Abstract
Snakebite envenoming is a major public health burden in tropical parts of the developing world. In sub-Saharan Africa, neglect has led to a scarcity of antivenoms threatening the lives and limbs of snakebite victims. Technological advances within antivenom are warranted, but should be evaluated not only on their possible therapeutic impact, but also on their cost-competitiveness. Recombinant antivenoms based on oligoclonal mixtures of human IgG antibodies produced by CHO cell cultivation may be the key to obtaining better snakebite envenoming therapies. Based on industry data, the cost of treatment for a snakebite envenoming with a recombinant antivenom is estimated to be in the range USD 60–250 for the Final Drug Product. One of the effective antivenoms (SAIMR Snake Polyvalent Antivenom from the South African Vaccine Producers) currently on the market has been reported to have a wholesale price of USD 640 per treatment for an average snakebite. Recombinant antivenoms may therefore in the future be a cost-competitive alternative to existing serum-based antivenoms.
Highlights
The global disease burden from snakebite envenoming is massive, and affecting poor rural tropical areas in Africa, Asia, Oceania, and Latin America [1]
We provide the conservative estimate that the sub-Saharan African need for therapeutically active antivenom antibodies to be at least 500 kgAPI per year
This number does not represent a precise estimation of the actual need, it provides a lower estimate of the magnitude required for production of antibodies for recombinant antivenoms, which may further be used to estimate the COGMAPI (USD/gram) for the manufacture of recombinant antibodies
Summary
The global disease burden from snakebite envenoming is massive, and affecting poor rural tropical areas in Africa, Asia, Oceania, and Latin America [1]. Animal-derived antisera remain the cornerstone of snakebite therapy [4], biotechnological advances are driving the emergence of different antivenom formats based on human or camelid antibody scaffolds [5,6], which in the future may pave the way for recombinant oligoclonal mixtures of antivenom antibodies [7]. The potential benefits of recombinant antivenoms for treatment of snakebite envenoming include higher potency and fewer side effects (serum sickness and anaphylaxis is not uncommon from animal-derived antisera) due to the possibility of producing fully human antibody formats targeting the medically relevant snake venom toxins [6,8]. Lack of costcompetitive production of antivenom antibody mixtures remains a critical hurdle against making such medicines widely available in poor rural regions of the developing world
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