This morning the RECOVERY trial reported crucial and encouraging results. It shows that the Regeneron man-made monoclonal antibodies against COVID19 saves lives in infected patients who have not made antibodies themselves. A reduction in mortality in hospitalised patients of a fifth is VERY worth having.

This result is NOT unexpected and to be honest I personally would have argued that this study was unethical to perform as the data already strongly suggested this would be the outcome a year ago as this review I wrote last June shows. Although the data then suggested EARLY use was more important. This is because the data suggests that giving this to outpatients before they get sick enough to go into hospital is MUCH MORE effective. So many thought that it was too late for hospitalised patients to benefit. Since, unlike the USA, for whatever reasons we did not approve this drug in the UK a year ago for either group, I am certainly glad the study was performed and it is always good to see confirmatory results.

The following Reuters article gives some more information, as well as a public statement by the team from Oxford who run this study.

The data has also been released in a clinical paper form and can be read in more detail.

Crucially we also see that immune compromised patients are obviously hugely overrepresented in hospitalised patients. They enrolled around 9735 patients in hospital with COVID and a whopping 30% of them had not made antipodes in response to the infection. It is this group, unsurprisingly, who benefit from being given antibodies. This is the exact same principle behind IVIG and SCIG so really should not shock anyone.

This also is yet another piece of data which confirms how VITAL it is to know if you have antibodies in your blood is to protect against COVID19. This data should immediately end the arguments of some that we don’t know if antibodies are important and the NHS MUST immediately make the tests available to all immune compromised patients. In the meantime if you want to know your antibody level you can purchase a test online, more information in my previous article on this.

How many lives of patients with blood cancer and other immune compromise would we have saved if like the USA we had made this available under an emergency authorisation last year?

It is time to stop the prevarication and make this available in the UK and all other countries that are able to deliver it logistically to ANY patient who has not made antibodies in response to a COVID19 vaccine if they are infected with COVID19.

In fact it seems so implausible that the treatment will not also prevent infection in the first place that I would argue it should be made available NOW to all patients with blood cancer who have not responded to two doses of the COVID19 vaccine even if they have not yet been exposed to COVID19. They will be exposed at some point and this can save lives (especially if the long acting forms are used, such as the one being studied by Astra Zeneca). If the NHS wants to save a bit of money on this or to ensure the stock is used most appropriately they could first give a third vaccine and only give the treatment to those who then fail to respond to the booster dose also. There is now some data that a third booster may help some immune compromised patients.

The only controlled study that is now ethical for us in my view would be to take patients with immune compromise who had not responded to vaccines but who had not yet been exposed to COVID19 and randomise them to receive antibodies or placebo. The placebo group should then be given the antibodies if they do test positive for COVID19 to avoid denying them access to what is now a proven treatment that can save their lives. The only uncertainty is the timing of when we should give this treatment i.e. before or after COVID19 exposure or infection.

In the meantime it is surely now beyond question that knowing your plasma antibody level after a vaccine is fundamentally important at this time and can definitely at least inform your decision making processes about COVID19 risk and will determine eligibility for these monoclonal antibodies as soon as they are available.

It is also crucial to document antibody repose or non response within a reasonable period of time as some people might make antibodies that then disappear but would hopefully reappear if rechallenged either by a third booster shot or infection with the disease.

Third boosters now also seem to me like a no-brainer decision and it is scandalous that immune compromised patients are currently excluded from the UK trials!

Perhaps it should also be a prompt for us to examine more carefully the immune systems of people with blood cancer to help determine just how much each individual has had their immune system impaired by the illness and its treatment.

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