monica gandhi twitter
The Effect of BQ.1 and BQ.1.1 on COVID-19 TreatmentI'm Dr Monica Gandhi associate chief of,the divis
Updated on Jan 18,2023
The Effect of BQ.1 and BQ.1.1 on COVID-19 Treatment
I'm Dr Monica Gandhi associate chief of,the division of HIV infectious disease,and Global medicine at UCSF and today,we're going to be discussing the effects,of the bq1 and BQ 1.1 subvariance on,covid treatments so this is the latest,data from the CDC and you can see at,this point that the prevalence of,subvariance around the country is really,growing in terms of bq1 and BQ 1.1,prevalence in fact only about 11 percent,of strains are ba5 and over 40 percent,are bq1 baq BQ 1.1 with a smattering of,ba275 and xbb and when we think about,the lineage of the emerging subvariants,of Omicron really think of ba2 as being,kind of the parent and then that's,divided into ba45 and the offshoots of,ba45 are ba7 bq1 bq11 and then another,major family is the ba-275 and its,offshoot is xbb this is really to say,that all these subvariants of Omicron,are emerging they're more transmissible,and their impacts on the monoclonal,antibodies that we can use so in terms,of the monoclonal antibodies,unfortunately we really have a sort of,increasingly lost them as these,mutations have emerged in the spike,protein that render our old monoclonal,antibodies pretty pretty useless and in,fact on November 30th bem televomab or,beb was sort of taken away in terms of,its eua status because the subvariance,of bq1 bq11 xbb which are now dominant,in our country really beb does not work,against them,and then what about the prophylaxis,agent of tixa give themab and silgavimab,I'll know I'll refer to that as tix sill,well essentially in vitro if you look at,these subvariants that are dominant this,particular tick sill monoclonal antibody,for prophylaxis does not work against,these emerging subvariants so here this,really shows you on this slide what are,the remaining treatments that we have,for covid-19 in the face of these,subvariants that are predominant and,actually we do absolutely have three,options uh the first is essentially the,protease inhibitor so this is,normatravir with retonovir they are,administered separately and this is,really a bid or twice a day regimen for,five days unless the glomerular,filtration rate is below 30 in which,case you want to give it once a day this,five-day course of this protease,inhibitor is not Disturbed perturbed by,this of variance it still works very,well this is an oral treatment for,outpatient treatment the second is ramde,severe ramdasavir we do given the,inpatient setting but it's also been,approved for outpatient treatment,for all of the emerging subvariants,absolutely works and we can give this,down to very low kilograms essentially,we have to change the dose obviously if,someone is between 3 and 40 kilograms is,indicated here or above 40 kilograms and,this is an outpatient therapy but given,as an infusion and then the third is,monoperavir and this is a nucleoside,analog that is also effective against,the subvariant one thing to say about,all of these is the protease inhibitor,really and the monoperative drug have,both been studied in randomized,controlled trials in those who are,unvaccinated at risk for severe disease,and the um and they showed very high,rates of prevention of hospitalization,and death actually 89 protection from,hospitalization and death,for a normatrovir and retinovir and for,mold a pair of it was 30 reduction in,hospitalization and death the data that,we have among vaccinated patients are,really from large observational,databases and at least for the protease,inhibitor those over 65 benefit the most,in a large Israeli study published in,the New England Journal of Medicine,likely doesn't at least for those less,than 65 in the panoramic UK study,doesn't seem to improve hospitalizations,and death for those who are vaccinated,so I'll just say in my own practice the,loss of the baptolivumab eua on November,30th has affected the way that we think,about treatment we are very fortunate to,have three remaining treatments used for,outpatients though beb was very useful,because it could be given as a very,rapid push but essentially we're moving,now more to giving out the protease,inhibitor the nucleoside analog paxilvid,and appear very respectively and we,definitely have restarted our outpatient,infusion of remdessavir especially for,those younger patients since the two,oral medications are not approved for,younger so it has affected us but we,still have options left thank you so,much for joining me today and for more,information on covid-19 treatments,please visit the series landing page at,exchangecme.com and the latest updates,on kova 19 subscribe to exchange cme's,YouTube channel and check back regularly,thank you so much
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monica gandhi twitter catalogs
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