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 great deal of development. treatment of the disease: Last year (and again in February and May) monoclonal antibodies were approved as therapy for patients at risk of developing serious disease. Recently, television commercials have announced the option for patients with COVID-19 and the Biden administration has encouraged its use. But what they are monoclonal antibodies, anyway?

These antibodies are not exactly the same as those produced by the body from the vaccine, but are created in a laboratory and focus only on the most dangerous part of the SARS-CoV-2 virus. But for those at risk for serious illness, in addition to people who cannot receive the vaccine safely, monoclonal antibodies can save lives.

According to experts, here is everything you need to know about monoclonal antibody treatment for COVID-19, as well as why you should still look for vaccines as soon as possible.

What are monoclonal antibodies?

Monoclonal antibodies are “laboratory-produced molecules that act as substitute antibodies that can restore, enhance, or mimic the immune system’s attack on cells,” according to the U.S. Food and Drug Administration (FDA). In this case, these antibodies replicate the body’s immune response to COVID-19, blocking or neutralizing the SARS-CoV-2 virus before it can cause serious illness.

Monoclonal antibody therapy is not new; in fact, it has been evolving for decades, explains Shmuel Shoham, MD, an associate professor in Johns Hopkins University School of Medicine, and has been used for cancer patients. More recently, doctors have deployed treatment for infectious diseases.

In November, the FDA authorized monoclonal antibody treatments casirivimab and imdevimab, intended for co-administration to patients 12 years of age and older who test positive for the virus and have a high risk of progressing to severe COVID-19. Three months later, he authorized another pair, bamlanivimab and etesevimab, for the same population.

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

Unlike COVID-19 vaccines, monoclonal antibody therapy is given after you are diagnosed with the disease; the goal is to keep high-risk patients out of the ICU. It is also not safe: if you can get vaccinated, you should do so, as there is no guarantee that monoclonal antibodies will prevent you from suffering from serious illnesses.

How do monoclonal antibodies treat COVID-19?

When the body produces COVID-19 antibodies after contracting the disease or getting vaccinated (they are called polyclonal antibodies), there is no universal protective result; different types of antibodies focus on different parts of the structure of the virus. But laboratory-made antibodies only target the most crucial destructive piece of the SARS-CoV-2 virus.

“Monoclonal antibodies focus on a part of the virus, which is called the ear protein,” explains Dr. Shoham. According to him, by getting stuck between these punctured parts and the tissue, monoclonal antibodies prevent the virus from sticking to you so easily.

“[COVID-19] it is caused by the virus itself and, after a period of time, it is caused by the body’s excessive reaction to the virus, “continues Dr. Shoham.” For monoclonal antibodies to work, they must do so. [arrive] at the moment the virus is causing the disease. ”After about ten days, there’s not much to do. (That’s why all the ads you see are focused on people who have recently been diagnosed with COVID-19 , but who are not yet seriously ill.)

Monoclonal antibodies only provide protection for so long; the body cannot produce more. It’s still unclear how long the protection will last, but they will definitely be worn out after 90 days, the FDA notes.

Are monoclonal antibodies safe?

“Anything you put on your body can have side effects,” Dr. Shoham says. “Complications with monoclonal antibody infusions are quite rare, but some people may have an allergic reaction to them,” in the same way as COVID-19 vaccines. Other minor complications include fever, rash, nausea, chills, and dizziness.

In clinical trials, a single infusion of bamlanivimab and etesevimab “significantly reduced COVID-19-related hospitalization and death” compared with a placebo over a month, the FDA explains.

Who should receive monoclonal antibodies?

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

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

Monoclonal antibodies are not authorized by the FDA for hospitalized COVID-19 patients or for those receiving oxygen, because they will not be able to help much. In addition, according to the FDA, monoclonal antibodies could be associated with “worse clinical outcomes” for patients who need ventilation or elevated oxygen flow.

“If someone is already in the intensive care unit or in the hospital with oxygen, the disease is no longer caused by the virus, but by the body’s excessive reaction,” says Dr. Shoham. In this case, 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 (either from a vaccine or the virus itself) and passive immunization (from therapies such as monoclonal antibodies).

Active vaccination teaches the body to produce antibodies, has no immediate effect and lasts relatively long; passive immunization provides prefabricated antibodies, does not teach the immune system how to do more, has effect almost instantly, and lasts relatively little time.

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

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

Vaccinated people who become infected (known as “advanced” cases), however, should consider monoclonal antibody treatment if they fall into FDA-approved categories, the CDC explains, without worrying about the weather. “Unless someone has a specific reason for not getting the vaccine, and they are very rare, the vaccine is something I would encourage,” says Dr. Shoham.

This article is accurate from the time of the press. However, as the COVID-19 pandemic evolves rapidly and the understanding by the scientific community of the new coronavirus develops, it is possible that some of the information has changed since its last update. While we want to keep all of our stories up to date, visit the online resources provided by CDC, WHO, and yours local public health department to be informed of the latest news. Always talk to your doctor for professional medical advice.

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