Focosi Daniele, Tuccori Marco
North-Western Tuscany Blood Bank, Pisa University Hospital, 56124 Pisa, Italy.
Division of Pharmacovigilance, Pisa University Hospital, 56124 Pisa, Italy.
Pathogens. 2022 Jul 22;11(8):823. doi: 10.3390/pathogens11080823.
Anti-Spike monoclonal antibodies have been considered a promising approach to COVID-19 therapy. Unfortunately, the advent of resistant lineages jeopardized their effectiveness and prompted limitations in their clinical use. Change in the dominant variant can be fast to such an extent that, in the absence of timely medical education, prescribers can keep using these drugs for relatively long periods even in patients with resistant variants. Therefore, many patients could have been exposed to drugs with unlikely benefits and probable risks. We show here that about 20% of bamlanivimab+etesevimab, 30% of casirivimab+imdevimab, and 30% of sotrovimab courses were administered in Italy during periods in which a fully resistant variant was dominant. Additionally, for monoclonal antibody cocktails, the vast majority of usage occurred against variants for which one of the mAbs within the cocktail was ineffective. Given the high costs of these drugs and their potential side effects, it would be important to consider a frequent review of the appropriateness of these drugs and timely communication when the benefit/risk balance is no longer favorable.
抗刺突单克隆抗体被认为是治疗新冠肺炎的一种有前景的方法。不幸的是，耐药谱系的出现危及了它们的有效性，并促使其临床应用受到限制。优势变异株的变化速度可能很快，以至于在缺乏及时医学教育的情况下，即使在感染耐药变异株的患者中，处方者也可能在较长时间内持续使用这些药物。因此，许多患者可能接触到了益处不大且有潜在风险的药物。我们在此表明，在意大利，当完全耐药的变异株占主导时，约20%的巴瑞替尼+依替西单抗疗程、30%的卡西瑞维单抗+英地维单抗疗程以及30%的索托维单抗疗程仍在使用。此外，对于单克隆抗体鸡尾酒疗法，绝大多数使用情况是针对鸡尾酒疗法中的一种单克隆抗体对其无效的变异株。鉴于这些药物成本高昂且有潜在副作用，当益处/风险平衡不再有利时，频繁审查这些药物的适用性并及时沟通将很重要。
