Noninferiority of Subcutaneous Versus Intravenous Casirivimab/Imdevimab for Outpatient Treatment of SARS-CoV-2 in a Real-World Setting

Monoclonal antibody (mAb) therapy has emerged as one of the mainstay treatment options for SARS-CoV-2. To improve speed of delivery and decrease bedside nursing needs, subcutaneous (SC) delivery of mAbs has been explored as an alternative to standard intravenous (IV) administration. To date, data regarding the effectiveness of SC compared with IV mAb are lacking. This retrospective cohort analysis conducted between April 2021 and August 2021 compared hospitalization rates among patients receiving IV versus SC administration of casirivimab/imdevimab (Regen-COV) at a single institution in Arkansas. Casirivimab/imdevimab was a promising mAb therapy utilized during the height of the Delta variant surge of the SARS-CoV-2 pandemic. Before resistance developed by the Omicron variant, casirivimab/imdevimab was utilized for outpatient treatment of SARS-CoV-2 patients at risk of deterioration. Primary outcomes of this investigation were the 30-day post-treatment rate of hospitalization and intensive care unit (ICU) care during hospitalization. There was no increased risk of hospitalization or ICU care with SC administration compared with IV administration. As SARS-CoV-2 continues to mutate into variants such as Omicron and develop resistance to existing mAbs, these preliminary findings of noninferiority of SC versus IV warrant ongoing investigation into SC administration of other mAbs.

Identifying the European fossil fuel plumes in the atmosphere over the Northeast Atlantic Region through isotopic observations and numerical modelling

As part of the Danish NEAREX project the origin and variability of anthropogenic atmospheric CO(2) over the Northeast Atlantic Region (NEAR) has been studied. The project consisted of a combination of experimental and modelling activities. Local volunteers operated CO(2) sampling stations, built at University of Copenhagen, for (14)C analysis at four locations (East Denmark, Shetland Isles, Faroe Isles and Iceland). The samples were only collected during winter periods of south-easterly winds in an attempt to trace air enriched in fossil-fuel derived CO(2) due to combustion of fossil fuels within European countries. In order to study the transport and concentration fields over the region in detail, a three-dimensional Eulerian hemispheric air pollution model has been extended to include the main anthropogenic sources for atmospheric CO(2). During the project period (1998-2001) only a few episodes of transport from Central Europe towards NEAR arose, which makes the data set for the evaluation of the method sparse. The analysed samples indicate that the signal for fossil CO(2), as expected, is largest (up to 3.7+/-0.4% fossil CO(2)) at the Danish location closest to the European emissions areas and much weaker (up to approximately 1.5+/-0.6% fossil CO(2)) at the most remote location. As the anthropogenic signal is weak in the clean atmosphere over NEAR these numbers will, however, be very sensitive to the assumed background (14)CO(2) activity and the precision of the measurements. The model simulations include the interplay between the driving processes from the emission into the boundary layer and the following horizontal/vertical mixing and atmospheric transport and are used to analyse the meteorological conditions leading to the observed events of high fossil CO(2) over NEAR. This information about the history of the air masses is essential if an observed signal is to be utilised for identifying and quantifying sources for fossil CO(2).

Antipsychotic drugs classified by their effects on the release of dopamine and noradrenaline in the prefrontal cortex and striatum

Dose-effect curves were established for the effects of the antipsychotic drugs haloperidol, clozapine, olanzapine, risperidone and ziprasidone on extracellular levels of dopamine and noradrenaline in the medial prefrontal cortex, and of dopamine in the striatum. Haloperidol was more effective in stimulating the release of dopamine in the striatum, whereas clozapine was much more effective in the medial prefrontal cortex. The efficacy of risperidone, olanzapine and ziprasidone did not differ for the two brain areas. The benzamides sulpiride and raclopride increased dopamine release in the striatum but did not affect the release of dopamine and noradrenaline in the medial prefrontal cortex. In the presence of dopamine/noradrenaline reuptake inhibitors, the benzamides strongly increased the release of dopamine-but not of noradrenaline-in the medial prefrontal cortex. The 5-HT(2) receptor antagonist R-(+)-alpha-(2,3-dimethoxyphenyl)-1-[2-(4-fluorophenyl)ethyl]-4-piperidinemethanol (MDL100,907) (800 nmol/kg) and the dopamine D(2) receptor antagonist raclopride (2 micromol/kg) displayed a clear synergism in increasing the release of dopamine in the medial prefrontal cortex. No such synergism was seen in the case of noradrenaline. Co-administration of the 5-HT(2) receptor agonist (+/-)-2,5-dimethoxy-4-iodoamphetamine HCl (DOI) (850 nmol/kg) with clozapine (10 micromol/kg) or haloperidol (800 nmol/kg) blocked the increase in dopamine as well as noradrenaline in the medial prefrontal cortex. It is concluded that typical and non-benzamide atypical antipsychotics increase extracellular dopamine in the medial prefrontal cortex via a synergistic interaction by blocking 5-HT(2) as well as dopamine D(2) receptors. The increase in extracellular noradrenaline in the medial prefrontal cortex that was observed after administration of antipsychotics is explained by inhibition of 5-HT(2) receptors and not dopamine D(2) receptors. Finally, the significance of the classification of antipsychotic drugs based on their selective action on the release of dopamine and noradrenaline in the medial prefrontal cortex is discussed. In particular, the position of the benzamides is discussed.