WHO recommends antibody cocktail to treat Covid – Expert Reaction

The World Health Organization is recommending two monoclonal antibodies, casirivimab and imdevimab, be used to treat Covid-infected people who are most at risk of being hospitalised.

The antibody cocktail uses the brand name Ronapreve in New Zealand, and the WHO guidance says it should be targeted to high-risk groups like older or immune-compromised patients with Covid-19, and severely-ill patients who have no natural antibodies to Covid-19.

The SMC asked experts to comment on the new guidance. 

Professor Kurt Krause, Infectious Diseases Physician; Professor of Biochemistry, University of Otago, comments:

“The newest edition of the WHO Covid-19 guidelines recommends the use of neutralising monoclonal antibodies like casirivimab and imdevimab for patients with Covid-19 who are at a high risk of requiring hospitalisation. This would typically be older people with age > 65, and people with co-morbidities like diabetes and many other serious chronic conditions. To be most effective these antibodies must be given early in the course of Covid-19.

“The WHO recommendations focus specifically on casirivimab and imdevimab but it is likely that other monoclonal antibodies directed at SARS-CoV2, which are produced by a number of pharmaceutical companies, will prove to be similarly effective. More research will need to be done to prove this. The Regeneron Pharmaceuticals product (casirivimab and imdevimab) has the advantage of strong evidence of effectiveness at preventing symptomatic infection following exposure to SARS-CoV2.  In addition this preventive therapy works following subcutaneous administration which is advantageous over intravenous administration routes.

“Anti-SARS-CoV2 antibodies have the potential to greatly decrease infection post SARS-CoV-2 exposure and to lessen symptoms following any infections that do occur, but they must be given early in the course, preferably within 96 hours of the index case having a positive test.

“This treatment (known as Ronapreve in NZ) is not currently approved in New Zealand. However, an application was lodged with Medsafe on 3 Sept by Roche Products, which is handling the Regeneron product in NZ. It is undergoing priority review.”

No conflict of interest declared.