Monoclonal antibody therapies in the management of SARS-CoV-2 infection

Abstract

Introduction Neutralizing antibodies (NAbs) that target key domains of the spike protein in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may have therapeutic value because of their specificity. Depending on the targeted epitope, single agents may be effective, but combined treatment involving multiple NAbs may be necessary to prevent the emergence of resistant variants. Areas covered This article highlights the accelerated regulatory processes established to facilitate the review and approval of potential therapies. An overview of treatment approaches for SARS-CoV-2 infection, with detailed examination of the preclinical and clinical evidence supporting the use of NAbs, is provided. Finally, insights are offered into the potential benefits and challenges associated with the use of these agents. Expert opinion NAbs offer an effective, evidence-based therapeutic intervention during the early stages of SARS-CoV-2 infection when viral replication is the primary factor driving disease progression. As the pandemic progresses, appropriate use of NAbs will be important to minimize the risk of escape variants. Ultimately, the availability of effective treatments for COVID-19 will allow the establishment of treatment algorithms for minimizing the substantial rates of hospitalization, morbidity (including long COVID) and mortality currently associated with the disease.

Effectiveness of the neutralizing antibody sotrovimab among high-risk patients with mild to moderate SARS-CoV-2 in Qatar

“…Several monoclonal antibodies (mAbs) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been developed for treatment of coronavirus disease 2019 (COVID-19) [1]. One of these is sotrovimab, which significantly reduced the risk of COVID-19 hospitalization and death due to infection with pre-Omicron SARS-CoV-2 variants in a randomized clinical trial [2].…”

Biologics in COVID-19 So Far: Systematic Review

“…SARS-CoV-2 has four main structural proteins: spike (S), envelope, membrane, and nucleocapsid, being the S protein responsible for receptor attachment and membrane fusion, facilitating viral entry into host cells by binding to angiotensin-converting enzyme 2 (ACE2) receptors [ 145 ]. Monoclonal antibodies can help neutralize the virus in infected patients and are used as a passive immunotherapy [ 146 ].…”

Mutational Pattern, Impacts and Potential Preventive Strategies of Omicron SARS-CoV-2 Variant Infection

“… 85 But several other mAbs, such as Paxlovid, Veklury (remdesivir), and molnupiravir, are also expected to work against the omicron variant, and are approved by the FDA to treat patients with mild-to-moderate COVID-19 who are at high risk of progression to severe disease, including hospitalization or death. 109 , 110 In addition, as of February 25, 2022, the FDA has authorized the use of bebtelovimab as an emergency treatment for COVID-19 patients who are at risk of progressing to severe disease or requiring hospitalization. 111 Generally, the concentration of mAbs required to halve viral replication is higher for Omicron than for other variants, and their potency is significantly reduced.…”