Coronavirus disease 2019 in an elderly patient who became severely ill despite antibody cocktail therapy but improved with lung-protective management: A case report

  • Authors

    • Eriko Mitsutome JA Onomichi general hospital
    • Kazunobu Une JA Onomichi general hospital
    • Ryuichi Nakanuno JA Onomichi general hospital
    2022-06-07
    https://doi.org/10.14419/ijm.v10i1.32070
  • Antibody-Cocktail, Covid-19, Elderly, Lung Injury.
  • Casilivimab/imdevimab, called antibody cocktail therapy, is a treatment for mildly and moderately ill COVID-19 patients. In our care facility, we encountered an elderly patient treated with an antibody cocktail after being diagnosed with a moderate disease at the initial presentation that became severe. An 80-year-old man with a history of diabetes, hypertension, and cerebral infarction presented with a 5-day history of fever and was diagnosed with coronavirus disease 2019. He was diagnosed with moderate disease and immediately ad-ministered the antibody cocktail therapy. However, his respiratory status deteriorated rapidly, and mechanical ventilation was initiated. We performed lung-protective ventilation, centered on low tidal volume and prone position therapy, with good outcomes. Throughout the pandemic, his case, as well as others, highlighted that immediate intervention for mild and moderate cases and intensive treatment, such as lung-protective ventilation and prone position, for severe cases improved patient outcomes.

     

     

     


  • References

    1. [1] C. Huang, Y. Wang, X. Li, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 395 (2020) 497–506 https://doi.org/10.1016/S0140-6736(20)30183-5.

      [2] Ministry of Health, Labour and Welfare. About special approval of novel coronavirus therapeutic agents [Press release: 2021.7.19]. Retrieved from: https://www.mhlw.go.jp/content/11123000/000807746.pdf (in Japanese).

      [3] M. Dougan, A. Nirula, M. Azizad, et al. Bamlanivimab plus etesevimab in mild or moderate Covid-19. N. Engl. J. Med. 385 (2021) 1382–1392 https://doi.org/10.1056/NEJMoa2102685.

      [4] Chugai Pharmaceutical Co., Ltd. Casiribimab/Imdebimab intravenous Infusion Set, Package insert. July.2021 description (https://chugai-pharm.jp/content/dam/chugai/product/ron/div/pi/doc/ron_pi.pdf).

      [5] C. Guérin, J. Reignier, J.C. Richard, et al. Prone positioning in severe acute respiratory distress syndrome. N. Engl. J. Med. 368 (2013) 2159–2168 https://doi.org/10.1056/NEJMoa1214103.

      [6] L. Munshi, L. Del Sorbo, N.K.J. Adhikari, et al. Prone position for acute respiratory distress syndrome. A systematic review and meta-analysis. Ann. Am. Thorac. Soc. 14 (2017) S280–S288 https://doi.org/10.1513/AnnalsATS.201704-343OT.

      [7] L. Gattinoni, P. Taccone, E. Carlesso, et al. Prone position in acute respiratory distress syndrome. rationale, indications, and limits. Am. J. Respir. Crit. Care Med. 188 (2013) 1286–1293 https://doi.org/10.1164/rccm.201308-1532CI.

      [8] E.L. Scholten, J.R. Beitler, G.K. Prisk, et al. Treatment of ARDS with prone positioning. Chest. 151 (2017) 215–224 https://doi.org/10.1016/j.chest.2016.06.032.

      [9] L. Brochard, A. Slutsky, A. Pesenti. Mechanical ventilation to minimize progression of lung injury in acute respiratory failure. Am. J. Respir. Crit. Care Med. 195 (2017) 438–442 https://doi.org/10.1164/rccm.201605-1081CP.

      [10] A. Coppo, G. Bellani, D. Winterton, et al. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. Lancet Respir. Med. 8 (2020) 765–774 https://doi.org/10.1016/S2213-2600(20)30268-X.

      [11] Y. Wang, D. Zhang, G. Du, et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet. 395 (2020) 1569–1578.

      [12] Brochard L, Slutsky A & Pesenti A (2017), Mechanical Ventilation to Minimize Progression of Lung Injury in Acute Respiratory Failure. American journal of respiratory and critical care medicine 195, 438-442. https://doi.org/10.1164/rccm.201605-1081CP.

      [13] Chugai Pharmaceutical Co., Ltd. Casiribimab/Imdebimab intravenous Infusion Set, Package insert. July.2021 description (https://chugai-pharm.jp/content/dam/chugai/product/ron/div/pi/doc/ron_pi.pdf).

      [14] Coppo A, Bellani G, Winterton D, Di Pierro M, Soria A, Faverio P, Cairo M, Mori S, Messinesi G, Contro E, Bonfanti P, Benini A, Valsecchi MG, Antolini L & Foti G (2020), Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. The Lancet Respiratory Medicine 8, 765-774. https://doi.org/10.1016/S2213-2600(20)30268-X.

      [15] Dougan M, Nirula A, Azizad M, Mocherla B, Gottlieb RL, Chen P, Hebert C, Perry R, Boscia J, Heller B, Morris J, Crystal C, Igbinadolor A, Huhn G, Cardona J, Shawa I, Kumar P, Adams AC, Van Naarden J, Custer KL, Durante M, Oakley G, Schade AE, Holzer TR, Ebert PJ, Higgs RE, Kallewaard NL, Sabo J, Patel DR, Dabora MC, Klekotka P, Shen L, Skovronsky DM, Amin F, Azizad M, Belden K, Boscia J, Bukhman Y, Cardona J, Chen P, Cook P, Crystal C, Dougan M, Fischer W, Glassberg J, Gottlieb RL, Herbert C, Huang H, Huhn G, Kingsley J, Kumar P, Malik A, Malvestutto C, Milligan P, Mocherla B, Mohseni R, Morris J, Nathan R, Pitrak D, Purow J, Ramesh M, Sachdeva Y, Schwartz A, Shawa I, Sobh N, Stosor V, Thompson C, Verma O, West EK, Wheeler D, Winnie M, Zeno B, Sullivan K, Hall K, Nakatani L, Bitar F, Toven J, Gutierrez H, Brown M, Johnson T, Flores T, Palarca J, Flores E, Miller C, Silva L, Forte D, Gardner D, Moreno B, Lopez E, Martini N, Beck K, Hawkins J, Maldonado V, Duff L, Martinez T, Bachowska J, Barcena S, Murray D, Filus J, Fajardo J, Reyes T, Salvador J, Garrett JS, Holmes M, Spak C, Burris S, Baker R, Bassett S, Brock E, Carino G, Clariday L, Coleman T, Davis A, Hurutado-Rodriguez M, Fowlks A, Iram N, Jerrow J, Jones F, Jones T, Leonard K, Lusk E, Martits-Chalangari K, Patel C, Perez S, Ramirez N, Robert R, Robinson D, Ryan M, Villa S, Wang S, Killian AD, Soliz Palacios A, Solia EJ, Youree B, Albright N, Ashraf A, Avirineni A, Bista D, Darwin A, Duraiswamy SS, Gautam S, Lalani E, Mathew S, McDonald C, Moise D, Ni J, Nwagbara W, Nwelue I, Oubre A, Paika H, Ramarathnam V, Rasheed N, Baldridge J, Brown S, Cheyne T, Garcia S, Perez K, Vaughan F, Washington D, Wiemann N, Berihun E, Mullen S, Rao S, Yarger T, Davis S, Engle R, Johnson B, Boudreau A, Buckner R, Duque K, Garcia B, Thammavong J, Wallace M, Cullen J, Ferdosian S, Joshi H, Samuelson C, Stacey A, Thomas AC, Tran M, Tobleman W, Bent N, Quezada T, Sutton C, Zoelle E, Berg A, Bayoumi E, Caudill A, Clapham G, Falk J, Frishberg D, Gellepis B, Herrera L, Hindoyan N, Huynh C, Jackman S, Jawanda H, Kissell E, Matusov Y, Mehdikhani S, Parimon T, Pascual E, Tapson V, Torbati S, Zaman T, Wynter T, Ebuh J, Galdamez D, Greer B, Espinoza D, Davis H, Benfield M, Shetley T, Barefoot C, Turner P, Bourque J, Comeaux M, Guillory D, Ingalls B, Lee C, Liprie S, Moss S, Prather P, Rice K, Hanson K, Nazar J, Burcheci E, Codreanu P, Alboucq S, Bixler S, Kennedy M, McKay B, O'Donnell J, Thoreson H, Yousefi H, Lang G, Jamula A, Hanson J, Grey K, Gross K, Norton J, Gross S, Carrillo M, Fields S, Karsai B, Mehdi S, Ejiogu CB, Coffee C, Epner S, Everett T, Forbes K, Hosek S, Itterra M, Keckler K, Kroc K, Mycyk M, Needleman R, Prescaro H, Quindipan M, Pineda D, Reyes K, Mounce K, Simon T, Alford S, Kioussopoulos K, Kunz T, Underwood K & Beckner C (2021), Bamlanivimab plus Etesevimab in Mild or Moderate Covid-19. The New England journal of medicine 385, 1382-1392.

      [16] Gattinoni L, Taccone P, Carlesso E & Marini JJ (2013), Prone position in acute respiratory distress syndrome. Rationale, indications, and limits. American journal of respiratory and critical care medicine 188, 1286-1293. https://doi.org/10.1164/rccm.201308-1532CI.

      [17] Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, Mercier E, Badet M, Mercat A, Baudin O, Clavel M, Chatellier D, Jaber S, Rosselli S, Mancebo J, Sirodot M, Hilbert G, Bengler C, Richecoeur J, Gainnier M, Bayle F, Bourdin G, Leray V, Girard R, Baboi L, Ayzac L, Guérin C, Richard JC, Bayle F, Bourdin G, Leray V, Wallet F, Delannoy B, Debord S, Stoian A, Nesme P, Porot V, Rosselli S, Argaud L, Martin O, Reignier J, Greau E, Maquigneau N, Beuret P, Le Tulzo Y, Gacouin A, Boulain T, Runge I, Benzkri D, Mathonnet A, Skarzynski M, Bretagnol A, Perrotin D, Mercier E, Simeon-Vieules V, Mercat A, Masson L, Badet M, Clavel M, Tanty J, Baudin O, Gissot V, Cracco C, Desachy A, Fally MA, Robin L, Robert R, Chatellier D, Goudet V, Goyheneix E, Guignon C, Jaber S, Young B, Belafia F, Carr J, Rossel N, Mancebo J, Turella M, Roche-Campo F, Aguirre-Bermeo HM, Hilbert G, Coz S, Sirodot M, Levrat A, Gainnier M, Bisbal M, Richecoeur J, Combaux D, Lefranc JY, Bengler C, Casano F, Lloret S, Timsit JF, Bonadonna A, Pavaday K, Zeni F, Diconne E, Perez D, Souweine B, Lautrette A, Hussain AA, Demoule A, Kontar L, Cadiergue V, Ayzac L, Girard R, Baboi L, Escande J, Flandreau G, Moreau D, Vanhove M, Sidibe M, Villier JM, Ayzac L, Girard R, Baboi L, Guérin C, Schreiber V, Escande J, Flandreau G, Moreau D, Vanhove M, Sidibe M, Albert RK, Chiche JD & Tassaux D (2013), Prone positioning in severe acute respiratory distress syndrome. The New England journal of medicine 368, 2159-2168. https://doi.org/10.1056/NEJMoa1214103.

      [18] Huang C, Wang Y, Li X, Ren L, Zhao L, Hu Y, Zhang L, Fan G, Xu J, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J & Cao B (2020), Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395, 497-506. https://doi.org/10.1016/S0140-6736(20)30183-5.

      [19] Ministry of Health, Labour and Welfare. About special approval of novel coronavirus therapeutic agents [Press release: 2021.7.19]. Retrieved from: https://www.mhlw.go.jp/content/11123000/000807746.pdf (in Japanese).

      [20] Munshi L, Del Sorbo L, Adhikari NKJ, Hodgson CL, Wunsch H, Meade MO, Uleryk E, Mancebo J, Pesenti A, Ranieri VM & Fan E (2017), Prone Position for Acute Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis. Annals of the American Thoracic Society 14, S280-S288. https://doi.org/10.1513/AnnalsATS.201704-343OT.

      [21] Scholten EL, Beitler JR, Prisk GK & Malhotra A (2017), Treatment of ARDS With Prone Positioning. Chest 151, 215-224. https://doi.org/10.1016/j.chest.2016.06.032.

      Wang Y, Zhang D, Du G, Du R, Zhao J, Jin Y, Fu S, Gao L, Cheng Z, Lu Q, Hu Y, Luo G, Wang K, Lu Y, Li H, Wang S, Ruan S, Yang C, Mei C, Wang Y, Ding D, Wu F, Tang X, Ye X, Ye Y, Liu B, Yang J, Yin W, Wang A, Fan G, Zhou F, Liu Z, Gu X, Xu J, Shang L, Zhang Y, Cao L, Guo T, Wan Y, Qin H, Jiang Y, Jaki T, Hayden FG, Horby PW, Cao B & Wang C (2020), Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet 395, 1569-1578. https://doi.org/10.1016/S0140-6736(20)31022-9
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    Mitsutome, E., Une, K., & Nakanuno, R. (2022). Coronavirus disease 2019 in an elderly patient who became severely ill despite antibody cocktail therapy but improved with lung-protective management: A case report. International Journal of Medicine, 10(1), 7-11. https://doi.org/10.14419/ijm.v10i1.32070