The use of the drug Sotrovimab for the management of Covid-19 patients in the UAE is probably the best news to have emerged over the last three months, according to health experts.

Treatment and management of Covid-19 worldwide has come a long way since the start of the biggest health crisis in modern history, and the UAE has proactively addressed the pandemic by approving effective treatment protocols. In May, the UAE became the first country to both license Sotrovimab and enable it for immediate use. 

Sotrovimab is an investigational, single-dose monoclonal antibody -- an antibody made by cloning a white blood cell -- for treatment of mild-to-moderate Covid-19 in adults and teens 12 years and older who weigh at least 40 kg. If used early, the drug, which was developed by GlaxoSmithKline (GSK) and Vir Biotechnology, can reduce hospitalization time by 24 hours and fatalities by as much as 85 percent.

In an earlier statement, AbdulRahman Al Owais, the UAE health minister, said the medicine would significantly reduce Covid-19 related deaths and hospitalization. The Abu Dhabi Media Office recently released a video featuring doctors explaining that the drug is administered via intravenous drip (IV), and offered to adults of various ages, pregnant women, children aged 12 and above, vulnerable groups and people with chronic diseases.

In Dubai, the medicine is authorized for use in a number of categories within 10 days of the onset of symptoms. It is approved for use in individuals over 65, those with obesity or who are overweight, people with a variety of diseases including diabetes, hypertension, heart, cardiovascular, lung, kidney and sickle-cell disease. It's also an option for those with neuro-developmental disorders, who have suppressed immune systems or who rely on medical devices. 

Dr Abhilash Ramachandran Nair
Dr Abhilash Ramachandran Nair of Aster Hospital, Qusais/Photo courtesy Aster Healthcare Group

Dr Abhilash Ramachandran Nair, a specialist in internal medicine at Aster Hospital, Qusais, says that once bound to the virus, says Sotrovimab is more useful in the early stages of the disease because it reduces Covid's ability to enter human cells. There is no data on the efficacy or safety of Sotrovimab in severe cases.

"It should not be used in individuals with new onset oxygen requirement or new onset fall in oxygen saturation," he explains.

Quoting a randomized controlled trial of high-risk individuals, he says that only seven out of 291 individuals who received Sotrovimab within five days of symptom onset died or required hospitalization, compared to 21 out of 292 individuals who received placebo. 

"This translates to an efficacy of 85 percent for preventing death or hospitalization in high-risk individuals. Data from the UAE also shows good clinical outcome and no safety concerns," he says.

He adds that the epitope, or part of an antigen molecule to which an antibody attaches itself, of the spike protein is a relatively conserved or stable region, meaning it is less likely to undergo mutations. "Hence, Sotrovimab is likely to retain its neutralizing power against the new variants of concern, such as the Delta and Beta variants."

Dr Adel Al Sisi, chief medical officer and head of the intensive care unit at Prime Hospital, Dubai, elaborates: "Sotrovimab is mostly given to patients who isolate at home, early on because it stops replication of the virus."

Hospitalized patients are treated differently, with steroids and a five-day course of Remdesivir. "Research studies and trials are still being done, and we still cannot say that we have specific treatment to kill the Covid-19 virus, but we have possible therapeutic options to prevent the progression of the disease," adds Dr Sisi.

The experts also say that treatment protocols have vastly changed since the pandemic started. "It is now standardized with recommendations rooted in evidence-based medicine, as compared to the initial months when we had to do with poor-quality evidence and hypotheses based on pharmacologic theories," explains Dr Nair. 

For hospitalized patients with low blood-oxygen levels, the standard pharmacologic therapy includes steroid, the antiviral Remdesivir, anticoagulants at a preventive dose, with or without some other immunosuppressant. Antibiotics are generally not needed and should be avoided unless a bacterial infection is strongly suspected. Simply moving patients to laying on their stomach has been a game-changer for those with respiratory failure. 

Then there is the use of statins, which Dr Nair explains is based on two retrospective observational studies.

"One study of 10,500 individuals involving patients from the American Heart Association registry showed people who were having cardiovascular disease or hypertension and were already on statin had better chances of survival than patients who had cardiovascular disease or hypertension and were not on statins."

Dr Adel Al Sisi
Dr Adel Al Sisi of Prime Hospital, Dubai/Photo courtesy Prime Healthcare Group

"The second study involving around 2,626 individuals showed similar results," he says. "The key takeaway from these studies is that for individuals who already have cardiovascular disease, being on statin may provide a survival advantage if they get Covid requiring hospitalization, but we still need randomized controlled trials to have more confirmatory data on the topic.

"Some therapies that found favor in the initial days of the pandemic such as hydroxychloroquine, azithromycin, antivirals like lopinavir-indinavir and oseltamivir have been discarded," he adds.

A few clinical trials have claimed to suggest beneficial effects for the controversial treatment, Ivermectin, but due to methodological issues, no meaningful conclusions can be reached. 

"So far, there are no grounds to recommend Ivermectin and like hydroxychloroquine. They are not authorized for use in the UAE," says Dr Nair. 

Studies are still ongoing worldwide to find the most effective treatment. "There are various molecules under trial which have shown some benefit in their initial phase studies. These are now in advanced phase trials or are awaiting emergency use authorization," adds Dr Nair.

Perhaps the most promising group under study for severe Covid are the monoclonal antibodies lenzilumab and mavrilimumab, colony-stimulating factors -- aka glycoproteins -- that alter certain immune cells responsible for helping the body fight infection. "Initial trials have shown improved survival among hospitalized patients," he says.

Sargramstim, which is an inhaled and another colony stimulating factor, might improve oxygenation in patients. Aviptadil is a synthetic vasoactive intestinal peptide, which is a neuropeptide synthesized and released by immune cells, that might improve survival in critically ill patients; another drug, Molnupiravir, is an oral antiviral for outpatient treatment.

There are three forms of immunotherapy included in an NIH study for hospitalized Covid patients -- cenicriviroc, abatacept and infliximab. Also under study are Mesenchymal stem cells for severe Covid and a category of molecules called phosphodiesterase inhibitors, which have been approved by the US Food and Drug Administration to treat everything from chronic obstructive pulmonary disease to psoriasis.