Monoclonalantibodies are positioned as the best option against SARS-CoV-2, mainly in pre-exposure prophylaxis. Although viral variants are the greatest threat to their effectiveness, in oncohematological patients, these drugs continue to be very powerful.
MADRID, Spain — Monoclonal antibodies are positioned as the best option against SARS-CoV-2, mainly in pre-exposure prophylaxis in adults and in patients without supplemental oxygen at high risk of progression. Although viral variants are the greatest threat to their effectiveness, in oncohematological patients, these drugs continue to be very powerful and may be combined with other therapeutic strategies.
Rafael de la Cámara, MD, hematologist at the Princesa de la Hospital in Madrid, gave an update about passive immunotherapy in oncohematological patients. A review of 21 clinical trials conducted last year formed the basis for a strong recommendation against the use of convalescent plasma in patients with nonsevere COVID-19. The treatment also is not recommended in those with the severe-critical form of COVID-19.
Administration is not recommended in unselected hospitalized patients with moderate or severe COVID-19.It is not recommended for uninfected patients in close contact with a person with COVID-19 .Regarding monoclonal antibodies, de la Cámara said,"Their development has been very significant, so it is difficult to follow their scientific and administrative situation.
Regarding whether an antiviral or a monoclonal antibody is better, the specialist said,"According to a UK study in Omicron outpatients with at least one risk factor and in which 88% had received three or more doses of the vaccine, treatment with sotrovimab entailed a significantly lower risk of hospitalization and death 28 days after the start of therapy, with the same result in those vaccinated vs molnupiravir therapy.
"In oncohematological patients, the virus kills more than the inflammation. Mortality in these patients remains very high, around 9%, despite the Omicron variant and the high rate of vaccinated patients. The good news is that by paying attention to blood tests and starting treatment early, we can change this trend," she said.
García concluded,"An early, personalized treatment, probably combining antiviral strategies, is necessary in patients with pneumonia. In addition, early therapy in high-risk hematological patients with oral antivirals has been associated with excellent prognosis and low viral persistence."Another aspect that continues to cause concern is the appearance of hypercoagulability phenomena in hospitalized COVID-19 patients.
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