New findings suggest a significant benefit from REGN in terms of the primary outcome of mortality for patients who have low levels of their own antibodies at the time of admission.

This was an unexpected result for me as I’ve usually considered the REGN antibodies to be an antiviral action as opposed to immunomodulatory and thus far it is the immunomodulatory drugs that have shown mortality benefit, whereas the large number of antiviral drugs tested has shown little impact (Remdesivir changes illness duration but not mortality).

The finding that a lack of the patient’s own antibodies at the time of randomisation was associated with adverse outcomes was seen back in March (see tweet below) in the results of the convalescent plasma arm of RECOVERY.

I’m not sure I understand the mechanism of why this would then be more likely to lead to higher death rates, but it is clear that the host response/infection interaction is complex and at the heart of why people go on to develop the pneumonitis and other life threatening complications (though most patients in the trial will have pneumonitis at the point of randomisation).

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