Therapeutic monoclonal antibodies for COVID-19 management: an update

ABSTRACT

Background

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected more than 529 million people, and today the world is facing different mutant strains of the virus, leading to increased morbidity rates, fatality rates, and surfacing re-infections. Various therapies, such as prophylactic treatments, repurposed drug treatments, convalescent plasma, and polyclonal antibody therapy have been developed to help combat the coronavirus disease 2019 (COVID-19).

Area covered

This review article provides insights into the basic aspects of monoclonal antibodies (mAbs) for the therapy of COVID-19, as well as its advancement in terms of clinical trial and current approval status.

Expert opinion

Monoclonal antibodies represents the most effective and viable therapy and/or prophylaxis option against COVID-19, and have shown a reduction of the viral load, as well as lowering hospitalizations and death rates. In different countries, various mAbs are undergoing different phases of clinical trials, with a few of them having entered phases III and IV. Due to the soaring number of cases worldwide, the FDA has given emergency approval for the mAb combinations bamlanivimab with etesevimab and casirivimab with imdevimab.

KEYWORDS:

• COVID-19
• SARS-CoV-2
• monoclonal antibody
• casirivimab
• bamlanivimab
• imdevimab
• etesevimab
• tixagevimab with cilgavimab
• bebtelovimab
• clinical trial
• repurposed mAbs

Article highlights

• Anti-SARS-CoV-2 monoclonal antibodies (mAbs) targeting the spike protein have been proven to be clinically beneficial in the treatment of SARS-CoV-2 infection.

• Anti-SARS-CoV-2 mAb therapy should begin as soon as feasible once SARS-CoV-2 infection is established by an antigen test or a nucleic acid amplification test (NAAT), and within 10 days of disease onset.

• The US FDA has granted an emergency use authorization (EUA) for the investigational long-acting monoclonal antibodies tixagevimab and cilgavimab to be administered concurrently by IM injection for COVID-19.

• Sotrovimab’s effectiveness against the Omicron subtype is likely to be maintained.

• In the United States, the widespread distribution of bamlanivimab plus etesevimab and casirivimab plus imdevimab has been halted since the Omicron variant has significantly reduced in vitro susceptibility to these mAbs, and thus this treatment is not projected to continue providing interventional therapeutic benefit during the Omicron infestation.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.