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Some early monoclonal antibody results - Printable Version

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Some early monoclonal antibody results - Goose - 09-16-2020

https://www.prnewswire.com/news-releases/lilly-announces-proof-of-concept-data-for-neutralizing-antibody-ly-cov555-in-the-covid-19-outpatient-setting-301131785.html

Still an early result (phase 2), but encouraging nevertheless. If we can keep people out of the hospital with this kind of treatment we can tolerate a higher case load, and fewer people will die.


RE: Some early monoclonal antibody results - akiddoc - 09-16-2020

(09-16-2020, 07:24 AM)Goose Wrote:  https://www.prnewswire.com/news-releases/lilly-announces-proof-of-concept-data-for-neutralizing-antibody-ly-cov555-in-the-covid-19-outpatient-setting-301131785.html

Still an early result (phase 2), but encouraging nevertheless. If we can keep people out of the hospital with this kind of treatment we can tolerate a higher case load, and fewer people will die.

The cost of these drugs will likely make it impractical use them in mildly sick individuals. Side effects are sometimes severe with MOABS as well. Whether they will do much for you once you are really sick is to be determined.


RE: Some early monoclonal antibody results - dabigv13 - 09-16-2020

I share akkidoc's skepticism about these drugs. Hard to imagine they will play a big role in the management of the pandemic at large. Won't be used widely in mild cases, and once a case is severe, most of the damage at that point is done by the immune system not the virus.

In addition to cost, they are administered by IV, which will also limit widespread usage.


RE: Some early monoclonal antibody results - Goose - 09-16-2020

(09-16-2020, 07:00 PM)akiddoc Wrote:  
(09-16-2020, 07:24 AM)Goose Wrote:  https://www.prnewswire.com/news-releases/lilly-announces-proof-of-concept-data-for-neutralizing-antibody-ly-cov555-in-the-covid-19-outpatient-setting-301131785.html

Still an early result (phase 2), but encouraging nevertheless. If we can keep people out of the hospital with this kind of treatment we can tolerate a higher case load, and fewer people will die.

The cost of these drugs will likely make it impractical use them in mildly sick individuals.
Interesting, because that seems to be the patient population they are looking at, people who are positive within the last three days but not really sick yet. Seems that wouldn't make sense if this drug was going to be real expensive for exactly the reason you cite. It wouldn't be given to people who were not in great need if the cost is high.
Quote:Side effects are sometimes severe with MOABS as well.
True, but they are saying that so far at least they have no treatment-related SAEs. We will obviously have more data at the end of the study.
Quote:Whether they will do much for you once you are really sick is to be determined.
True, and this study isn't really targeting those individuals. This study is done on an outpatient basis, so you get the IV and go home. They are claiming pretty significant reductions in hospitalizations.


RE: Some early monoclonal antibody results - BostonCard - 09-17-2020

Quote:These biomarker data correlated with LY-CoV555's positive impact on the prespecified endpoint of COVID-19-related hospitalization or ER visit. This endpoint occurred in 1.7 percent (5/302) of LY-CoV555 patients, pooled across dose groups, as compared to 6 percent (9/150) of placebo patients, which corresponds to a 72 percent risk reduction in this limited population.

The numbers are small and the confidence interval is wide, but if you used the point estimate, you would need to treat 23 patients with COVID-19 to prevent one COVID-19-related hospitalization on ER visit.  Whether it is worth it might depend on whether most of those are hospitalizations or ER visits.

BC


RE: Some early monoclonal antibody results - Goose - 09-17-2020

(09-17-2020, 09:57 AM)BostonCard Wrote:  
Quote:These biomarker data correlated with LY-CoV555's positive impact on the prespecified endpoint of COVID-19-related hospitalization or ER visit. This endpoint occurred in 1.7 percent (5/302) of LY-CoV555 patients, pooled across dose groups, as compared to 6 percent (9/150) of placebo patients, which corresponds to a 72 percent risk reduction in this limited population.

The numbers are small and the confidence interval is wide, but if you used the point estimate, you would need to treat 23 patients with COVID-19 to prevent one COVID-19-related hospitalization on ER visit.  Whether it is worth it might depend on whether most of those are hospitalizations or ER visits.

BC
Indeed this is another example of the "relative benefit" making a treatment look more useful than it actually is. Since only 6% of the control group was hospitalized, you would need to treat a lot of people to have any real benefit (1 in 23). Obviously the ability to do that depends greatly on the cost of the therapy, which we don't know. It may be that a sub-fraction of the subjects benefited more significantly, like possibly the people over 50 years old. The phase 2 study probably isn't large enough for this kind of analysis, so we won't know for a while.

I would also assume that there is a trial going on with patients that are already hospitalized. In those cases lowering the virus titers is only part of the story. The immune system response, secondary infections and a host of other things also become factors. That said, it is not unreasonable to expect that the ability to drive down the virus titers while still suppressing an over-active immune system would be very useful.

An obvious possibility for improvement in effectiveness would be obtained if the ability to predict who would require hospitalization was available. In the clinical trial this was not attempted. I am sure that in the "real world" there is some ability to do this, but in the absence of any real treatment being available it probably hasn't been a priority. If there is an effective treatment available even a modest improvement in predicting who should receive it would be a big force multiplier.