NHS rolling out nMABs for high risk Covid patients
The NHS in all parts of the UK will be rolling-out neutralising monoclonal antibodies (nMABs) and antiviral treatments for non-hospitalised patients at the highest risk of severe disease and hospitalisation from Covid-19 from 16 December.
The intravenous treatments will be available to those who are PCR positive and aged 12 and above, and who are considered to be at high risk of severe disease, hospital admission or death. Eligible patients may receive antiviral therapy if an nMAB is contraindicated.
Eligibility has been determined by a DHSC-commissioned independent advisory group and approved by all four home nations. Most of these high-risk patients will be sent a letter or email telling them in advance they may be eligible for nMAB treatment if they test PCR positive for Covid-19.
GP practices will not be prescribing (or pharmacies dispensing) nMABs or antivirals. Practices have been asked to refer high risk patients to the local Covid-19 Medicine Delivery Unit (CMDU) which will assess eligibility and arrange treatment.
If a patient in the highest risk cohorts with a positive PCR test contacts their local pharmacy, they should be advised to stay at home and contact their GP for a referral to a CMDU, or to call NHS 111 if out of hours.
Neutralising monoclonal antibodies (nMABs) bind to specific sites on the spike protein of the SARS-CoV-2 virus particle, blocking its entry into cells and therefore inhibiting its replication.
Ronapreve is a combination nMAB containing equal amounts of casirivimab and imdevimab that binds specifically to two different sites on the spike protein.
Recent evidence suggests that nMABs and oral antivirals significantly improve clinical outcomes in non-hospitalised patients with Covid-19 who are at highest risk of progression to severe disease and/or death. Key findings are:
- Casirivimab and imdevimab administered intravenously reduced the composite outcome of hospitalisation or death by 70 per cent and reduce median time to resolution of Covid symptoms by 4 days in non-hospitalised patients with mild-to-moderate disease.
- Final results from the Phase 3 MOVe-OUT trial show that the oral antiviral molnupiravir resulted in a relative risk reduction of 30 per cent in a composite primary outcome of hospitalisation or death at day 29.
As molnupiravir is not recommended during pregnancy, all individuals of childbearing potential who are prescribed molnupiravir (where an nMAB is contraindicated) should be advised to use effective contraception for the duration of treatment and for four days after the last dose of molnupiravir.