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WHO advises against the use of two antibody treatments against COVID – this is what it means

New guidance from the World Health Organization (WHO) strongly advises not to use Antibody treatment sotrovimab and casirivimab-imdevimab for treating patients COVID-19,

This guidance, published in the British Medical Journal, replaces previous conditional recommendations for the use of these drugs. This is based on emerging evidence that they are unlikely to work against current COVID types such as omicron,

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This means that, at least for the time being, there are no recommended antibody treatments to treat covid, However, there are still other treatment options. let’s take a look.

We know that severe COVID is driven by our own collateral damage immune system,

Some of the most effective COVID treatments are anti-inflammatory drugs, which reduce the exaggerated immune response against the virus. Strong evidence continues to support the use of drugs such as corticosteroids, anti-IL-6 and baricitinib.

Different from anti-inflammatory drugs, we have two types of treatments that directly target SARS-CoV-2, the virus that causes COVID-19. these are antiviral drugs and antibody treatment.

Antiviral drugs allow the virus to enter our cells but prevent it from replicating, thereby reducing the effects of the infection.

Remdesivir, which was originally developed for hepatitis CPreserves efficacy against omicron Sub-variants BA.2.12.1, BA.4 and BA.5 in the lab.

In the new guidance, WHO conditionally recommends remdesivir for the treatment of patients with severe COVID, but has recently recommended its use for critically unwell patients based on the results of a series of randomized trials. advised against.

Other antivirals include mollupiravir, which the WHO conditionally recommends, and nirmatrelavir and ritonavir (a combination known as Paxlovid), which is strongly recommended. These drugs are taken orally, while remdesivir is administered intravenously.

Meanwhile, antibody therapy works by coating a protein on the surface of SARS-CoV-2, called a spike protein, that prevents the virus from entering human cells. They can also help eliminate infected cells that have been hijacked by the virus.

Sotrovimab is one such antibody therapy. It is a monoclonal antibody, which means it only targets a specific region of the virus’s spike protein. in clinical trials conducted before omicron type Emerged, sotrovimab reduced the risk of disease progression.

This led to emergency authorization in 2021 by the US Food and Drug Administration and the UK’s Medicines and Healthcare products regulatory agency.

So what’s changed?

A major challenge with using monoclonal antibodies to manage SARS-CoV-2 infections is that they bind to only one region of the spike protein.

As the virus evolves, this region of the protein that antibodies recognize can be changed by mutation. So it is not entirely surprising that laboratory studies suggest that the emergence of Omicron reduced the efficacy of sotrovimab.

Casirivimab-imdevimab combines two monoclonal antibodies, targeting two different regions of the spike protein, to attempt to overcome the speed at which SARS-CoV-2 can transform.

Certain infections or chronic diseases can further damage the immune system, which naturally weakens with age (Source: Getty Images/Thinkstock)

But this combination has proven ineffective in preventing omicron infections in laboratory experiments, prompting the WHO to change its advice.

Evidence will evolve along with virus regulatory agencies and the WHO will keep a close eye on how existing treatments emerge. Variantsand issue prescribed recommendations accordingly.

For drugs such as remdesivir that have minor effects on certain groups of patients, the WHO issues conditional recommendations. Drugs that work consistently get stronger recommendations, but they may also be reviewed as the virus develops.

While it may sound worrying that the WHO has changed its mind on both Antibodies Healing, it is actually a sign that the scientific process is working as it should.

This is now the 12th iteration of the WHO survival guideline, and advice on the provision of COVID treatment is likely to continue as an update Epidemic to end.

Who will be affected the most?

We are not all equal in the fight against infection. Vaccination has significantly reduced the risk of severe COVID-19 for the vast majority of the population.

However, some people are born with a low immune system or receive treatments that weaken their immune response later in life, for example after receiving an organ transplant or chemotherapy.

Certain infections or chronic diseases can further damage the immune system, which naturally weakens with age. One of the most common forms of immune deficiency is the inability to produce enough antibodies following vaccination or infection. So antibody treatments, which seek to artificially complement or replace those antibodies, stand to particularly benefit many immune-compromised people.

Guaranteeing the effectiveness of monoclonal antibodies against rapidly changing viruses is a challenge, but it is not necessarily the end of this type of treatment. covid,

Next-generation monoclonal antibodies that optimally neutralize the omicron subvariant are well recognized, although these are also unlikely to be effective for long.

For the immuno-compromised, but also for the wider public, there is a need for continued research, and access to effective COVID treatments – antiviral, antibody and otherwise.

Unfortunately, when dealing with RNA viruses, mutations can rapidly undermine our defenses. In order to prolong efficacy, combination treatments will be an important method compared to single-agent treatments.

The authors are Associate Professor in Viral Immunology, University of Birmingham and Adrian Shields, Associate Professor in Clinical Immunology, University of Birmingham, Birmingham (UK)

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