ArticleCureus2025
In-Use Stability and Functional Efficacy of a Monoclonal Antibody Cocktail (TwinRab™) for Rabies Post-exposure Prophylaxis.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Rabies remains a major public health problem in India, accounting for nearly one-third of global human deaths each year. Limited access to human and equine rabies immunoglobulins (RIGs) continues to restrict effective post-exposure prophylaxis (PEP) coverage, particularly in resource-limited settings. TwinRab™, a two-antibody monoclonal cocktail containing docaravimab and miromavimab, was developed as a standardized, scalable alternative to plasma-derived RIGs. This study evaluated the in-use stability and biological efficacy of TwinRab™ under simulated field-use conditions. In the in vitro arm, TwinRab™ samples from 300 IU/mL and 600 IU/mL batches were diluted in 0.9% sodium chloride to obtain twofold, fivefold, and 10-fold dilutions and stored at room temperature (25 ± 2 °C) for 4-24 hours. Potency was measured using the rapid fluorescent focus inhibition test (RFFIT) against the CVS-11 rabies virus strain. In the in vivo arm, undiluted TwinRab™ was administered six or 24 hours after viral challenge in a Syrian hamster model, and survival outcomes were compared with human RIG (Kamrab). TwinRab™ retained its neutralizing potency after dilution and ambient storage for up to 24 hours. The 600 IU/mL batch showed no significant loss of activity across all dilutions (p > 0.05), while minor but statistically significant differences were noted at higher dilutions of the 300 IU/mL batch (p < 0.05). In vivo, TwinRab™ achieved 90% survival when administered six hours post-challenge and 70% when administered after 24 hours, demonstrating comparable efficacy to Kamrab. These findings confirm that TwinRab™ maintains stability and functional efficacy under conditions that simulate routine clinical practice. Its thermostability, potency, and protective efficacy highlight its potential as a field-adaptable, next-generation alternative to conventional RIGs for PEP, particularly in high-burden regions with limited cold-chain infrastructure.
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