Covid: Lo Caputo (UniFg), ‘monoclonals protect the elderly and frail from disease’

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Monoclonal antibodies with proven and relevant clinical efficacy reduce the risk of hospitalizations for severe forms of Covid-19 in particularly fragile patients and should be used in this phase of the pandemic, according to Sergio Lo Caputo, Policlinico Università di Foggia

24 NOV

“Never as in this phase of the pandemic is it necessary to focus more and more on monoclonal antibodies, which are very useful in fragile immunocompromised patients because they play a crucial role in blocking the entry of the virus into the cells, helping to help the immune response of the infected subject, thus guaranteeing a immediate response in the fight against Covid-19. Not only that. Several studies demonstrate the efficacy of monoclonals in very high percentages in reducing the risk of hospitalizations for severe forms of the disease in particularly fragile patients”, he declares Sergio LoCaputohead of infectious disease trials at the University of Foggia Polyclinic, to Adnkronos Salute, on the sidelines of the XXI Simit National Congress.

“To date – underlines the specialist – among the patients admitted to hospitals for Covid, the very elderly prevail”, therefore the over 80s, patients who are fragile due to age and comorbidities (chronic, metabolic, haematological, neoplastic diseases) or immunocompromised due to transplants, dialysis, solid tumor export. These patients “have a response to the anti-Covid vaccination, including the booster dose, which is extremely variable and with a coverage level that is not very effective and reduced over time. In these circumstances and in other patients, even younger ones and with various comorbidities, the the indication is to use monoclonal antibodies within 5 days of the appearance of the first symptoms of the infection, but this requires timely diagnosis and equally timely referral of patients to specialist centers to evaluate the most suitable type of treatment, with antiviral drugs rather than with monoclonal antibodies”.

In clinical practice and in real life, “studies tell us that the mere in vitro sensitivity of monoclonals to the different variants is not a reliable indicator of the efficacy of these molecules – highlights Lo Caputo – because the drug concentration reached can be higher and therefore it cancels this resistance to the mutations present on the Spike antigen of the virus. These data on the clinical efficacy of monoclonal antibodies continue to be increasingly numerous, focusing on the most fragile patient categories”.

Monoclonal antibodies “do not replace the booster dose of the anti-Covid vaccine in these at-risk subjects – specifies the expert – but general practitioners have a fundamental role in identifying early those in need of other treatments. Family doctors they know their clients well, they know who falls into the categories of fragile subjects, consequently more at risk. So the advice is to arrive at a timely diagnosis and to send this type of patient to specialist centers as soon as possible”.

There are two monoclonal antibodies that have demonstrated “proven and relevant clinical efficacy on the most fragile patients”, recalls Lo Caputo: “Sotrovimab, which requires a single intravenous administration, and the association of tixagevimab with cilgavimab, which instead requires two intramuscular injections and is also used in the prevention of infection in the most exposed subjects”.

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However, the infectious disease specialist complains that “in hospitals, the reduction in the number of patients hospitalized for Covid was also followed by a reduction in staff in the infectious disease departments”. In this way “it is more complex and difficult to organize and set up efficient structures for the treatment of Covid patients with antiviral drugs or monoclonal antibodies, avoiding costly hospitalizations, but which put the lives of fragile patients at risk. Each center has attempted to organize themselves autonomously, based on the requests of the territory, but it is often difficult to reach the whole national territory equally”.


November 24, 2022
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