Thread by @michaelmina_lab

POSITIVE news

Monoclonals antibodies (mAbs) have been quietly built and tested for months now. IMO mAbs have some of the best chances of offering powerful treatments for #COVID19

Lilly is now posting positive results from a relatively small trial

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statnews.com/2020/09/16/lil…

Monoclonal antibodies are manufactured antibodies that are built, in part, based on looking at recovered people’s cells and asking “What antibodies naturally formed in these people” and then recreating the “successful” or protective antibodies as a treatment.

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Many different antibodies are tried in the lab and in animal studies and the most potent are eventually manufactured - and in the case of Lilly and Regeneron are now being trialed, with early but positive looking results

Why do I think monoclonal antibodies are promising?...

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mAbs are promising because we are literally taking proteins (antibodies) that our bodies normally make to defend us from pathogens, we are choosing the best ones, producing them and simply giving them as treatments...

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So biologically, our bodies are built to be OK with these types of molecules.

Also, we have a tremendous amount of experience with mAbs. Different mAbs are produced for all different conditions. Some to defeat viruses like RSV and some to help defeat cancers...

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Point is, we know how to build them, know they can be given to people safely (caveat that each needs to be assessed on its own), we have examples where they work for similar-ish viruses, and we know that the body can break them down safely.

Also, a great aspect of mAbs...

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Is that they could even be given prophylactically. mAbs can even potentially be produced and given to people as a preventative measure - almost like a temporary vaccine - but instead of your body developing immune memory, you give the immune products and they last temporarily

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Some mAbs can be produced to stick around in the blood for months. So there is a potential, particularly for elderly people who may not take to a vaccine very well, to provide a shot of mAbs each winter, for example...

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But mAbs aren’t here quite yet. But I’ve been banking on them (metaphorically - I have no investments) as one of the most promising class of drugs to help us out of this mess. Perhaps moreso even then vaccines - at least for the short term...

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If mAbs (plus other therapies and medical innovations) can help people stay alive and out of the hospital, it can change the overall risk equation and perhaps increase our tolerance for outbreaks, helping the economy to stay open more safely.

But we aren’t there yet.

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mAbs may come to market at very high price points and very limited distribution

Like vaccines, they’re unlikely to be widely available soon. But maybe for ex for compassionate use in hospitalized patients.

So, I’m not holding my breath, but I will remain optimistic.

11/11

People are asking my take on the lack of a dose response.

It’s a small sample - so tough to make much out of it. If the lack of dose response holds, it will be peculiar.

The Lilly mAb may not end up as the winning ticket, but IMO mAbs have best chances of a potent treatment.