Just in time! UK approves new COVID-19 treatment for immunocompromised individuals

Just in time! UK approves new COVID-19 treatment suitable for immunocompromised individuals as OCTAVE study sheds light on immune response in those with chronic illness

A collaboration between two pharmaceutical companies; Regeneron and Roche has resulted in a first of it’s kind treatment for COVID-19: Ronapreve. Better known for being tested on Donald Trump when he contracted the coronavirus in the run up to the 2020 American presidential election, this treatment has been approved for use in the UK by the MHRA with plans to roll it out across the NHS as soon as possible.

Designed for use in those who have already been infected with the COVID-19 virus it can dramatically reduce the risk of hospitalisation if given rapidly after first exposure. This treatment could be of great benefit for those who are less well protected by current vaccines and therefore at greater risk of serious illness and hospitalization from COVID-19. That group includes anyone who is being treated with immunosuppressants.

The ‘antibody cocktail’ which can be given as an injection or an infusion, uses artificial monoclonal antibodies to mimic the natural antibodies produced by a healthy immune response. It combines two different antibodies which recognise and bind to separate places on the coronavirus spike protein thereby preventing the virus from entering any body cells. Using two different antibodies also gives this treatment a much higher chance of effectively neutralising future variants as it is unlikely that both of the sites where the antibodies bind would mutate simultaneously. Therefore, even if one was unable to bind, the other still would and the treatment will remain effective.

Why is this treatment so exciting for people taking immunosuppressants?

For those with a healthy immune system, exposure to the COVID-19 virus generate long term immunity, by targeting our ‘adaptive’ immune response. In response to COVID-19 infection, the body initiates a search and destroy protocol – producing T and B cells which specifically recognise the Covid-19 virus to complete this mission.

T-cells are responsible for the destroy campaign - recognizing cells infected with the COVID-19 virus and killing them in a targeted manner.  B-cells tackle the search element, producing specialised proteins called antibodies. Antibodies are specialised proteins that recognize and bind to ‘foreign invaders’ in the body, in this case, COVID-19. Antibodies bind to the spike protein on the COVID-19 virus, neutralising it stopping it from entering any body cells preventing illness and infection. When the infection has passed, B and T cells act as the long-term memory for how to tackle COVID-19, meaning that any future encounters with the virus can be dealt with swiftly and easily.

For people who are immunosuppressed this isn’t quite as simple. Typically, immunosuppressive medicines are taken to prevent the immune system attacking either the body’s own tissue, or any deliberately placed foreign tissues (e.g. organ transplants). This is achieved by deliberately weakening the immune system. Research is ongoingto examine the exact effect that this has on the immune response of those taking immunosuppressants, and how it may differ from ‘healthy’ individuals. The UK Research & Innovation (UKRI) funded OCTAVE study, sought to explore immune responses of those with a range of chronic illnesses (inflammatory arthritis, solid cancers, hepatic and renal disease) who may be taking immunosuppressant medications differs from healthy controls.  It’s preliminary findings, published on Tuesday,  show that 40% of the immunocompromised or immunosuppressed participants mounted a low antibody response following two COVID-19 vaccinations with 11% of the participants not generating any antibodies four weeks after their second vaccine. However, this was a mixed participant group comprising many conditions and there has been limited analysis of the effects of treatments on antibody responses after vaccination making it hard to draw conclusions on individual patient groups. T cell responses were more encouraging with a preliminary analysis showing comparable responses between OCTAVE patients and healthy controls.

These latest OCTAVE results highlight just how important this newly approved therapy is. Offering those who are less well protected through vaccination an additional treatment or even means of being protected against COVID-19 ‘levelling the playing field’ between those who are immunosuppressed and the rest of the population. With potential applications in treatment and prevention of coronavirus, it has been shown to reduce the risk of hospital admission by 70% if given rapidly after the first exposure to the virus. Sajid Javid, the UK Health and Social Care Secretary said: “This treatment will be a significant addition to our armoury to tackle COVID-19” and that the government were “working at pace” to ensure Ronapreve is rolled out to NHS patients as quickly as possible.