What are monoclonal antibodies? COVID-19 treatment, explained

The three COVID-19 vaccines available in the United States have dominated the conversation for months, but there has also been a major development in the processing of the disease: Last year (and again in February and May), monoclonal antibodies were approved as therapy for patients at risk of developing severe disease. Lately, TV commercials have announced the option for COVID-19 patients and the Biden administration has encouraged its use. But what are monoclonal antibodies, anyway?

These antibodies aren’t exactly the same ones your body makes from the vaccine – they’re created in a lab and only focus on the most dangerous part of the SARS-CoV-2 virus. But for those at risk of serious illness, as well as for people who cannot safely receive the vaccine, monoclonal antibodies can save lives.

Here’s everything you need to know about monoclonal antibody treatment for COVID-19, experts say, and why you should always seek vaccines as soon as possible.

What are monoclonal antibodies?

Monoclonal antibodies are “molecules produced in the laboratory that act as surrogate antibodies capable of restoring, enhancing or mimicking the immune system’s attack on cells,” according to the US Food and Drug Administration (FDA). -United. In this case, these antibodies replicate your body’s immune response to COVID-19, blocking or neutralizing the SARS-CoV-2 virus before it can make you seriously ill.

Monoclonal antibody therapy is not new – in fact, it has been evolving for decades, says Shmuel Shoham, MD, associate professor at Johns Hopkins University School of Medicine, and has been used for cancer patients. . More recently, doctors have rolled out the treatment of infectious diseases.

In November, the FDA cleared the monoclonal antibody treatments casirivimab and imdevimab, to be administered together to patients 12 years of age and older who test positive for the virus and who are at high risk of progressing to severe COVID-19. . Three months later, she authorized another couple, bamlanivimab and etesevimab, for the same population.

Another monoclonal antibody treatment, sotrovimab, was approved in May for the treatment of mild to moderate COVID-19 in patients over 12 years of age at risk for severe COVID-19. “With the approval of this monoclonal antibody treatment, we are offering another option to help keep high-risk patients with COVID-19 out of hospital,” said Patrizia Cavazzoni, MD, director of the Center for Drug FDA Evaluation and Research, in a press release.

Unlike COVID-19 vaccines, monoclonal antibody therapy is given after diagnosis of the disease; the goal is to keep high-risk patients out of the ICU. It is also not a sure thing – if you can get the vaccine, you should, as there is no guarantee that the monoclonal antibodies will keep you from getting seriously ill.

How do monoclonal antibodies treat COVID-19?

When your body makes COVID-19 antibodies after contracting the disease or having been vaccinated (these are called polyclonal antibody), there is no universal protective result; different types of antibodies concentrate on different parts of the structure of the virus. But antibodies made in the lab only target the most crucial and destructive part of the SARS-CoV-2 virus.

“Monoclonal antibodies focus on a part of the virus called the spike protein,” says Dr Shoham. By getting stuck between those spiky parts and your tissues, he says, monoclonal antibodies prevent the virus from attaching itself to you so easily.

“[COVID-19] is caused by the virus itself and then after a while it is caused by the body overreacting to the virus, ”Dr Shoham continues. “For monoclonal antibodies to work, they must [arrive] when the virus causes illness. After about 10 days there is not much for them to do. (That’s why all of the ads you see focus on people who have recently been diagnosed with COVID-19, but who are not yet seriously ill.)

Monoclonal antibodies only provide protection for a limited time; the body cannot produce more of it. It is still not clear how long the protection lasts, but they will be permanently gone after 90 days, notes the FDA.

Are monoclonal antibodies safe?

“Anything you put in your body can have side effects,” says Dr. Shoham. “Complications with monoclonal antibody infusions are quite rare, but some people may have an allergic reaction,” much like COVID-19 vaccines. Other minor complications include fever, rash, nausea, chills, and feeling light-headed.

In clinical trials, a single infusion of bamlanivimab and etesevimab “dramatically reduced COVID-19-related hospitalizations and deaths” compared to a placebo over the course of a month, says the FDA.

Who Should Receive Monoclonal Antibodies?

Monoclonal antibody therapy has been approved by the FDA in COVID-19 patients 12 years of age and older who are at high risk of developing severe disease. “The first two days [after diagnosis] are the best time to get it, ”says Dr Shoham.

This treatment is also ideal for those who need to approach COVID-19 vaccines with caution, including those who are immunocompromised, those receiving high doses of steroids, transplant patients, and people with certain cancers. “They should still get vaccinated, but their response to the vaccine might not be as robust,” Dr Shoham said. “Therefore, they may not be as protected. “

Monoclonal antibodies are not approved by the FDA for COVID-19 hospital patients or those receiving oxygen because they won’t be able to help much. Additionally, the FDA notes, monoclonal antibodies may be associated with “worse clinical outcomes” for patients who require high flow oxygen or ventilation.

“If someone is already in the intensive care unit or in the hospital on oxygen, the disease is usually no longer caused by the virus – it is caused by an overreaction of the body,” says Dr Shoham. In this case, the antibody treatment will not be effective.

Can monoclonal antibodies replace the COVID-19 vaccine?

No, at least not in the long run. There are two types of immunization, explains Dr. Shoham: active immunization (from a vaccine or the virus itself) and passive immunization (from therapies like monoclonal antibodies).

Active immunization teaches the body to make antibodies, does not take effect immediately and lasts a relatively long time; passive immunization provides prefabricated antibodies, does not train the immune system to make more, takes effect almost instantly and lasts relatively short time.

Another key difference relates to the transmission. COVID-19 vaccines appear to make asymptomatic transmission less likely, but monoclonal antibodies do not limit a patient’s ability to spread the disease.

The Centers for Disease Control and Prevention (CDC) currently recommends that anyone who has received monoclonal antibody treatment wait at least 90 days after being diagnosed with COVID-19 to receive available vaccines. This is a precautionary measure to “avoid potential interference of antibody therapy with immune responses induced by the vaccine,” the agency explains.

Vaccinated people who are infected (called “breakthrough” cases), however, should still consider treatment with monoclonal antibodies if they fall into FDA-approved categories, the CDC says, regardless of the timing. “Unless someone has a specific reason for not getting the vaccine, and these are very rare, the vaccine is something I would strongly encourage,” Dr Shoham said.

This article is accurate at time of press. However, as the COVID-19 pandemic rapidly evolves and the scientific community understands the new coronavirus, some information may have changed since it was last updated. While we aim to keep all of our stories up to date, please visit the online resources provided by the CDC, WHO, and your local public health service to stay informed of the latest news. Always consult your doctor for professional medical advice.

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