Aya Allam, M.D., Steven Lippmann, M.D.

Besides all the pandemic talk these days, we hear lots about coronavirus treatment with monoclonal antibodies. There are many of them. What is the big deal?

Casirivimab and imdevimab are two monoclonal antibodies synthesized by the pharmaceutical company Regeneron, brand-named REGEN-COV. These dual proteins are a monoclonal antibodies intervention delivered parenterally to quickly provide a brief defense against severe coronavirus disease (COVID-19). At this, REGEN-COV is safe and effective.

The real answer to COVID-19 is a high percentage of fully vaccinated people. Otherwise, post-infection, recovered persons also have immunity especially when further augmented by a supplemental vaccination. Casirivimab and imdevimab remains primarily a rescue therapy for individuals particularly vulnerable to a coronavirus SARS-Co-V-2 infection.

This virus is very infectious and gains entry to cells via the angiotensin-converting enzyme-2. Once intracellular, it replicates and often causes cell destruction; the person then becomes sick. A high viral load can induce a damaging hyper-immunity with potential pulmonary and other poly-organ failures. COVID-19 is most dangerous to older and/or obese people and to most anyone with a wide variety of comorbidities and exposures.

The casirivimab and imdevimab monoclonal antibodies mimic the spike protein of the SARS-Co-V-2. That blocks cell receptors and yields protection by preventing virus entry into cells; that usually diminishes the seriousness of subsequent illness.

These two monoclonal antibodies are an approved pharmaceutical, administered under medical supervision and when a physician certifies that they are indicated in an individual case. Casirivimab and imdevimab are prescribed only in the very earliest stages of potential COVID-19 disease; the earlier the better. Not a preventative; it is an emergent intervention. Candidates include anyone over 12 years old and weighing over 40 kilograms. It can also be administered to someone soon after a viral exposure, if they test-result positive to virus presence, and have comorbidities of medical concern. This most especially applies to elderly persons and to those with immunocompromise. Casirivimab and imdevimab are not recommended for patients with severe COVID-19 disease, those hospitalized and/or receiving supplemental oxygen, even for those only requiring additional oxygen flow for pre-existing conditions.

Casirivimab and imdevimab is prepaid for those having Medicare or Medicaid. Financial costs might be anticipated for some insured patients and other people. A safe medication, it often attenuates COVID-19 disease, shortens the course of illness, and may avert death.