Thread by @DrEricDing

FANTASTIC NURSING HOME NEWS—Eli Lily’s monoclonal antibody drug can lower the risk symptomatic #COVID19 by 80% when used preventively among nursing home residents. Cuts risks overall by 57% among both staff+residents. Huge.

2) Lily will now seek expanded emergency use authorization from the FDA. The detailed numbers are linked below.

https://twitter.com/drericding/status/1352241211508142082

3) Unlike vaccines that trains / teaches your bodies how to recognize the spike protein and build your own immunity, monoclonal antibody drugs directly infuse working synthetic antibodies against the virus into your system. This is useful for people with slower immune systems.

4) MAB drugs (also made by Regeneron) also useful in early #COVID19, which it is currently used for, as long as illness isn’t severe yet. but unclear how it would mix with vaccines. Govt rules currently says avoid mixing for 3 months initially. But maybe updated soon.

5) And yes, MAB drugs are designed for the classic older variant. Unclear on efficacy against new variants. But it can be updated over time with extra work and testing.

6) That said, some have speculated extended use of MAB drugs could be also driving mutations as well—since it forces evolution of viruses via extra selective pressure. Some say the same for overuse of convalescent plasma therapy. But similar argument on antibiotic overuse too.

7) But do we stop using antibiotics for bacteria infections? No, but there is some risk of antibiotic resistance long term. But it buys us time.

MAB drugs are not a way out of this pandemic. Vaccines are. But maybe a temporary stopgap.

8) Also note that unlike vaccines, MAB drugs wanes quickly within weeks. Vaccine derived immunity should be robust for much longer - especially with the 2nd dose. MAB drugs also slows your body from building its own immune defense to the virus too.

9) This is akin to “giving a person a fish to feed for a day”, as opposed to “teaching a person how to fish” like vaccines do. Teaching how to fish is much better long term. So MAB drugs are a stopgap temporary measure.

10) MAB drugs are also pain in the rear to mass produce. They can’t be chemically synthesized like molecules in typical drugs can. They must be made by slow biological reactors that create them slowly. So much slower on mass production.

11) Also worrisome, neutralization by 14 of the 17 most potent mAbs tested in one study was reduced or abolished by either K417N, or E484K, or N501Y mutations (found in the most recent South Africa 🇿🇦 #B1351 and Brazil 🇧🇷 #P1 variants). Not good. biorxiv.org/content/10.110…