Oct 15, 2021
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Ministry of Health recommends monoclonal antibody treatment for vulnerable patients with COVID-19

Who should be treated with monoclonal antibodies?

The recommendation mentions single-component (sotrovimab, regdanvimab), as well as combined (bamlanivimab + etesevimab; kasirivimab + imdevimab) drugs. All these drugs are not registered on the territory of the Russian Federation, therefore, the Ministry of Health allows their appointment only by decision of the medical commission and with a permit for temporary treatment in an emergency.

The use of monoclonal antibodies is recommended in a hospital setting, including daytime, and no later than the 7th day from the onset of the disease.

“Their use in patients with risk factors for a severe course will neutralize the virus at an early stage and stop the unfavorable development of the disease,” the ministry said in a statement.

First of all, treatment with monoclonal antibodies is indicated for pregnant and recently given birth women with COVID-19 from risk groups and children over 12 years of age with immunodeficiency, with oncohematological diseases and after organ transplantation. Priority patient groups also include children over 12 years old with severe chronic pathologies and people over 65 years old with chronic diseases.

How do these drugs work and how effective are they?

Usually antibodies against the SARS-CoV-2 coronavirus appear in the body on the 13th day of illness, the concentration of neutralizing antibodies increases until the 23rd day. People who have had severe COVID-19 tend to have higher antibody concentrations over time than those who have had mild illness. However, the immune response (production of antibodies) in them may be delayed, which can negatively affect the course of the disease.

Monoclonal antibodies are produced in a laboratory and have the same mechanism of action as neutralizing antibodies, which are produced by your own immune system. Thus, these drugs help the body fight infection if the immune response is delayed.

Studies in outpatients with COVID-19 have shown that monoclonal antibodies can reduce viral load, shorten illness time, and reduce the risks of hospitalization and death. Later it became known that these drugs can help hospitalized patients who have not yet developed antibodies. This effect was confirmed in the large RECOVERY study, which evaluated the efficacy of the monoclonal antibodies kasirivimab and idevimab from Regeneron.

During the distribution of patients into groups of various treatments, scientists tested the presence of antibodies to coronavirus. Of the 9875 participants, half had antibodies (seropositive group), and one third (seronegative group) had no antibodies. Sero-negative patients with severe COVID-19 who received standard (non-experimental) treatment had a 30% risk of death – twice that of seropositive patients.

Treatment with monoclonal antibodies reduced the risk of death in seronegative patients within 28 days to 24% – by 20% compared to the results with conventional treatment, reduced the duration of hospitalization by an average of 4 days and the need for mechanical ventilation (30% versus 37% in the control group).

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