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NICE updates monoclonal antibody recommendation for Covid-19 patients

monoclonal antibody treatment

A monoclonal antibody combination treatment is now being recommended in the UK for patients in hospital with Covid-19 who are immunocompromised.

NICE updated its guidance after evidence showed that treatment with casirivimab and imdevimab (also known as Ronapreve, REGEN-COV, or REGEN-COV2) is associated with a significant reduction in mortality in patients who do not have existing SARS-Cov-2 antibodies in their system.

But NICE said those who are seropositive will not benefit from the treatment which can be used in patients aged 12 and over in the hospital setting.

The update comes after the World Health Organization recommended that patients with Covid-19 at high risk of hospitalisation should also receive treatment with the monoclonal antibody combination.

Their review of the evidence found that Ronapreve probably reduces the risk of hospitalisation and duration of symptoms in those at highest risk of severe disease, such as unvaccinated, older, or immunosuppressed patients

They also recommended the treatment – which is given intravenously – for patients hospitalised with severe Covid-19 but who are seronegative, the rapid recommendation published in the BMJ concluded.

The Department of Health and Social Care had already confirmed that the drug had the potential to benefit thousands of patients and would be made available in the UK but would be initially targeted at those in hospital.

WHO guidelines noted that there were cost and resource implications associated with its use, not least identifying who are the high risk patients who would benefit and how to provide that treatment in patients being cared for in a community setting.

‘Major feasibility challenges include limited production of casirivimab-imdevimab and, for outpatients, the requirement for parenteral administration,’ the guideline development group concluded.

While the treatment should be reserved for those at highest risk of being admitted to hospital, in routine care there is a lack of tools to identify who those patients are, they said.

‘Regarding intravenous administration, it is likely that specialised clinics with adequate amounts of the antibodies and staff to ensure safe and effective administration of the intervention will be required.

‘For the intervention to achieve substantial use, health systems will have to address these challenges.’

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