Antibody cocktail

CHANDIGARH: In a first for the Tricity, monoclonal antibody cocktail therapy against Covid was administered to a patient, a 72-year-old with diabetes and chronic kidney disease, at a private hospital in Mohali. This therapy was first administered to former US president Donald Trump. Shimona Kanwar speaks to Dr Zafar Ahmed, senior consultant, department of critical care, pulmonology and chest and sleep medicine at Fortis hospital, who treated the patient with the ‘cocktail’
What is antibody cocktail therapy?
The therapy is a cocktail of two monoclonal antibodies.Antibodies are proteins that the body generates to defend itself against disease. Monoclonal antibodies are artificially created in a laboratory. Normal antibodies in any Covid patient develop only after 14 days of contracting the infection. Casirivimab and imdevimab, produced by Switzerland-based Roche, are specifically directed at the spike protein of SARS-CoV-2, which causes Covid. They block the virus’s attachment and its subsequent entry into human cells.
Who are the ideal candidates for this therapy?
The “anti-body cocktail therapy” is for those above the age of 65, who are isolating at home, have an SpO2 of 93, require no oxygen support but are at risk of developing a severe form of the infection on account of their co-morbidities. It can also be administered to those suffering from an immunocompromising condition or those with weakened immunity on account of immune suppressive treatment. It is for treatment of mild to moderate Covid-19 in adults. It is not a magic drug but an add on therapy for Covid.
Can it be given to those who have been vaccinated?
No, it cannot be given to those who are vaccinated. There are not many direct studies that it works against variants, but it is expected to work.
How does this therapy work? Any word of caution?
These are artificial antibodies given with the intention to neutralise the newly viral insult that has come into post infection. Somebody who is in the early stages is the potential candidate. When Covid infection occurs, the virus enters the body and starts multiplying. It grows in numbers and affects the organs. This is in the early phase of the infection. The neutralising antibodies neutralise the virus. As seen in studies, this therapy can reduce chances of progression by about 70%. That is why it was tried in the US on Donald Trump. But it is not to be taken by anybody and is reserved for those who are at high risk, especially with comorbidities and elderly. But this is prior to the insult that happens in the form of lung injury and oxygen requirements. We are late to get this therapy in India. It will probably be most useful in the third wave as the idea is to prevent complications, progression and therefore deaths.
When is the effect of the treatment seen?
When we give, we are not looking at the effect but if it will prevent progression or not. After 2 weeks of this drug, if the patient is asymptomatic and has no progression, then it is successful. We are observing our patient who is at home now. He will be evaluated physically at the hospital after a week.
What is the cost of the drug?
Cost is Rs 1,20,000 for two vials. One vial is of 1,200mg of each monoclonal antibody. But the DCGI has approved half the dose for Indian population. Thus, it can cost around 60,000 to a patient. But once the cocktail is prepared, it must be used within 36 hours to 48 hours to divide the cost.