2023-06-12 18:44:00
The pandemic is over, but not for everyone. For the most fragile, viral diseases remain an element of alarm. In fact, in Italy there are still about 30 deaths a day from Sars-CoV-2 infections, many of whom are part of the so-called ‘fragile patients’ (there are 1 out of 5 in Italy). For this reason, Aip OdV – Association of primitive immunodeficiencies called the associations of transplant recipients, dialysis patients, oncologists and nephropaths, sharing a condition of fragility, for a direct confrontation with health professionals and institutions, at the meeting table “Fragile! Protect with care…Covid and viral infections, have you escaped the danger?”, scheduled for tomorrow at the Hotel Nazionale in Rome and created with the non-conditioning contribution of GSK.
Fragile patients in Italy are those identified by the National Anti-Covid-19 Vaccination Plan due to the high risk of developing serious forms of the disease, due to organ damage, a rare disease, severe physical disability, or impaired immune response (such as occurs in people with primary immunodeficiency). In the latter – reads a note – the vaccine may not exercise the same effectiveness. “Although vaccination has given an important proof of effectiveness – says Alessandro Segato, president of Aip – the advent of the new variants has in part evaded the protection of both the vaccine and previous natural infections”.
The therapeutic approach – continues the note – sees the central role of monoclonal antibodies, in response to the unsatisfied needs of fragile patients, as established last December in the consensus document “Sars-Cov-2: early diagnosis and better access to treatment for fragile patients” drawn up and signed by Simit (Italian Society of Infectious and Tropical Diseases), Simg (Italian Society of General Medicine and Primary Care), Sifo (Italian Society of Hospital Pharmacy) and Cittadinanzattiva. Fortunately there are monoclonal antibodies that have resisted the mutating variants. Some, in particular, have shown an ability to contain the risk of hospitalization.
Monoclonal antibodies are an obstacle to the progression of the disease in serious forms – the note details – early therapy, in fact, blocks the entry of the virus into the host cell. They should be administered within 3-5 days of the onset of symptoms. Meanwhile, use in the form of pre-exposure prophylaxis is being investigated for individuals with an inadequate immune response and in individuals in whom vaccination is contraindicated. While there is a high number of new infections, there is no increase in hospitalizations in the general population. Severe cases and the increased risk of death are the prerogative of elderly, chronic or frail subjects. The variability of the virus has also led to the loss of effectiveness of some monoclonal antibodies and the reduction of some antivirals.
“Immuno-compromised subjects are a special population which, in encountering the virus, present negative peculiarities – explains Massimo Andreoni, scientific director of Simit – the viraemic phase appears to be prolonged with infections lasting several months, a high number of recurrences, forms severe and resistant to available treatments and less favorable outcomes – The goal is to block the entry of the virus before it can enter the host cell. Furthermore, monoclonals are a concrete option in frail subjects on polytherapy or who cannot take antivirals, thanks to the absence of drug interactions”.
Individual and collective protection through vaccination, early and timely diagnosis and prompt administration of the monoclonal drug – concludes the note – are therefore the simple operational guidelines that must see a synergistic action of patients and doctors and healthcare professionals. Healthcare institutions, and in particular the Regions, and politics must facilitate awareness, through dedicated and multi-channel information and communication, and interventions that simplify the access path to therapies.
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