Covid, Galli: “Monoclonal hopes for prevention, but destined for a few”

“Monoclonals represent hope for those who do not respond to the vaccine or cannot be vaccinated.” For these people, “a substantially limited number of the general population”, it is “an alternative to the vaccine”, based on the “transfer of already formed antibodies to a person who is unable to produce them by himself through vaccination”. This is how Massimo Galli, professor of Infectious Diseases at the State University and primary at the Sacco di Milano, comments on the Provent phase III study on the “first combination of two long-acting antibodies (Laab) to prevent Covid-19”, whose first results were communicated by AstraZeneca. “This study is further confirmation, in the context of a series of studies currently underway – he explains to Adnkronos Salute – of the possibility of arriving at a prophylaxis on non-responders. But, and this is the point, to know that a person does not respond to the vaccine, it must be evaluated before he falls ill and this must be done, in particular, in the most fragile subjects and in situations where it is easier to predict that there may not have been a response to the vaccine “. For Galli “until one thinks about the need to evaluate the antibody response that people have to vaccination, it is clear that it will not be possible to identify who needs this kind of passive immunoprophylaxis. Today we only know the people who need it when they arrive at the hospital , to damage already done “. “In general, they are people who tend to protect themselves, but when faced with a variant such as Delta, highly diffusive, rather than talking about a third dose, it is necessary to establish whether these people have a response or not. And possibly cover them with passive immunoprophylaxis. “, concludes Galli, who underlines the distinction between” the therapeutic use of monoclonals and the prophylactic one. The therapeutic use concerns the very early intervention in people with infection who have characteristics such that a negative course of the disease is foreseeable. L ‘prophylactic use concerns people who are not infected but who either cannot be vaccinated or have not responded to the vaccine “.