WHO recommends antibody treatment for covid patients at high risk of hospital admission

WHO recommends antibody treatment for covid patients at high risk of hospital admission

A therapy regimen comprising two antibodies (casirivimab and imdevimab) was recommended today in The BMJ by a WHO Guideline Development Group (GDG) panel of worldwide specialists and patients for two distinct subgroups of patients with covid-19.

The first category includes patients with non-severe covid-19 who are at the greatest risk of hospitalisation, whereas the second category includes patients with severe or critical covid-19 who are seronegative, meaning they have not mounted their own antibody response to covid-19.

The first suggestion is based on new evidence from three unpublished trials that indicate casirivimab and imdevimab likely reduce the risk of hospitalisation and duration of symptoms among patients at highest risk of severe disease, such as those who are unvaccinated, elderly, or immunocompromised.

This second recommendation is based on data from the RECOVERY trial, which indicates that casirivimab and imdevimab likely reduce deaths (ranging from 49 fewer deaths per 1,000 severely ill patients to 87 fewer deaths per 1,000 critically ill patients) and the need for mechanical ventilation in seronegative patients.

All other covid-19 patients are unlikely to benefit meaningfully from this antibody treatment. Casirivimab and imdevimab are monoclonal antibodies that, when taken in combination, bind to the SARS-CoV-2 spike protein, preventing the virus from infecting cells.

The recommendations are part of a living guideline developed by the World Health Organization with methodological support from the MAGIC Evidence Ecosystem Foundation to provide up-to-date, trustworthy guidance on covid-19 management and to assist physicians in making more informed decisions with their patients.

Living guidelines are advantageous in rapidly evolving fields of study such as covid-19 because they let researchers to update previously verified and peer reviewed evidence summaries as new information becomes available.

The panel recognised several financial and resource implications of this treatment, which may make it difficult for low- and middle-income nations to obtain it. For instance, quick serological testing will be required to identify eligible patients who are critically ill, medication will need to be administered intravenously using specialised equipment, and patients will need to be monitored for allergic responses.

Additionally, they acknowledge the risk that novel variations may evolve in which casirivimab and imdevimab antibodies are ineffective.

However, they assert that, given the shown advantages to patients, "the recommendations should serve as a catalyst for utilising all available means to expand global access to the intervention and related testing."

Today's guideline supplements prior recommendations against the use of interleukin-6 receptor blockers and systemic corticosteroids in patients with severe or critical covid-19 and against the use of ivermectin and hydroxychloroquine in all patients with covid-19, regardless of disease severity.