COVID patients who are at high risk of hospitalisation or have severe illness should be given a combination of two antibody therapies, according to the most recent World Health Organization guidelines, which were published in The BMJ on Friday.
The WHO Guideline Development Group (GDG) panel advises combining casirivimab and imdevimab therapy for two particular categories of COVID-19 patients.
The first group consists of patients with non-severe COVID-19 who are at high risk of hospitalisation, while the second group consists of patients with severe or critical COVID-19 who are seronegative, which means they have not established their own antibody response to COVID-19.
The first suggestion is based on fresh information from three unpublished clinical studies.
The research found that casirivimab and imdevimab may lower the risk of hospitalisation and the length of symptoms in individuals who are at high risk of severe illness, such as those who are unvaccinated, elderly, or immunocompromised.
The second suggestion is based on results from another research, which indicates that the two antibodies may minimise mortality and the requirement for mechanical ventilation in seronegative individuals.
This study found that Casirivimab and imdevimab therapy resulted in 49 fewer deaths per 1,000 seriously sick patients and 87 fewer deaths in critically ill patients.
The panel concluded that any advantages of this antibody therapy for all other COVID-19 patients are unlikely to be significant.
Casirivimab and imdevimab are monoclonal antibodies that, when combined, bind to the SARS-CoV-2 spike protein, preventing the virus from infecting cells.
The spike protein aids the virus in binding to and infecting human cells.
The panel acknowledged several cost and resource implications associated with this treatment, which may make access to low and middle income countries challenging.
For example, rapid serological tests will be needed to identify eligible patients who are severely ill, treatment must be given intravenously using specialist equipment, and patients should be monitored for allergic reactions.
They also recognise the possibility that new variants may emerge in which casirivimab and imdevimab antibodies may have reduced effect.
However, the panel says given the demonstrated benefits for patients, “the recommendations should provide a stimulus to engage all possible mechanisms to improve global access to the intervention and associated testing.”
The latest guidance adds to previous recommendations for the use of interleukin-6 receptor blockers and systemic corticosteroids for patients with severe or critical COVID-19.
The panel also recommends against the use of ivermectin and hydroxychloroquine in patients with COVID-19 regardless of disease severity.