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In yet another addition to the treatments attempted for management of covid-19 patients, several private and government hospitals are increasingly using monoclonal antibody cocktail therapy. The treatment, essentially a combination of antibodies, once used on former US President Donald Trump, was approved by the Drugs Controller General of India (DCGI) in May. While Nellore district in Andhra Pradesh recently used this therapy on more than 10 people, Delhi’s Lok Nayak Hospital has also started the treatment, besides several private hospitals in the national capital, Mumbai and other states. Monoclonal antibodies were previously used in the treatment of diseases such as Ebola and HIV. The department of biotechnology is also supporting the development of monoclonal antibody against covid-19.

What is monoclonal antibody cocktail therapy?

Similar to antibodies which are proteins that the body naturally produces to defend itself against disease, monoclonal antibodies are artificially created in the lab, tailor-made to fight the disease they treat. Casirivimab and Imdevimab are monoclonal antibodies specifically directed against the spike protein of SARS-CoV-2, designed to block the virus’ attachment and entry into human cells. The two monoclonal antibodies specifically target the spike protein of SARS-CoV-2. The antibodies are designed to block the virus’ attachment and entry into human cells. The two different antibodies can exist together to fight the virus. They can bind with the coronavirus cell surface, and prevent it from infecting healthy cells.

Monoclonal antibodies such as Bamlanivimab and Etesevimab are also being used, which result in faster recovery, doctors claim. In February, the US Food and Drugs Administration (FDA) issued an emergency use authorization (EUA) to the antibody cocktail for the treatment of mild to moderate covid-19 patients. Doctors have said that the single-dose infusion-based treatment can be provided on an outpatient or daycare basis and marks a dramatic shift in covid care in India.

How does the therapy work, and who should take it?

The artificially prepared neutralizing antibodies neutralize the replicating viruses. Hence, these are effective only in the phase when the virus is actively replicating. It is not a drug and does not bring about any change in the host. The benefit is actually absence or worsening symptoms and signs, says Dr. Zafar Ahmed, senior consultant, pulmonary medicine, sleep and critical care at Fortis Hospital in Mohali. The therapy has not been extensively used in India. This is recommended in those patients who are at high risk of disease progression in the presence of multiple co-morbidities.

“Also, it should be used in the very early phase of the disease course in covid-19 in those patients who do not have organ involvement and are not on oxygen support. It is used only in mild to moderate cases," said Ahmed. This therapy is most effective if taken as early as possible in the disease course; so the sooner the better, even if the patient is not feeling that bad yet. In high-risk patients, receiving treatment earlier, when symptoms are less severe, may help prevent progression of the disease that would otherwise require hospitalization. However, physician consultation and prescription are mandatory.

What is the cost and advantages of the antibody cocktail therapy?

The total cost is 1.2-1.3 lakh. Ahmed explained that, however, only half the dose is recommended in Indian population, and the cost is reduced to half when one dose is shared between two patients. “It is a very safe therapy and can be done in emergency or day care and hence avoid admission. It is not recommended in severe cases," said Ahmed. The main advantage of this therapy is that it prevents covid-19 from becoming life-threatening, by controlling it at the very initial stage. However, doctors claim that it is too early to comment on its actual impact.

How is this therapy given to a patient, and what are the challenges and risks?

Monoclonal antibody cocktail therapy is given through an intravenous (IV) infusion or via subcutaneous route and requires about an hour to administer. The patient is discharged after a few hours of observation. Regardless of whether a patient has received the antibody therapy, anyone who has tested positive for covid-19 needs to quarantine. There are no challenges in conducting the therapy as such, apart from standard precautions. The associated risks are like any other such therapy, which is why it is preferred to be given in hospitals and not clinics.

Does the therapy help?

Dr. Salil Bendre, consultant, pulmonology at Nanavati Max Super Speciality Hospital, Mumbai, said that the therapy helped two severely obese and co-morbid patients recover significantly. Since 1 June, the hospital has successfully administered the antibody cocktail to four patients to prevent the probability of serious covid-19 illness in elderly, high-risk patients.

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