Casirivimab – Moderate to Severe – recomm

We do not recommend Casirivimab-Imdevimab for treating hypoxic hospitalized patients with detectable COVID-19 antibodies (Strong recommendation)

Definition of moderate illness

  • Pneumonia (clinical or radiological) OR hypoxia (SpO2 <94% in adults with no underlying lung disease)
  • AND respiratory rate ≤30/min
  • AND SpO2 ≥90% on room air

Definition of severe illness:

Pneumonia with ANY ONE of the following:

  • respiratory rate >30/min
  • severe respiratory distress
  • SpO2 <90% on room air
  • NO invasive or non-invasive respiratory support needed

Definition of critical illness:

  • Requirement for high-level respiratory support: noninvasive ventilation, high-flow oxygen (≥20 litres per minute) or invasive mechanical ventilation
  • OR acute respiratory distress syndrome (PaO2/FiO2 ratio of <300)
  • OR sepsis
  • OR shock
We recommend Casirivimab-Imdevimab in those hospitalized with a non Omicron variant of COVID-19 requiring oxygen support in early illness (< 7 days of symptoms) and no detectable COVID-19 antibodies (Conditional recommendation)

A conditional recommendation is one for which the desirable effects probably outweigh the undesirable effects (weak recommendation FOR an intervention) or undesirable effects probably outweigh the desirable effects (weak recommendation AGAINST an intervention) but appreciable uncertainty exists. This implies that not all will be best served by this recommendation and decisions can be made by the patient and caregiver based on patient values, resources and setting with a clear understanding of the ensuing harms and benefits.

Definition of moderate illness

  • Pneumonia (clinical or radiological) OR hypoxia (SpO2 <94% in adults with no underlying lung disease)
  • AND respiratory rate ≤30/min
  • AND SpO2 ≥90% on room air

Definition of severe illness:

Pneumonia with ANY ONE of the following:

  • respiratory rate >30/min
  • severe respiratory distress
  • SpO2 <90% on room air
  • NO invasive or non-invasive respiratory support needed

Definition of critical illness:

  • Requirement for high-level respiratory support: noninvasive ventilation, high-flow oxygen (≥20 litres per minute) or invasive mechanical ventilation
    •  OR acute respiratory distress syndrome (PaO2/FiO2 ratio of <300)
    •  OR sepsis
    •  OR shock

Rapid COVID-19 Antibody tests

Antibody tests can indicate that an individual has been exposed to the SARS CoV2 virus in the past and has mounted an immune response against it. Hence a positive result in an antibody test indicates that this this individual has been exposed to SARS COV2 virus in the past and has mounted an immune response against it. A negative antibody test indicates that the individual has not mounted an immune response against SARS CoV2 virus. This drug is only recommended in those with a negative antibody test (seronegative). Only antibody tests validated by ICMR should be used and interpreted in accordance with ICMR guidelines dates 12 February 2021 (12) https://www.icmr.gov.in/pdf/covid/kits/Antibody_based_tests_12022021.pdf