On Friday, 24 Spetember, WHO (World Health Organisation) has recommended the COVID-19 treatment combining two monoclonal antibodies — casirivimab and imdevimab— for a certain subset of patients.
In India, the treatment developed by Roche in partnership with Regeneron, the company that was made famous when its antibody cocktail was given to former US President Donald Trump under "compassionate grounds" when he contracted COVID-19, and is being distributed by Indian pharmaceutical company Cipla Limited.
This treatment was given emergency use authorisation by India's Central Drugs Standards Control Organisation (CDSCO) on 3 May, and has been much anticipated.
But one thing that dampens the news of this launch is the high pricing of the treatment. One dose is said to cost Rs 59,750.
In it's latest statement, WHO has asked companies to reduce the price of the treatment in order to improve access to the possibly life saving treatment, particularly in middle and low income countries.
What Do We Know About This Antibody Cocktail?
The Antibody Cocktail is a treatment that contains two neutralizing antibody drugs, casirivimab and imdevimab.
According to Dr Bharat Gopal, Senior Consultant Pulmonology, Fortis Hospital, Delhi, "these two antibodies work similarly to the antibodies produced naturally by the immune system when one gets infected by COVID 19 Virus."
“These antibodies attach to the spike protein of the coronavirus and prevent it from attaching to the human cells and hence preventing symptoms and progression of disease.”Dr Bharat Gopal, Senior Consultant Pulmonology Fortis Hospital, Delhi
According to Roche, the cocktail of Casirivimab and Imdevimab also shows efficacy against the widest spread variants.
"It also reduces the risk of losing its neutralisation potency against new emerging variants," says the company.
Who Is It Meant For?
According to Roche, this antibody cocktail "is to be administered for the treatment of mild to moderate COVID in high-risk patients."
By ‘high risk’, they mean people who are immunocompromised or suffering from serious comorbidities such as chronic kidney disease, cardiovascular disease, and thalassemia among others.
They further specify that it is meant for adults and paediatric patients (over the age of 12, weighing at least 40 kg), who are confirmed to be infected with COVID.
"Its phase 3 trial data showed that the treatment actually cut the risk of hospitalisation and death by 70-71 percent when used in different dosages," says Dr Gopal.
The drug has authorisation in the United States and in Europe it is authorised in non-hospitalised patients.
What WHO Recommends
WHO recommends the treatment for two groups of COVID patients.
Those with non-severe COVID-19, but are at the highest risk of hospitalisation.
These include terminally ill patients, unvaccinated people, particularly older people, and immunosuppressant people with mild COVID symptoms.
The second are those with severe or critical COVID-19 who are seronegative, meaning they have not mounted their own antibody response to COVID-19.
The experts also reiterated that for all other COVID patients, the treatment is unlikely to help.
Is There a Flip Side?
“Like any new therapy which has been developed during the pandemic, this one also comes with fast-tracking, and emergency approvals —all these do give us doctors some apprehensions”Dr Bharat Gopal, Senior Consultant Pulmonology, Fortis hospital, Delhi
But Dr Gopal is also confident in its safety and efficacy shown in the data available, saying, "We have hope that this may help our patients when used judiciously and appropriately."
He explains this by saying, "please understand that this is a drug for the treatment of mild to moderate COVID-19 who are at high risk for progressing to severe COVID-19 and/or hospitalisation."
“It’s not meant to be used in those who are hospitalized due to COVID-19, OR who require oxygen therapy due to COVID-19, or who require an increase in baseline oxygen flow rate due to COVID-19 in those on chronic oxygen therapy due to underlying non-COVID-19 related comorbidity.”Dr Bharat Gopal, Senior Consultant Pulmonology, Fortis Hospital, Delhi
"Hence, patient selection and early initiation will be the key to successful usage of this therapy," he adds.
Dr Gopal also fears that "the indiscriminate usage may lead to shortages for those who may benefit."
Another drawback to consider is the steep price of the treatment.
As mentioned, single dose of the antibody cocktail is priced at Rs 59,750, and the two-dose multipack (for two individuals) retails at an MRP of Rs 1,19,500— a price that is clearly beyond a large section of the country's population.
What Does This Mean for India?
According to Dr Gopal, fewer hospitalisations would mean less pressure on healthcare facilities that India has been facing as a result of the surge in cases.
The treatment, according to the joint statement by the two companies, "can potentially benefit 200,000 patients as each of the 100,000 packs that will be available in India offers treatment for two patients."
(At The Quint, we are answerable only to our audience. Play an active role in shaping our journalism by becoming a member. Because the truth is worth it.)