Severe COVID-19: WHO update guideline on monoclonal antibody use

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The new WHO guideline on using monoclonal antibodies for severe COVID-19 appears in the BMJ. Newsday LLC/Getty Images
  • The World Health Organization (WHO) recently updated a living guideline on COVID-19 drugs. In it, they conditionally recommend the use of monoclonal antibodies to treat patients with non-severe disease at highest risk for hospitalization and patients with severe or critical illness who have not mounted an antibody response.
  • The guideline is based on a meta-analysis of several studies and trials. In one of these trials, monoclonal antibody treatment with casirivimab and imdevimab reduced hospitalization risk by 71%.
  • In another trial, treatment with monoclonal antibodies decreased the risk of death in patients with severe or critical COVID-19 who did not generate SARS-CoV-2 antibodies by 15%.
  • Areas that need further research include accurate clinical guides to predict hospitalization risk in patients with non-severe COVID-19, determining optimal dosage and administration routes in non-severe and severe or critical COVID-19, and establishing safety and efficacy in children and during pregnancy.

The WHO recently updated a living guideline that provides recommendations for new COVID-19 drug treatments to include monoclonal antibodies (casirivimab and imdevimab).

Casirivimab and imdevimab are two laboratory-made proteins, similar to human antibodies, that target the spike protein of the SARS-CoV-2 virus, blocking its attachment and entry into the human cell.

The recommendations were published based on a systematic review of meta-analyses and large and international clinical trials. A meta-analysis in patients with non-severe disease showed monoclonal antibody treatment with casirivimab and imdevimab reduced hospitalization risk by 71%.

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In the RECOVERY trial quoted by the WHO, treatment with monoclonal antibodies decreased the risk of death in seronegative patients with severe or critical COVID-19 by 15%. Seronegative describes people whose blood serum tests revealed no antibodies for SARS-CoV-2.

In an interview with Medical News Today (MNT), Dr. William Schaffner, professor of infectious diseases at Vanderbilt University Medical Center, TN, explained: “Once people are infected, […] these antibodies can be given […] by intravenous infusion, and they will latch onto the virus, preventing it, thereby, from infecting more of our cells. If the virus cannot do that, it cannot evolve into creating more serious disease; in other words, the good guys cut the bad guys off at the pass.”

The WHO conditionally recommends treatment with casirivimab and imdevimab for those with non-severe COVID-19 at the highest risk for hospitalization. Their guideline appears in the BMJ.

In an MNT interview, according to the WHO, “This is the first drug that [the] WHO is recommending as a treatment for non-severe patients to reduce the risk of disease progression for those with the highest risks.”

People at increased risk for hospitalization include those who have not had the vaccination, people who are immunocompromised, older adults, people from racial and ethnic minority groups, people with disabilities, and people with other specific medical conditions.