Doctors bank on new antiviral drug Molnupiravir and antibody cocktails for high-risk patients
Doctors said the number of patients qualifying for these medicines has increased over the past 10 days since the city began experiencing a surge
Mumbai: With Mumbai emerging as the epicentre of a fresh wave of Covid-19 cases, doctors said that they will bank on two medications, the new antiviral drug molnupiravir and the monoclonal antibody cocktail drug, to treat patients who are at risk of developing severe disease. Doctors said the number of patients qualifying for these medicines has increased over the past 10 days since the city began experiencing a surge.
Both molnupiravir and the antibody cocktail drug are indicated for patients with mild disease who are at the risk of progression to severe Covid-19. “In the past few days, we have been getting a lot of patients who are in the mild category and a large number of them are candidates for these medications,” said Dr Vasant Nagvekar from Lilavati Hospital in Bandra.
With the highly mutated Omicron variant in circulation, a considerable number of the new cases are among people who have been fully vaccinated, many of them senior citizens and those with co-morbidities. Doctors also said that the more potent Delta variants of the virus is still in circulation and is also causing hospitalisations.
Nagvekar said he has started prescribing molnupiravir to the patients soon as they report symptoms. If the symptoms don’t subside within a span of 48 to 72 hours but they have not progressed, he prescribes the antibody cocktail drug. “Molnupiravir allows some breathing space to observe the patient and his disease progression, before moving on to the more expensive cocktail drug,” he said adding that he administered molnupiravir to seven patients on Friday.
Molnupiravir was granted emergency use approval by the U.S. Food and Drug Administration in December. The Drug Controller General of India also allowed its emergency use last week. According to Nagvekar, a five-day course of molnupiravir costs ₹2,700.
The monoclonal antibody cocktail drug is a combination of two or more monoclonal antibodies. In November 2020, the U.S. FDA issued an emergency use authorisation to REGEN-COV, which contains two monoclonal antibodies— casirivimab and imdevimab. It received emergency use authorisation in India in May 2021. REGEN-COV is available in India through a tie-up between Roche India and Cipla. While REGEN-COV is widely in use, India’s drug regulator has also approved American pharmaceutical company Eli Lilly’s antibody-drug combination.
Early in December, a study by Frankfurt-based researchers found that the REGEN-COV’s cocktail failed to neutralise the Omicron variant in a laboratory setting. Eli Lilly has also announced that its cocktail has “reduced neutralisation activity” against Omicron.
At the civic-run Seven Hills Hospital in Marol, 1660 patients have received the REGEN-COV cocktail since May 2021; 220 received it in December. “We have been admitting a lot of international travellers since the Omicron scare began and fitting candidates have received the cocktail therapy. We have observed beneficial results in almost all patients,” said Dr Smita Chavan, deputy dean at Seven Hills Hospital. “It’s hard to comment on the cocktail’s impact on Omicron patients as we have not done any specific study. But none of the patients who were administered the therapy in December has progressed to severe disease,” she said.
While Seven Hills is administering the cocktail therapy free of cost, a pack of REGEN-COV costs 119,500 in the private sector. One pack can be used for two patients, thus the cost per patient comes to ₹59,750.
Infectious disease expert Dr Om Srivastava said that a combination of molnupiravir and antibody cocktail drugs is likely to become the mainstream treatment in the coming days.
“Both the medications are targeted at the mild patient category that has increased now. The cocktail therapy definitely plays a role in shortening the recovery period,” he said adding that he had administered the cocktail drug to nearly 10 patients in the past week.