In May, the Central Drugs Standard and Control Organisation approved a cocktail of two monoclonal antibodies to be given to patients suffering from mild or moderate COVID-19 to prevent their disease from progressing into the severe stage. India has approved two different antibody cocktails for use in the country, one by Switzerland based Roche that is being distributed by Cipla in India and the other by US-based Eli Lilly. Even Indian pharmaceutical Zydus Cadila is conducting clinical trials for one of their own antibody cocktails.
The charge for a 600 gram dose of both antibodies is ₹59,750.
With such an expensive price tag attached to one dose, very few hospitals and doctors are prescribing these medicines. Those who have prescribed have done so only when patients whose COVID-19 symptoms are mild and moderate but have persisted longer than two to three days.
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There have been reports of the medicine being prescribed at Delhi's Medanta and Fortis hospitals and Mumbai's Kokilaben Ambani Hospital. BOOM spoke to Dr. Tanu Singhal, infectious diseases expert and pediatrician at Kokilaben to understand when the cocktail is prescribed.
"We do not prescribe it to patients who are already admitted to our COVID-19 wards in the hospital. We only ask those patients who are at high risk, who we tele-consult when their symptoms such as fever, cough have not subsided after the first couple of days. There is a specific window within which this medicine should be given to patients," Dr. Singhal explained.
It is normally prescribed in patients older than 12 years of age and who weigh more than 40 kilograms.
The monoclonal antibody cocktail got popular after it was used to treat ex-US President Donald Trump in 2020 after he was diagnosed with COVID-19.
What Is An Antibody Cocktail?
Antibodies are a part of the human immune system which the body creates when exposed to any pathogen. They are one type of protection against the SARS-CoV-2 virus, too.
As they help in fighting the virus, several pharmaceuticals have prepared COVID-19 specific antibodies in laboratories after repeatedly cloning a single individual cell. The mixture of two different tailor-made, artificially prepared antibodies is an antibody cocktail
They are normally administered via an injection which can be either intravenous (within the veins) or sub-cutaneous (under the skin). If taken via the sub-cutaneous method, four different spots are selected in the body for one complete dosage to be inserted. After receiving a dose, the patient is monitored for at least half an hour to ensure there are no adverse events.
How Are Roche And Eli Lilly Cocktails Different?
Roche has collaborated with biotechnology company Regeneron to produce two antibodies- casirivimab and imdevimab. These are directed to the spike protein of the COVID-19 virus. The spike protein assists the SARS-CoV-2 to attach and break into healthy cells in the human body.
The Eli-Lilly antibody cocktail consisting of bamlanivimab and etesevimab was halted in the US in June 2021 even though it was the first one to receive US Food and Drug Administration's approval. It was found that this cocktail was not effective against the Gamma and Beta variants (found in Brazil and South Africa, respectively). This came at a time when the variants were driving the rise in cases in the country.
The US has also approved the GlaxoSmithKline's monoclonal antibody sotrovimab.
How Effective Are These Antibodies?
Both GSK and Roche-Cipla claim that their antibodies are effective against the COVID-19 variants.
In March 2021, Regeneron-Roche shared that their cocktail was 70 per cent effective in reducing the progression of moderate disease to hospitalisation and death.
"All the patients that we prescribed the cocktail to, recovered and did not have to be hospitalised. Our patients did not have any side effects," Dr. Singhal concluded.