anesthesiology and Reanimation, Belgrade, Serbia; University Clinical Center of Serbia, Clinic for Pulmonology, Belgrade, Serbia
DOI: https://doi.org/10.5937/smclk6-55371
Keywords: COVID-19, casirivimab/indevimab, monoclonal antibody therapy, cervical spine injury

Abstract


Introduction/Aim: We present a patient suffering from COVID-19 with a cervical spine injury who was treated with the antiviral drug casirivimab/indevimab (Regen-CoV), monoclonal antibodies for COVID-19, during hospital treatment at the Batajnica Hospital of the University Clinical Center of Serbia.

Case report: The administration of the drug casirivimab/indevimab (Regen-CoV) prevented the development of a more severe picture of Covid-19 and led to the rapid negativization of the nasopharyngeal swab for SARS-CoV-2 in our patient who had a cervical spine injury. The patient underwent successful cervical spine surgery at the Institute for Orthopedic-Surgical Diseases in Banjica, which led to the recovery of the neurological deficits he had previously.

Conclusion: We showed another significant indication for using casirivimab/indevimab (Regen-CoV) in hospital conditions, which was off-label according to therapeutic protocols.

References

Weinreich DM, Sivapalasingam S, Norton T, Ali S, Gao H, Bhore R, et al. Trial Investigators. REGEN-COV antibody combination and outcomes in outpatients with Covid-19. N Engl J Med. 2021 Dec 2;385(23):e81. doi: 10.1056/NEJMoa2108163.

COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines [Internet]. Bethesda (MD): National Institutes of Health (US); 2021 Apr 21 – 2024 Mar 1 [cited 2022 Mar 16]. Available from: https://www.covid19treatmentguidelines.nih.gov/.

Blanco-Melo D, Nilsson-Payant BE, Liu WC, Uhl S, Hoagland D, Møller R, et al. Imbalanced host response to SARS-CoV-2 drives development of COVID-19. Cell. 2020 May 28;181(5):1036-45.e9. doi: 10.1016/j.cell.2020.04.026.

Weinreich DM, Sivapalasingam S, Norton T, Ali S, Gao H, Bhore R, et al. Trial Investigators. REGN-COV2, a neutralizing antibody cocktail, in outpatients with Covid-19. N Engl J Med. 2021 Jan 21;384(3):238-51. doi: 10.1056/NEJMoa2035002.

Wang Q, Zhang Y, Wu L, Niu S, Song C, Zhang Z, et al. Structural and functional basis of SARS-CoV-2 entry by using human ACE2. Cell. 2020 May 14;181(4):894-904.e9. doi: 10.1016/j.cell.2020.03.045.

Baum A, Ajithdoss D, Copin R, Zhou A, Lanza K, Negron N, et al. REGN-COV2 antibodies prevent and treat SARS-CoV-2 infection in rhesus macaques and hamsters. Science. 2020 Nov 27;370(6520):1110-5. doi: 10.1126/science.abe2402.

Yan R, Zhang Y, Li Y, Xia L, Guo Y, Zhou Q. Structural basis for the recognition of SARS-CoV-2 by full-length human ACE2. Science. 2020 Mar 27;367(6485):1444-8. doi: 10.1126/science.abb2762.

Copin R, Baum A, Wloga E, Pascal KE, Giordano S, Fulton BO, et al. The monoclonal antibody combination REGEN-COV protects against SARS-CoV-2 mutational escape in preclinical and human studies. Cell. 2021 Jul 22;184(15):3949-61.e11. doi: 10.1016/j.cell.2021.06.002.

Ballotta L, Simonetti O, D’Agaro P, Segat L, Koncan R, Martinez-Orellana P, et al. Case report: Long-lasting SARS-CoV-2 infection with post-COVID-19 condition in two patients with chronic lymphocytic leukemia: the emerging therapeutic role of casirivimab/imdevimab. Front Oncol. 2022 Sep 30;12:945060. doi: 10.3389/fonc.2022.945060.

Palomba E, Carrabba M, Zuglian G, Alagna L, Saltini P, Fortina V, et al. Treatment of SARS-CoV-2 relapse with remdesivir and neutralizing antibodies cocktail in a patient with X-linked agammaglobulinaemia, Int J Infect Dis. 2021 Sep;110:338-40. doi: 10.1016/j.ijid.2021.07.064.

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 Aug 21;369(6506):1014-8. doi: 10.1126/science.abd0831.

Gilbert DN, Chambers HF, Saag MS, Pavia AT, Boucher HW, Sanford JC. The Sanford guide to antimicrobial therapy. 52nd ed. Sperryville, VA, USA: Antimicrobial Therapy, Inc; 2022. 317 p.

Drożdżal S, Rosik J, Lechowicz K, Machaj F, Szostak B, Przybyciński J, et al. An update on drugs with therapeutic potential for SARS-CoV-2 (COVID-19) treatment. Drug Resist Updat. 2021 Dec;59:100794. doi: 10.1016/j.drup.2021.100794.

O'Brien MP, Forleo-Neto E, Musser BJ, Isa F, Chan KC, Sarkar N, et al. Covid-19 Phase 3 Prevention Trial Team. Subcutaneous REGEN-COV Antibody Combination to Prevent Covid-19. N Engl J Med. 2021 Sep 23;385(13):1184-95. doi: 10.1056/NEJMoa2109682.

Centers for Medicare and Medicaid Services. CMS adult elective surgery and procedure recommendations: limit all non-essential planned surgeries and procedures, including dental, until further notice [Internet]. 2020 March 15 [accessed 2020 April 1]. Available from: https://www.cms.gov/files/document/31820-cms-adult-elective-surgery-and-procedures-recommendations.pdf

American College of Surgeons. ACS recommendations for management of elective surgical procedures [Internet]. 2020 March 13 [accessed 2020 April 1]. Available from: https://www.facs.org/media/b04pkoxp/recommendations_for_management_of_elective_surgical_procedures.pdf

Moletta L, Pierobon ES, Capovilla G, Costantini M, Salvador R, Merigliano S, et al. International guidelines and recommendations for surgery during Covid-19 pandemic: a systematic review. Int J Surg. 2020 Jul;79:180-8. doi: 10.1016/j.ijsu.2020.05.061.

American College of Surgeons, American Society of Anesthesiologists, Association of periOperative Registered Nurses, American Hospital Association. Joint statement: roadmap for resuming elective surgery after COVID-19 pandemic [Internet]. 2020 April 16 [accessed 2020 April 22]. Available from: https://www.asahq.org/about-asa/newsroom/news-releases/2020/04/joint-statement-on-elective-surgery-after-covid-19-pandemic/.

Jain NS, Alluri RK, Schopler SS, Hah R, Wang JC. COVID-19 and spine surgery: a review and evolving recommendations. Global Spine J. 2020 Aug;10(5):528-33. doi: 10.1177/2192568220923655.

Idrizi A, Gordon AM, Lam A, Conway C, Saleh A. The effect of the coronavirus disease 2019 (COVID-19) pandemic on elective cervical spine surgery utilization and complications in the United States: a nationwide temporal trends analysis. World Neurosurg. 2023 Feb;170:e1-8. doi: 10.1016/j.wneu.2022.07.095.

Surachman AJD, Yanuarso, Akbar DL. Emergency decompression and stabilization of 1st thoracic spinal cord injury and sacral fracture in a Covid-19 patient: a case report. Int J Surg Case Rep. 2021 Apr;81:105670. doi: 10.1016/j.ijscr.2021.105670.

Fehlings MG, Vaccaro A, Wilson JR, Singh A, Cadotte DW, Harrop JS, et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One. 2012;7(2):e32037. doi: 10.1371/journal.pone.0032037.

RECOVERY Collaborative Group. Casirivimab and imdevimab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet. 2022 Feb 12;399(10325):665-76. doi: 10.1016/S0140-6736(22)00163-5.

Miyashita N, Nakamori Y, Ogata M, Fukuda N, Yamura A, Ishiura Y. Clinical efficacy of casirivimab-imdevimab antibody combination treatment in patients with COVID-19 Delta variant. J Infect Chemother. 2022 Sep;28(9):1344-6. doi: 10.1016/j.jiac.2022.05.012.

Published
2025/04/09
Issue
Vol. 6 No. 1 (2025): Serbian Journal of the Medical Chamber
Section
Case reviews