A major study looking at almost 11,000 patients in the UAE has highlighted the effectiveness of the drug sotrovimab in preventing people from falling seriously ill with Covid-19.
The research on patients treated at Government of Dubai clinics and hospitals found that the monoclonal antibody — an antibody made by cloning a unique white blood cell — was far better than an anti-viral drug, favipiravir, at preventing people from needing hospital treatment.
Thought to be the largest such study in the world, the research highlights progress in developing treatments against the coronavirus.
However, new variants threaten to reverse gains, with sotrovimab less effective against the Omicron variant, which emerged in November.
Like the US Food and Drug Administration, the UAE authorities gave the green light to the use of sotrovimab in mid-2021. This was based on the results of an earlier international clinical trial in which nearly 300 patients administered the drug were compared with a similar number not given it.
The new study’s senior author, Prof Rabih Halwani, professor of immunology at the University of Sharjah, said there remained “a need for real-world data”.
“Based on that and previous studies, the efficacy of sotrovimab to reduce hospitalisation was expected. However, it was not proven on a cohort as large as the one we used in this study,” Prof Halwani said.
In the study, researchers looked at 10,882 patients, 1,135 of whom had been given sotrovimab alone, 2,653 sotrovimab and favipiravir, and 7,094 only favipiravir.
When they were treated between July and October last year, the patients had Covid-19 symptoms, but these were not serious enough for them to have been taken to hospital
Among people given sotrovimab alone, only 13 patients, or about 1.5 per cent, saw their symptoms worsen to the extent that they had to be admitted to hospital, while for those administered both sotrovimab and favipiravir, the rate was 2.9 cent. When favipiravir on its own was used, about four per cent of patients were taken to hospital.
“Sotrovimab was found to reduce the risk of progression of Covid-19 when administrated early to non-hospitalised patients with symptomatic Covid-19,” wrote the authors of the study, who are from the University of Sharjah, Dubai Health Authority and institutions in Saudi Arabia, the US and Canada.
Sotrovimab was developed from antibodies taken from a person who survived the 2002 to 2004 Sars outbreak, which was caused by a coronavirus similar to that which causes Covid-19.
Sotrovimab consists of multiple copies of antibodies (proteins that recognise and attack foreign substances that may harm the body) produced in the laboratory.
In the case of sotrovimab, the antibodies recognises a section of the coronavirus spike protein, which is the part that binds to human cells.
The UAE was a prime early user, with the country’s authorities co-operating closely with the company behind the drug, GSK (formerly GlaxoSmithKline).
Overall, the new study, published this month in Clinical Pharmacology and Therapeutics, indicates that sotrovimab should be used as an alternative to anti-viral drugs to combat Covid-19.
While suitable for patients particularly at risk from the coronavirus, sotrovimab should not be given to everyone with Covid-19, because, Prof Halwani said, “this may increase the pressure on the virus to mutate and produce new variants that escape the antibodies’ effect”.
Prof David Taylor, professor emeritus of pharmaceutical and public health policy at University College London, said the development of vaccines and drugs to combat Covid-19 had “exceeded expectations”.
“This has been a [faster] rate of development compared with historical rates, partly because people have been able to get through regulatory barriers faster than before and the science is at a stage where it’s [developing] very well, but people are still dying and it’s still disrupting the economies of countries like China that haven’t moved as fast in taking a pragmatic way of living with the disease,” he said.
Prof Taylor said there should be continued development of “a wide range of pharmaceuticals”, as these would be required for the foreseeable future.
There remained the risk, he said, that a coronavirus variant would appear that was both highly transmissible and virulent, and able to evade existing resistance.
Sotrovimab is thought to be less effective against omicron, which emerged in November last year (after data for the latest study was collected), and this may highlight the need for new treatments.
“We are, hence, in a race against Sars-Cov-2’s mutating ability and the development of a therapy or vaccine addressing the newly emerging variants is our ongoing challenge,” Prof Halwani said.