Dr. David Ho last night, in this interview with Rachel Madow on MSNBC, provided an excellent explanation of the Regeneron’s monoclonal antibodies (REGN-COV2) and the treatment use case that has now been spotlighted to the nation with President Trump. Dr. Ho is a legendary figure for his role in leading the development of therapeutic drugs that stemmed the AIDS crisis, and has since March been leading efforts to develop antibody-based drugs to fight COVID-19. As he points out, the critical factor is early intervention. As Dr. Ramesh Akkina, Science Advisor to Immunoprevention.org puts it:
Antibodies given after exposure/confirmed test work the following way, that is: antibody treatment can dampen the severity and reduce the time for recovery. But it is critical that the antibody is given during early stages before the fire gets out of hand.Dr. Ramesh Akkina
Therefore, it is not surprising that President Trump was treated so aggressively – nor is it a particular indication of the severity of symptoms that he was experiencing. President Trump in both age and weight is in a very high risk group for adverse outcomes for COVID-19, and the further the disease progresses, the higher the risk. The benefit of monoclonal antibodies is maximized by preventing the progression of disease at the outset by simulating a much more rapid immune response than can occur through natural development of adaptive immunity to a new pathogen such as SARS COV-2.
The development of adaptive immunity can take days or weeks, and particularly for people that are elderly and with other pre-existing conditions, the virus can overwhelm their immune system in that time and trigger a cascading series of other adverse reactions – most notably ‘cytokine storms’ – that cause severe disease and/or death. If treatment is given at that stage – which has often been the case with Convalescent Plasma – it is simply too late.
Dr. Ho also cleared up misconceptions caused by the label of ‘experimental’ used by much of the news media when describing this treatment. While it is true the Regeneron’s REGN-COV2 is still finishing Phase 3 trials, the data from these trials has been very strong – Dr. Ho cited reducing the risk of hospitalization from 6% to 1.6% for those with early treatment. Thus Regeneron was already given Emergency Use authorization, and received funding in July for the production of up to 1.3 million doses. Perhaps even more importantly, as Dr. Ho points out:
- the data from similar antibody-based drugs from multiple phase 2 and phase 3 trials all have yielded similar results;
- the principles which make antibody-based drugs effective have long been understood, proven and applied in medicines; and
- since antibodies come from humans who have recovered from the virus, they are inherently safer than either drugs or vaccines.
Hopefully, however one feels about how the President ended up in this predicament, this episode can be a learning moment and turning point for the nation by shining a very bright spotlight on the power and opportunity for antibodies to help turn the tide on COVID-19. Once people grasp how they work, we can only hope that the even more obvious use case – prevention – is embraced and funded. If the President and all the staff at the West Wing had received treatments with monoclonal antibodies or immunoglobulin, then both his illness and this major outbreak would have been prevented in the first place. This should be a call to action for the Biden campaign, and for all whose work creates social proximity and mixing.
None of this is to say that masks are not needed. They are essential. And vaccines are the best long term, permanent solution. But antibody based drugs are a crucial tool that can be scaled and applied rapidly over the next few months to save lives, reduce economic disruption and revive our cultural activities.