Infectious Disease

WHO updates guidelines on monoclonal antibody treatment for COVID-19

September 23, 2021

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A guideline committee of the WHO has updated the recommendations for treatment with monoclonal antibodies in its “living” guide to drugs against COVID-19. The guidelines are published in the BMJ.

The panel now recommends a combination of casirivimab and imdevimab (REGEN-COV; Regeneron) for patients with non-severe COVID-19 at high risk of hospitalization and patients with severe or critical COVID-19 who are seronegative.

The new update is the fifth revision that WHO has made to its treatment guide.

“Casirivimab / Imdevimab is unlikely to be available to everyone who would choose treatment, which supports the recommendation to reserve them for those at highest risk of hospitalization,” Bram Rochwerg, MSc, MD, FRCPC, Critical care physicians and researchers at McMaster University in Canada, and colleagues wrote.

Results from several randomized trials, including the RECOVERY trial, led to the new recommendations, according to the panel.
The first recommendation on patients with non-severe COVID-19 applies to adults only. While the panel “had no reason to believe that children with COVID-19 would react differently,” it did not recommend combination treatment for children with non-severe COVID-19 due to a lack of evidence.

The second recommendation, relating to patients with severe or critical illness, “reflects the likelihood that any benefit is limited to patients with seronegative status,” wrote Rochwerg and colleagues.

In the RECOVERY study, seronegative patients who received the combination treatment were less likely to need mechanical ventilation (42 fewer patients per 1,000; 95% CI, 74–6), the panel said. Only adults participated in the study, so the recommendation for children with severe or critical illnesses that are seronegative is “currently uncertain,” the panel wrote. However, it found that children who are seronegative with COVID-19 “may benefit from casirivimab / imdevimab”.

Healio Primary Care previously reported on what researchers consider to be the largest comparative randomized trial of the treatment of monoclonal antibodies to COVID-19. In the OPTIMISE-C19 study, Erin McCreary, PharmD, Infectious Disease Pharmacist and Clinical Assistant Professor of Medicine at the University of Pittsburgh School of Medicine, and colleagues found that Bamlanivimab / Etesevimab (Eli Lilly & Co.) and Casirivimab / Imdevimab were safe and appeared to be equally effective in patients with mild to moderate COVID-19.

Casirivimab / Imdevimab received FDA approval for emergency use in November 2020. The FDA granted the EEA after reviewing study data that found that only 3% of patients who received the treatment were hospitalized or went to the emergency room, compared with 6% of those who received placebo.

In the Living Guide to COVID-19 Drugs, the WHO panel also strongly recommended the use of interleukin-6 receptor blockers and systemic corticosteroids for patients with severe or critical COVID-19, but strongly advises against the use of ivermectin and hydroxychloroquine in those with COVID-19 from. 19, regardless of disease severity, outside of a clinical trial setting.

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