Bebtelovimab-Induced Bradycardia Leading to Cardiac Arrest

Abstract

BACKGROUND: Bebtelovimab is a monoclonal antibody used to prevent progression of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Complications of SARS-CoV-2 infection can include cardiac effects including sinus bradycardia. CASE SUMMARY: We describe the case of an 86-year-old male infected with SARS-CoV-2 who experienced bradycardia with cardiac arrest immediately following infusion of Bebtelovimab with return of spontaneous circulation obtained following 1 minute of chest compressions and administration of atropine. His bradycardia resolved, and he was extubated on hospital day 1, found to be neurologically intact, and discharged on hospital day 9. CONCLUSIONS: Due to the time course of the patient’s symptomatology, we attribute the bradycardic arrest to the Bebtelovimab infusion. This case illustrates the need for further research into the etiology of bradycardia due to SARS-CoV-2 infection and to examine potential links to monoclonal antibody infusion. It also serves as important caution to maintain close cardiac monitoring while administering monoclonal antibodies for SARS-CoV-2.

SARS-CoV-2 neutralizing antibody bebtelovimab – a systematic scoping review and meta-analysis

“…We could reasonably anticipate that the data carry prominent clinical implications for curbing severe COVID-19 illnesses arising from the current sublineages of the Omicron variant and are likely to resonate with growing evidence from future large-scale randomized controlled trials and real-world studies to recommend the use of bebtelovimab in a broader range of patients. Whilst bebtelovimab appears to be well tolerated in our review, case reports have documented that a patient experienced sinus bradycardia-mediated cardiac arrest immediately following infusion of bebtelovimab (63) and another patient developed colitis 10 days after the use of bebtelovimab (64). Postmarketing surveillance for adverse events and ad hoc safety studies are henceforth crucial for earlier detection of safety issues and preventing patients from unnecessary harm (65).…”

A Review of Hematological Complications and Treatment in COVID-19

“…The drug received emergency use authorization from the US Food and Drug Administration in February 2022, after in vitro data suggested its efficacy against the omicron variant [ 45 ]. The mechanism of action of Bebtelovimab is that it neutralizes the CoV-2, B.1.1.7, B.1.351, and B.1.617.2 omicron variants [ 46 , 47 ]. Current NIH guidelines suggest the use of Bebtelovimab only after the use of a 5-day oral course of nirmatrelvir plus ritonavir (Paxlovid), a single IV infusion of sotrovimab, or a 3-day course of IV remdesivir [ 48 ].…”

“…Of interest, there has been a report of an 86-year-old male with COVID-19 who experienced bradycardia and cardiac arrest immediately following Bebtelovimab infusion. Therefore, it is imperative to closely monitor cardiac signals while administering Bebtelovimab or other monoclonal antibodies for SARS-CoV-2 [ 46 ]. Along with the allergic reactions, difficulty in breathing, shortness of breath, low blood oxygen levels, tachycardia or bradycardia, hypo- or hyper-tension, angioedema, hives, vasovagal reactions (e.g., pre-syncope, syncope), and bleeding at the injection site are common side effects associated with Bebtolovimab [ 51 ].…”