According to the latest World Health Organization guidelines published Friday in the BMJ, people at high risk of hospitalization or with severe disease should be given a combination of the two antibody treatments.
The WHO Guideline Development Group (GDG) panel recommends a combination treatment of casirivimab and imdevimab for two specific groups of patients with COVID-19.
The first are patients with non-severe COVID-19 who are at highest risk of hospitalization and the second are those with severe or severe COVID-19 who are seronegative, meaning they did not produce their antibody response to COVID-19 Is.
The first recommendation is based on new evidence from three trials that have not yet been peer reviewed.
The trial shows that casirivimab and imdevimab can reduce hospitalization and duration of symptoms in people at highest risk of serious disease, such as unvaccinated, elderly or immunosuppressed patients. The second recommendation is based on data from another trial showing that the two antibodies possibly reduce deaths and the need for mechanical ventilation in seronegative patients.
This study showed that treatment with casirivimab and imdevimab resulted in 49 fewer deaths per 1,000 in critically ill patients and 87 fewer deaths in critically ill patients. The panel said that for all other COVID-19 patients, any benefit of this antibody treatment is unlikely to be meaningful.
Casirivimab and imdevimab are monoclonal antibodies that when used together bind to the SARS-CoV-2 spike protein, thereby inactivating the virus’s ability to infect cells. The spike protein helps the virus to bind to and infect human cells.
The panel acknowledged the many cost and resource implications associated with this treatment, which can make access challenging in low- and middle-income countries. For example, rapid serological tests will be needed to identify critically ill patients, treatment must be given intravenously using specialist equipment, and patients must be monitored for allergic reactions.
They also recognize the possibility that new variants may emerge in which the antibodies to casirivimab and imdevimab may be less effective. However, the panel says that given the demonstrated benefits for patients, “the recommendations should provide incentives to include all possible mechanisms to improve global access to interventions and related testing.” The latest guidance adds to previous recommendations for the use of interleukin-6 receptor blockers and systemic corticosteroids for patients with severe or severe COVID-19.
The panel also recommends against the use of ivermectin and hydroxychloroquine in patients with COVID-19, regardless of disease severity.
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