# Successful use of tocilizumab and casirivimab/imdevimab in a twin pregnancy with critical COVID-19 – A case report

## TL;DR

A pregnant woman with severe COVID-19 was successfully treated with tocilizumab and casirivimab/imdevimab, leading to recovery and a safe outcome for her twins.

## Contribution

Demonstrates the safe and effective use of tocilizumab and casirivimab/imdevimab in critical pregnancy-related COVID-19.

## Key findings

- The patient showed respiratory improvement after treatment and was extubated within 10 days.
- No severe or minor symptoms were observed in the mother or infants during the observation period.
- A planned caesarean section at 34+6 weeks resulted in the birth of twins with no reported complications.

## Abstract

COVID-19 in pregnancy is associated with increased maternal morbidity and mortality as well as higher risk for hospitalization in intensive care unit and mechanical ventilation. We present a 38-year-old 21+5week pregnant unvaccinated woman with twins and critical COVID-19 pneumonia caused by Delta SARS-CoV-2 strain. Because of rapid worsening of respiratory condition despite standard of care treatment with steroids, she received a combination of casirivimab/imdevimab and tocilizumab. After therapy we noticed respiratory improvement and after 10 days she was extubated. Due to selective fetal growth restriction of one of the twins, a planned caesarean section was performed at 34+6 weeks. Presented case indicates favorable outcome and safe use of casirivimab/imdevimab and tocilizumab in critical COVID-19, as no severe or minor signs or symptoms in the case presentation were observed neither in the mother nor in infants during the time of observation.