New neutralising antibody accessible for eligible COVID-19 patients
Ronapreve, a combination of two monoclonal antibodies, is the first targeted medicine developed for COVID-19 to receive marketing authorisation from the Medicines and Healthcare products Regulatory Agency (MHRA) for use in the UK and will now be available to treat thousands of hospitalised COVID-19 patients in the UK.
The medication will be available to those aged 50 years and over or those who are 12−49 and considered immunocompromised.
To qualify for the drug, antibody testing will first be used to determine whether COVID-19 patients are seronegative, and the treatment antibodies – casirivimab and imdevimab—will then be administered to eligible patients via a drip.
Clinical guidance is expected to be sent out to clinicians so they can begin prescribing the treatment as soon as possible.
Government pledge to reduce overprescribing of medicines
The government has put forward that they will be taking action to prevent medicines from being unnecessarily prescribed in England, following a new government-commissioned review was published. The review estimated that 10% of dispensed items in primary care are overprescribed, with 15% of people taking five or more medicines a day. It also reported that one in five admissions to hospital in over 65-year-olds is caused by adverse medicine effects.
The 10% of dispensed items that are overprescribed consist of items prescribed through primary care that are either inappropriate for the patients' circumstances and wishes or could be better served with alternative treatment.
For those admitted to hospital because of adverse medical effects, it is important to note that the more medicines a patient takes, the higher the chance that one or more of these medicines will cause unwanted and/or harmful effects. Medicines such as those that reduce blood pressure can also increase risks such as falling in the frail and elderly.
The newly published review sets out several practical and cultural changes to ensure that patients receive the most appropriate treatment for their needs while also making sure clinicians' time is being efficiently used and taxpayer money is spent wisely. These decisions include incorporating shared decision making with patients about starting or stopping a medicine, better use of technology, ways to review prescriptions more effectively, and considering alternative medicines that may be more effective.
The key recommendations from the review, as found on gov.uk, are:
- The introduction of a new National Clinical Director for Prescribing, who will lead a 3-year programme including research and training to help enable effective prescribing
- System-wide changes to improve patient records, improve handovers between primary and secondary care, develop a national toolkit and deliver training to help general practices improve the consistency of repeat prescribing processes
- Improving the evidence base for safely withdrawing inappropriate medication (deprescribing) and updating clinical guidance to support more patient-centred care. This would include ensuring GPs have the data and medical records they need and are empowered to challenge and change prescribing made in hospitals
- Cultural changes to reduce a reliance on medicines and support shared decision-making between clinicians and patients, including increasing the use of social prescribing. This involves helping patients to improve their health and wellbeing by connecting them to community services, which might be run by the council or a local charity
- Providing clear information on the NHS website for patients about their medication and the creation of a platform for patients to be able to provide information about the effectiveness and the adverse effects of their medicines
- The development of interventions to reduce waste and help deliver NHS's net zero carbon emissions.
The review also calls for further research to investigate which of these key points will benefit patients across the country and will help to ensure busy primary teams are supported by improved systems and resources.
The review concludes by stressing the importance of medicine optimisation. It also notes that reducing overprescribing will help the NHS to fulfil its commitment to become carbon net-zero.
All recommendations have been accepted by ministers and will now begin to be implemented – reforms to pharmacy training are said to be already underway.