Which monoclonal antibody would work with omicron covid 19?

[lankisterguy]

Which monoclonal antibody would work with omicron covid 19?

Reposted from [e-mail] : groups.io/g/CLLSLL/message/...

with permission from the author

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From: Rick Furman Date: Sat, 18 Dec 2021 19:29:29 EST

Right now, the majority of variants isolated in the US are still delta. All we know is that REGEN-COV and bamlanivimab-etesevimab have diminished activity against omicron and sotrovimab and Evusheld retains its neutralizing activity. Interestingly, the FDA has updated the Evusheld approval to require sequencing of all breakthrough cases of Evusheld to generate these data.

For now, it is important to just move forward with the same precautions and avoid getting infected. If infected or exposed, I would recommend receiving an antibody cocktail. Which one available will be dependent upon distribution and availability.

Fortunately, the Pfizer pill, Paxlovid, should be effective against all variants given its targeting of an internal enzyme.

Rick Furman

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Len

[neurodervish]

Thanks Len!

[db601]

Len, thank you for this post.

[KatieBlue]

GSK is supposed to still be effective against omicron. Regeneron and Eli Lilly versions, as noted above, not so much. Evusheld seems to be effective, and while approved for immuno compromised, is not yet available…

[bennevisplace]

Thanks Len. I think the claims for GSK-Vir's Sotrovimab (Xevudy) and Astrazeneca's Evusheld need to be tested in the real world before we know how well they neutralise Omicron.

UK members will be pleased to know that Xevudy is now available on the NHS, or so it was announced this morning. From memory, the government has purchased 100,000 doses, to add to the 480,000 of Ronapreve. We're still waiting for Evusheld to be approved by the medicines regulator.

[lankisterguy Volunteer in reply to bennevisplace]

I agree that it would be better to have more detailed data, but likely by the time we get enough data, the virus will have evolved several times, so experts providing informed guesses is the best we can do for now.

Len

[bennevisplace]

Yes, it's just that most of the experts concerned were evaluating their own drug: Regeneron, GSK and AZ, Even the German researchers, who found the most Omicron-neutralising monoclonals to be Sotrovimab and DZIF-10c, stated competing interests:

H.G., K.V., and F.Kl. are listed as inventors on pending patent application(s) on SARS-CoV-2-neutralizing antibodies filed by the University of Cologne medrxiv.org/content/10.1101... The patents being for DZIF-10c, which is in clinical trials.

[neurodervish]

This Forbes article titled How Omicron Evades Natural Immunity, Vaccination, And Monoclonal Antibody Treatments (shared by KatieBlue ) says, "Of the eight approved or authorized antibodies, all but sotrovimab completely or almost completely lost their neutralizing activity against the Omicron pseudovirus. A cocktail of cilgavimab and tixagevimab had a reduced potency of 200-fold. Sotrovimab, conversely, shows a drop of 3-fold drop in neutralization potency." forbes.com/sites/williamhas...

Cilgavimab and tixagevimab are the mAbs in Evusheld. I've been pinning my hopes on Evusheld, so... not sure what to think now.

[avzuclav]

lankisterguy did you see the FDA docs for Paxlovid? It says to avoid use of venetoclax and ibrutinib.

fda.gov/media/155050/download

Paxlovid - ibrutinib and venetoclax

[lankisterguy Volunteer in reply to avzuclav]

Thanks for posting that info. -

I just learned of the conflict this morning when my CLL expert Dr. Furman responded to a similar concern on CLLSLLgroups.io groups.io/g/CLLSLL/message/...

Re: Paxlovid Pill Approved for COVID 19 Treatment ... But check the Contraindications- Ibrutinib and Venetoclax

From: Rick Furman

Date: Wed, 22 Dec 2021 21:45:37 EST

Paxlovid is a CYP3A inhibitor and will impair clearance of many drugs. This would include all drugs with the "grapefruit" warning. Given the course is only five days, holding the agent is often all that is necessary, but dose reductions, etc. would also work.

Rick Furman

(reposted here with permission from Dr. Furman)

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I have printed a copy and clipped it to my CLL Society COVID-19 Action Plan documents cllsociety.org/covid-19/ and alerted my wife that we will confer with Dr. Furman for a dose adjustment or pause of Venetoclax for 5 days if I need to take Paxlovid at any time in the future.

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Len

[Justasheet1 in reply to lankisterguy]

Len,

Can you repost this as this is important to see.

Jeff

[Justasheet1]

Good catch Avz. Just when I saw a glimmer….. ☹️

[skipro]

Bebteluvomab works against Omicron