Is Monoclonal Antibodies Cocktail a panacea?

Every time there is a new COVID wave, a few medicines become popular. The desperation to save family members or avoid severe forms of the infection makes hapless people opt for the ‘promising’ drugs. Currently, people are made aware of one such drug called ‘Monoclonal Antibodies Cocktail’, which costs around ₹60,000.

However, several doctors from Telangana have underscored that the antibodies cocktail, available in India, are not effective against the Omicron variant. They have also stressed that 93% to 95% of the current COVID cases are of Omicron variant.

Even if it is Delta variant, the drug cocktail has to be given within seven days of onset of the infection, and it is ineffective if the patient is in a severe stage of infection. Doctors said Remdesivir is suggested for patients with Omicron, after examining infection severity, presence of co-morbidities, immunity levels, and other factors.

Antibodies Cocktail

Antibodies developed in a lab are called Monoclonal Antibodies. The combination available in India is Casirivimab 600, and Imdevimab 600. So how does one arrive at a decision to give or take the antibodies cocktail? Doctors said that they have to know the variant, and antibodies’ levels in the patient before taking a call.

In November 2021, AIG Hospital’s doctors had announced results of a study conducted on 285 high-risk individuals. They had claimed that Monoclonal antibody therapy reduces severe disease and death in high-risk individuals infected with Delta variant of SARS CoV 2 by 100%.

Several doctors in Hyderabad said that the cocktail is not effective against Omicron. Consultant physician at AIG Hospitals Dr. Apoorva Munigela, who too gave the same opinion, said that Omicron variant has mutations in spike protein and Receptor Binding Domain, which cover the virus.

“The Monoclonal Antibodies cocktail loses the function of neutralizing the virus because of these mutations,” said Dr. Aproova. In this situation, it becomes imperative to know the variant in a COVID patient before administering the drug cocktail.

Genome sequencing is a conclusive method to know the variant. Another method is also used but as an indication. Usually, RT PCR test is done for N-Gene and ORF 1ab Gene.

Private labs collect around ₹800 more to test for S-Gene, whose presence indicates Delta variant. Absence of the S-Gene indicates that the person might have Omicron. The method is called S-Gene Target Failure (SGTF).

However, these tests will make the situation tricky.“The S-Gene is present in BA.2 sub-lineage of Omicron. This means that the presence of S-Gene does not necessarily mean a person has Delta, it could be the BA.2 sub-lineage,” said Dr. Apoorva. In such a situation, what can one do? The doctors said that all these details are explained to patients and their family members, who are then asked to take a decision. She and other doctors said that Remdesivir is given for Omicron.

Consultant physician at Sunshine Hospitals Dr. Tudi Pavan Reddy said, “If somebody has Omicron, has persistent high grade fever, cough, oxygen saturation below 93, experiences difficulty in breathing, they have to consult doctors who decide if Remdesivir has to be given, or if the patient has to be hospitalised”. He said even if a youngster has Delta with mild symptoms, the antibody cocktail might not be required. The decision is taken after considering other factors. This drug is not administered at Gandhi Hospital.

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Printable version | May 22, 2022 12:14:38 am |