Infectious disease specialist Lichtner, ‘monoclonals work but we can do more

“Excellent response from 801 virus-positive patients to Goretti di Latina, avoiding hospitalizations and deaths”

“Monoclonal antibodies work. We have obtained an excellent response from the 801 Covid-19 positive patients treated with these drugs, avoiding them – subjects at risk for various comorbidities – from developing the severe form of the disease or ending up in intensive care . The Santa Maria Goretti hospital in Latina is the center in Lazio that has administered the most monoclonal antibodies, but we can do more to avoid hospitalizations and deaths “. Thus Miriam Lichtner, head of the infectious diseases department of the Goretti hospital in Latina, at the forefront of emergency management from the beginning, takes stock on the basis of the experience gained in the field of anti-Covid monoclonals in use since March 2021.

“We started the administration after the favorable opinion of the AIFA and the publication of the decree in the Official Gazette – explains Lichtner – organizing an effective and efficient path and network. Since then we have treated 801 patients with the association of monoclonal antibodies, a number of very important administrations. In Lazio we are the center that has done the most so far, a goal that we have achieved in two ways: first of all with the direct relationship with general practitioners and other hospitals in the area and then, in when there was a drop in requests, we began to enroll people with active calling. My department has the opportunity to view the Sar-CoV-2 positive platform daily. Of these, patients who have the characteristics to be subjected to treatment with monoclonals were and still are called directly. At this time, with the increase in cases, we have an average of the 10-15 administrations per day carried out in two shifts “.

The identikit of the patient to be treated with monoclonal antibodies in recent months has changed. “At the beginning we had the possibility to enroll only subjects who were older than 65 years associated with a comorbidity – recalls Lichtner – Gradually, with the expansion of the criteria, the age of the population has changed: today we treat patients with an average age of 60, but also the elderly. We treated a 105-year-old woman, although there is no shortage of 12-13 year old boys with respiratory or neuropsychiatric problems. Today all patients over 65 years even without other risk factors are candidates for therapy. Even younger patients, but with pathologies such as hypertension, asthma, chronic pulmonary diseases, tumors, immunosuppressions, diabetes can be treated “.

The subjects most at risk of developing the severe form of Sars-CoV-2 infection are overweight or obese people, with previous respiratory (asthma or BPCO) and metabolic (diabetes) diseases. “These patients must be intercepted early”, warns Lichtner who adds: “In our experience with monoclonals, in 97% of cases the patient did not develop a severe form, his infection did not evolve into pneumonia and therefore did not end up in therapy. sub-intensive or intensive “. Furthermore, “in 80% of cases the patient had a resolution of symptoms within 7-10 days – underlines the infectious specialist – so the effectiveness was and is very important. Results obtained, it must be said, in the subjects at risk that present themselves to our observation still in the phase of the paucisymptomatic or symptomatic disease and which has not yet transformed into pneumonia “.

At the moment at Goretti in Latina, intravenous monoclonal antibodies are being administered, “but soon we could have simpler administrations available, for example subcutaneously or even the new antiviral drugs by mouth – highlights Lichtner – In the meantime we have organized the clinics, open in the morning and in the afternoon, to meet all requests. That’s not all: with the support of the ASL of Latina, we are working to facilitate the transport of patients, the majority of whom are frail and with limited mobility. For this reason we have organized an ambulance service: people are transported from home to hospital and from hospital to home. This is a very effective organizational model “.

Investing in prevention – and monoclonals are part of secondary prevention – is a priority for the head of infectious diseases at the Goretti hospital. “We must intercept the patient when he is in the initial phase of the disease – recommends the expert – but today it is a difficult thing to understand. Unfortunately we think ‘why investing resources in a patient who is fundamentally well and some time ago we said to this patient to stay at home? ‘. Instead we must invest because we believe in prevention, we believe that following that patient today means avoiding treating him in a serious form, if anything after 4-7 days. We must believe in this intervention, there are scientific data, there are real-life data and therefore we must ensure that the centers where monoclonal antibodies are administered are strengthened. But to do this we need more nurses and more doctors in addition to the transport network “.

The confirmation that with monoclonals are avoided hospitalizations in intensive care and deaths comes from the numbers. “In our series of 801 patients as of December 15, if we consider that 30% could develop the severe form of the disease, we prevented 240 people from developing into the serious disease”, concludes Lichtner.