The monoclonal antibodies and antivirals are confirmed to be effective against the new sub-variants of Omicron. This is confirmed by the experts gathered at the Icar (Italian Conference on Aids and Antiviral Research) congress in Bergamo from 14 to 16 June. Thousands of specialists present to address the most recent news on HIV and Covid, as well as the main infectious diseases. “We begin to better understand which parts of the spike protein tend to remain stable over time and this helps a lot in the selection criteria of monoclonals. The viral functions affected by antivirals, on the other hand, are not subject to strong evolution”, underlines Maurizio Zazzi, co-president by Icar.
“The manufacturing companies have real libraries of monoclonals and can produce new ones relatively quickly in the face of new variants with a different spike protein – underlines Zazzi – With the frequent changes of the virus, there has been much evidence of variation of The good news is that we begin to better understand which parts of the spike protein tend to remain stable over time and this helps a lot in selecting the monoclonals least prone to loss of activity with the evolution of the virus. reassure – he observes – that we have good monoclonal antibodies also to treat the most recent variants such as omicron BA.4 and BA.5, which could be the protagonists of a new autumn wave “. On the occasion of the Icar congress, several valuable Italian studies will be presented aimed at demonstrating the effectiveness of the use of monoclonals in clinical practice.
Direct antivirals respond without distinction to the variants that have emerged so far. “They are synthetic chemical compounds, developed to block specific functions in the viral replication cycle – explains Zazzi – We currently have three available. Unlike monoclonals, which block the virus from entering the cell, antivirals stop the virus at the cell. inside the cell itself. The viral functions affected by antivirals are not subject to strong evolution like the spike protein, so for the moment all variants remain sensitive to current antivirals, including the recent evolutionary lines of Omicron BA.4 and BA.5 ” .
According to official AIFA data, since the registers on the use of monoclonals and antivirals were activated, over 60 thousand patients have been treated in Italy with monoclonals while treatment with antivirals has involved about 45 thousand cases. The antiviral for the treatment of hospitalized patients, the first to be made available, has been used in almost 100,000 cases. A simple health decision-making chain and efficient digital tools remain essential.
“Administration must be as early as possible, within 5-7 days from the start of symptoms – highlights Zazzi – The second phase of the infection is in fact dominated by indirect pathogenetic mechanisms and blocking the virus becomes a very limited or no clinical benefit. The therapies are all of short duration, a single administration for the monoclonals, 3-5 days of therapy for the antivirals “.
“It must be reiterated that therapies do not replace vaccination, but integrate it with a treatment for those cases in which, in the impossibility of vaccination or in the ineffective vaccination, the patient becomes infected and is assessed at risk of developing serious disease . It must be added – continues the co-president of Icar – that with monoclonals it is also possible to use it in prophylaxis, that is to protect a fragile person from infection who has not been vaccinated or who has not responded to vaccination. Just a few days ago the combination of two monoclonals, already approved for prophylaxis, has also shown its usefulness in the treatment of infection in non-hospitalized people with frailty. Therefore – he concludes – the aids for prevention and therapy improve and are in continuous development, above all to protect people at risk of serious illness. Together with surveillance they constitute the recipe for managing the pandemic in the best possible way “.
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