“Monoclonals work, but if we manage to treat the patients most at risk with these antibodies in the first 5 days from the onset of the first symptoms their effect is even greater. And at this particular moment, with the Delta variant still dominant in Italy. , we need to focus even more and strongly on monoclonals. Soon we will also have oral therapies available. They can probably be administered together with monoclonals, we do not know yet, but surely this is the time to maximize the use of such antibodies, which may be used in conjunction with other therapies. Therefore, an effort on this must be made. ” This was stated by Carlo Tascini, director of the Infectious Diseases Clinic of the Santa Maria della Misericordia hospital in Udine, to Adnkronos Salute.
According to the infectious disease specialist, it is necessary to identify “patients who have Covid-19 infection early”, in particular those who are at risk of “developing the severe form of the disease – explains Tascini – or immunosuppressed people, with diabetes, obesity , kidney failure, heart disease or stroke. They must be intercepted and treated in time, possibly at home so as not to clog the hospitals because the full intensive care has caused, in the past more than now, the reduction of services. We identify patients at risk from the positive data we receive from the Department every day, and proactively call them. Or they are referred to us by general practitioners or special care continuity units (Usca). The administration takes place in the hospital where the patient is observed one hour after the treatment to avoid adverse events, then sent home “.
The early identification of subjects at risk “in the past was not one of the priorities – admits Tascini – due to the difficulty in carrying out diagnostic tests. Obviously, a high sensitivity and specificity of the tests is required, but they must also be rapid. We know that the antigen test and the molecular test have weak points. In general, the molecular test takes longer, which is why it does not allow the early identification of the patient who should be treated immediately with monoclonal antibodies. In the Friuli-Venice Region Giulia, on the other hand, thanks to virtuous paths, the tests are all done in the same day, in a few hours you have the answers even of the molecular ones “.
In the Santa Maria della Misericordia hospital in Udine, about 350 patients have been treated with monoclonal antibodies since April “, Tascini recalls – We have seen that if you start the administration of monoclonals within the first 5 days of symptoms, only 2% of patients need to be hospitalized. Instead, if we intervene after 5-10 days, the percentage of hospitalizations rises to 8%. And precisely because they helped us to reduce the number of hospitalizations, all the more reason now we need to focus on monoclonals promptly ” .
At the beginning, Aifa had “expected to be able to administer monoclonals within the first 10 days of the onset of symptoms – adds the expert – Now the new indication speaks of 7 days precisely because it has been seen that the monoclonal is active in the window viral disease, ie in the first week. After the patient progresses, usually due to an inflammatory response. At that point it is useless to give him a monoclonal antibody which could also worsen the inflammatory response “.
The one adopted by the Udine hospital is “an ideal management model for the Covid patient in the initial stages of the disease” admits Tascini, who however “needs medical personnel available to contact patients, to propose treatment, to verify that the conditions are in place. and risk factors for disease progression. It is an organization that requires a lot of commitment on the part of health personnel who have been tried by the last 18-20 months of the pandemic. One thing is certain: monoclonals were little known to each other, now citizens’ awareness of these treatments is increasing, but even among colleagues, the desire to identify patients at risk of developing the disease in a serious form soon has become the practice ” .
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