Even if the World Health Organization (WHO) could soon declare the end of the pandemic, the Sars-CoV-2 virus continues to infect and cause serious forms of infection especially in fragile subjects. This is why it is necessary not to throw away the anti-Covid weapons that are still effective, such as monoclonal antibodies. This was reiterated by the experts, gathered in Rome on the occasion of the event “mAbs in Early Treatment. Controversies and consensus in the fragile patient with Covid-19: we do not create antibodies”, promoted by GlaxoSmithKline. According to the latest bulletin released by the Ministry of Health, there are still 212 deaths caused by Covid in a week, about 30 a day. There is therefore an unmet need. “Early treatment with monoclonal antibodies and antivirals still represents the most effective strategy together with vaccination to prevent hospitalization, complications and death from Covid”, says Massimo Andreoni, scientific director of the Italian Society of Infectious and Tropical Diseases (Simit).
“Various personal and clinical conditions have been correlated with the risk of disease progression. In clinical practice – adds Andreoni – it is often complicated to be able to accurately classify the vulnerability and degree of risk of individual patients”. of the pandemic, the following risk factors have in fact been identified: advanced age, male biological sex and obesity.In addition to these factors, characterizing the early stages of the pandemic, other conditions linked to the burden of comorbidities have been defined, which have allowed to identify types of patients at greater risk of developing serious disease.Diseases that directly affect the immune system, such as HIV infection, and the use of chemotherapy or immunosuppressive treatments, can by themselves lead to an increase in the risk of hospitalization and serious illness from Covid-19 and a poor prognosis.Here’s why the scientific community for these patients at high risk of progression to severe forms of Covid recommends early therapy of the infection with monoclonal antibodies.
In frail patients, the advantage of the monoclonal antibody over antiviral drugs is that it blocks virus entry prior to entry into the host cell, and potentially induces antibody-dependent cytotoxic activity if cells become infected. . The further advantages of therapy with monoclonal antibodies, according to experts, concern the possibility of being used also in subjects with polypharmacy as drug interactions are practically absent. Among the monoclonal antibodies available in Italy against Covid, and which has also maintained its effectiveness against the now dominant Omicron variant, there is sotrovimab.
Just recently, the National Institute for Health and Care Excellence (Nice) of the United Kingdom intervened recommending its use for patients with a higher risk of developing a serious disease and for whom other therapeutic options are contraindicated. A Covid infection, when not asymptomatic, can lead to mild, moderate or severe disease. The patients eligible for treatment with sotrovimab are precisely the latter. It is also necessary, according to Aifa’s recommendations, not to have contracted the virus for more than 7 days, to be over 12 years of age, weighing over 40kg, not to be hospitalized and in supplemental oxygen therapy. There must also be mild to moderate symptoms and a high risk of progression to severe disease. In all these cases it is necessary to promptly contact the general practitioner or specialist.
“The use of monoclonal antibodies (mAbs) is now a concrete and effective therapeutic reality in various contexts, in particular in inflammatory diseases and in hemato-oncology”, clarifies Giovanni Di Perri, director of the Infectious Diseases Department of the Amedeo Hospital in Savoy of Turin. “The variability of Omicron’s subvariants has made it not always easy and obvious to clearly define the efficacy of monoclonal antibodies against Sars-CoV-2”, observes Carlo Federico Perno, director of microbiology and immunology diagnostics at the Bambino Gesù Pediatric Hospital From Rome.
“However, in the face of the loss of effectiveness of many of them, some monoclonals have maintained a significant effect even against the most recent subvariants of the virus, including those circulating mainly in Italy. Among them, sotrovimab – he continues – seems to be the one Sotrovimab also has a pharmacological and pharmacokinetic profile such as to make it a quite valid option in the present virological and clinical context, considering both its long half-life (especially important for maintaining a continuous effect in frail patients, those who are more benefit and will benefit from antiviral therapies) and the ability to stimulate an immune response which assists that of the organism and which enhances, through two cellular mechanisms, the removal and inactivation of the virus.The combination of these characteristics makes sotrovimab a monoclonal antibody still today to be taken into high consideration in the treatment of the infection by SarS CoV-2”.