As Covid cases across the city soar, so has the demand for cocktail therapy as compared to the second wave. However, doctors said that they are banking on two medications, the new antiviral drug Molnupiravir and the monoclonal antibody cocktail drug to treat patients who are at risk of developing severe disease. Doctors said the number of patients qualifying for these medicines has increased over the past 10 days since the city began experiencing a surge.
The new guidelines also include two new therapies/drugs — monoclonal antibody cocktail and Molnupiravir — for asymptomatic but high-risk patients and symptomatic patients with certain comorbidities, to prevent the disease from progressing towards severe infection.
Dr J Gogtay, global chief medical officer, Cipla, said cocktail therapy is given to two types of patients: those diagnosed with Covid and mildly symptomatic but are at risk of severe disease and the other for household contacts, where a person at home is infected and can spread the infection to others in the house at risk of severe disease, which is called post-exposure prophylaxis. The activity of monoclonal antibody is diminished against the Omicron variant.
“Currently both delta and omicron variants are circulating, with delta still the dominant variant in India. The demand for monoclonal antibodies has increased, with many physicians reporting an improvement in patient symptoms in 48 hours,” he said.
The monoclonal antibody cocktail drug is a combination of two or more monoclonal antibodies. In November 2020, the USFDA issued an emergency use authorisation to REGEN-COV, which contains two monoclonal antibodies— casirivimab and imdevimab. It received emergency use authorisation in India in May 2021. REGEN-COV is available in India through a tie-up between Roche India and Cipla. While it is widely in use, India’s drug regulator has also approved American pharmaceutical company Eli Lilly’s antibody-drug combination.
Early in December, a study by Frankfurt-based researchers found that the REGEN-COV’s cocktail failed to neutralise the Omicron variant in a laboratory setting. Eli Lilly has also announced that its cocktail has “reduced neutralisation activity” against Omicron.
While SevenHills is administering the cocktail therapy free of cost, a pack of REGEN-COV costs Rs 1,19,500 in the private sector. One pack can be used for two patients, thus the cost per patient comes to ₹59,750. The vials need to be stored at 2-8° Celsius. Once opened, the vials should be stored at the same temperature and used within 48 hours.
Dr Smita Chavan, deputy dean at SevenHills Hospital said the monoclonal antibody was being given to patients depending on the severity of infection. So far 1,680 patients have received the REGEN-COV cocktail since May 2021, with 220 receiving it in December. “It would not be right to say that cocktail therapy works on Omicron patients, as there are no studies so far. We are following ICMR treatment protocol, due to which none of the patients who were administered the therapy in December has progressed to severe disease,” she said.
Infectious diseases experts said that the selection of patients and the timing is crucial for the antibody cocktail to work. “If we pick our patients carefully and time the administering of the drug well, the results are very good. So far, we have treated 100 patients with the cocktail,” said a doctor.
He further said that it was ideal to start the therapy within 72 hours of symptoms. Patients who had already developed full-blown pneumonia or other complications may not benefit from the therapy, he said.