September 15, 2022

expert reaction to WHO advising against use of sotrovimab and casirivimab-imdevimab for COVID-19

WHO guidelines, published in the BMJ, advise against the use of sotrovimab and casirivimab-imdevimab for COVID-19.

Dr Kovilen Sawmynaden, Biologics Lead at Lifearc, said:

“As the emergence of new variants of SARS-CoV2 arise (such as Omicron), we should not be surprised that medicines developed early in the pandemic begin to lose their effectiveness. Hence, the recommendation to stop using first generation monoclonal antibodies (such as sotrovimab or casirivimab-imdevimab) is to be expected and in-line with recently published scientific data (see N Engl J Med 2022; 387:468-470; DOI: 10.1056/NEJMc2207519).

“However, this should not give the impression that monoclonal antibodies are a lost cause in our fight against COVID-19. Next generation monoclonal antibodies are likely to be identified with improved breadth (including the newer Omicron sub-lineages), potency (reducing the amount to be administered) and solubility (administration via an injection rather than IV drip).

“Furthermore, the use of monoclonal antibodies in a prophylactic setting (i.e. for prevention rather than cure) is likely to be more fruitful. This will be particularly pertinent for high-risk immunocompromised groups living in the UK and comprise ~ 0.5 M people. This includes patients living with solid tumours, undergoing immunotherapy, receiving treatment for autoimmune diseases and/or cell and organ transplant. For this group, the next generation of monoclonal antibodies should provide ‘instant immunity’ against COVID-19 and will improve their quality of life, particularly where vaccine efficacy is poor or wanes sooner than in healthy individuals.”

‘Rapid Recommendations: A living WHO guideline on drugs for covid-19’ by name of first author et al. was published in THE BMJ at 23:01 UK time on Thursday 15 September.

Declared interests

Dr Sawmynaden was a member of the Bioindustry Association (BIA) COVID-19 Antibody Taskforce and is a Board Observer to RQ Biotechnology”