Single monoclonal antibodies should not be used for COVID-19 therapy: a call for antiviral stewardship.

Publication date: Aug 08, 2024

The COVID-19 pandemic saw the largest deployment of monoclonal antibodies (mAbs) for an infectious disease in history. mAbs to SARS-CoV-2 spike protein proved safe and were initially effective for COVID-19 therapy, but each was defeated by continued SARS-CoV-2 evolution, leading to their withdrawal. This was a setback for people with impaired immunity who cannot mount an effective antibody response to SARS-CoV-2 and often cannot clear the virus. New mAbs have now been developed for pre-exposure prophylaxis (PreEP) in immunosuppressed people. Here we argue that while mAb use for PreEP is justified, single mAbs should not be used for COVID-19 therapy. In contrast to PreEP where the viral inoculum is small, immunosuppressed people with COVID-19 have large viral burden that can harbor mAb-escape variants that single-agent mAb treatments can rapidly select for resistance. Selection of mAb-escape variants has potential risks for patients, society and the feasibility of mAb therapy itself.

Concepts Keywords
Antibodies Antibodies
Covid Cov
Pandemic Covid
Safe Effective
Therapy Escape
Immunosuppressed
Mab
Mabs
Monoclonal
Preep
Sars
Single
Therapy
Variants
Viral

Semantics

Type Source Name
disease MESH COVID-19
disease MESH infectious disease
pathway REACTOME Infectious disease
disease IDO history
disease VO effective

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