WHO Recommends Antibody Treatment for Patients With COVID-19 at High Risk of Hospital Admission

September 29, 2021

A treatment combining 2 antibodies -- casirivimab and imdevimab -- is recommended by the World Health Organization (WHO) for patients with non-severe coronavirus disease 2019 (COVID-19) who are at highest risk of hospitalisation and for patients with severe or critical COVID-19 who are seronegative.

The recommendation was published in BMJ.

The recommendation for patients with non-severe COVID-19 who are at high risk of hospitalisation is based on new evidence from 3 trials that have not yet been peer reviewed, but show that casirivimab and imdevimab probably reduce the risk of hospitalisation and duration of symptoms in those at highest risk of severe disease, such as unvaccinated, older, or immunosuppressed patients.

This recommendation for patients with severe COVID-19 who are seronegative is based on data from the RECOVERY trial showing that casirivimab and imdevimab probably reduce deaths (ranging from 49 fewer per 1,000 in the severely ill to 87 fewer in the critically ill) and the need for mechanical ventilation in seronegative patients.

For all other patients with COVID-19, any benefits of this antibody treatment are unlikely to be meaningful.

The recommendations are part of a living guideline, developed by the WHOwith the methodological support of MAGIC Evidence Ecosystem Foundation, to provide up to date, trustworthy guidance on the management of COVID-1919 and help doctors make better decisions with their patients. Living guidelines are useful in fast moving research areas like COVID-19 because they allow researchers to update previously vetted and peer reviewed evidence summaries as new information becomes available.

The panel acknowledged several cost and resource implications associated with this treatment, which may make access to low and middle income countries challenging. For example, rapid serological tests will be needed to identify eligible patients who are severely ill, treatment must be given intravenously using specialist equipment, and patients should be monitored for allergic reactions.

They also recognise the possibility that new variants may emerge in which casirivimab and imdevimab antibodies may have reduced effect.

However, they said that given the demonstrated benefits for patients, “the recommendations should provide a stimulus to engage all possible mechanisms to improve global access to the intervention and associated testing.”

Reference: https://www.bmj.com/content/370/bmj.m3379