Thread by @PeterHotez

Thread on POTUS therapies: Being asked about mab cocktail from Regeneron and remdesivir and what it means?

I think a key point is that use of antiviral drugs, if they are to be effective likely must be administered early in the course of the illness during viral replication.

"Watch and wait" not an option, if you are going to do it and maximize the effectiveness of these two interventions you pretty much either do it now or not at all. Later you may need to deal with host cytokine, inflammatory responses, in which case there are separate agents.

So I'm sure it was a tough call, but given what we know about coronaviruses, our work over the last 10 years shows how virus neutralizing antibodies are paramount in fighting the infection. Most vaccines work by this principle, including our SARS1, MERS, now COVID19 vaccines.

Problem with vaccines is that it can take two doses and two months to induce virus neutralizing antibodies. The point of the two different mab cocktails from either @Regeneron or @AbCelleraBio is that you can administer those VNAs now.

I agree that we have limited experimental data in humans, not much much published, but the evidence so far shows how the Regeneron mab cocktail reduces viral load and some evidence of improved clinical outcome

Given the major risk factors of the POTUS: Age, male, co-morbidities, he has a high risk for a bad outcome. Given he was febrile, and that it was a go no-go decision for now or never (see discussion above), I agree with the decision to give the Regeneron mab cocktail.

A key point: Press touting Regeneron mab cocktail as a "hail Mary" extraordinary intervention. But it's really not, it's a well thought out targeting of the SARS-2 spike protein to give some VNA now. It's what I would want for myself, family until vaccines available.

Which brings us to decisions about Op Warp Speed vaccines once available. I feel that having VNA on board = a priority. So even if first vaccines are not the best (and we don't know that) still better than nothing. Later potentially we can get boosted with another vaccine

I should have clarified this comment a bit more...would want mabs after they have gone through FDA approval, etc.