Casirivimab and Imdevimab
(Date: December 2021. Version: 1.0)
This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by the UK Health Security Agency (UKHSA) on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.
What is it?
Ronapreve® is the brand name for a medicine that contains a mix of two synthetic (manmade) antibodies (casirivimab and imdevimab). These antibodies bind to the spike protein that sits on the surface of the COVID-19 virus. It works by blocking the way the virus enters cells, and it can also help your body to clear infection.
What are the benefits of Ronapreve in pregnancy?
Ronapreve is used in unvaccinated people who are at high risk of developing severe COVID-19 illness. It lowers the risk of being admitted to hospital, and of dying due to COVID-19.
Pregnant women are at increased risk of severe COVID-19 illness. Severe COVID-19 has been linked with a higher risk of babies being born too early, which can result in serious problems for the baby after delivery and in later life. There is also a higher risk of stillbirth. Synthetic antibodies like those in Ronapreve help your immune system to fight the virus, lowering the risk of severe illness.
Are there any risks of using Ronapreve in pregnancy?
Synthetic antibodies have been used in pregnancy for many years. They are routinely used to prevent conditions like rhesus disease (anti-D injections).
Ronapreve is a newly developed medication and has not yet been tested in pregnancy. However, because Ronapreve only binds to the spike protein of the COVID-19 virus, and does not bind to proteins that are made by the developing baby or placenta, it is not thought to be harmful to the baby.
Are there any alternatives to Ronapreve in pregnancy?
Yes. Other drugs can help prevent severe COVID-19 infection in those who have tested positive. One of these (sotrovimab, brand name; Xevudy®) is a synthetic antibody which also bind very specifically to the COVID-19 virus. As with Ronapreve, it is thought unlikely to be harmful in pregnancy.
Molnupiravir, is an antiviral medicine that can stop early COVID-19 infection from developing into serious illness. It is taken in tablet form by people with a positive COVID-19 PCR test and mild to moderate symptoms who are at risk of severe COVID-19. Unfortunately, there are concerns that it could be harmful to the developing baby, and it is not recommended in pregnancy. For more information, please see here.
Vaccination against COVID-19 is strongly encouraged for all pregnant women in the UK. It can reduce the chance of infection and help to prevent serious illness, and may reduce the need for other medicines. For more information, please see here.
What if I prefer not to have any treatment in pregnancy?
Pregnant women are at increased risk of severe COVID-19 illness, which has also been linked with a higher risk of premature delivery and stillbirth. Your doctor will only offer medicines to treat COVID-19 when absolutely necessary and will be happy to talk to you about any concerns that you might have.
Who can I talk to if I have questions?
If you have any questions regarding the information in this leaflet, please discuss them with your healthcare provider. They can access more detailed medical and scientific information from www.uktis.org.
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General information
Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks. They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.
Medicines use in pregnancy
Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby. There are, however, some medicines that can harm a baby’s normal development. How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.
If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.
When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.
Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.
www.medicinesinpregnancy.org