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

DOI record: { "DOI": "10.1093/cid/ciae408", "ISSN": [ "1058-4838", "1537-6591" ], "URL": "http://dx.doi.org/10.1093/cid/ciae408", "abstract": "<jats:title>Abstract</jats:title>\n <jats:p>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.</jats:p>", "author": [ { "ORCID": "http://orcid.org/0000-0002-9402-9167", "affiliation": [ { "name": "Department of Molecular Microbiology and Immunology, Johns Hopkins School of Public Health , Baltimore, MD" } ], "authenticated-orcid": false, "family": "Casadevall", "given": "Arturo", "sequence": "first" }, { "affiliation": [ { "name": "North-Western Tuscany Blood Bank, Pisa University Hospital , Pisa , Italy" } ], "family": "Focosi", "given": "Daniele", "sequence": "additional" }, { "affiliation": [ { "name": "Divison of Infectious Diseases, Albert Einstein College of Medicine , Bronx, NY" } ], "family": "Pirofski", "given": "Liise-anne", "sequence": "additional" }, { "affiliation": [ { "name": "Division of Infectious Diseases, Johns Hopkins School of Medicine , Baltimore, MD" } ], "family": "Shoham", "given": "Shmuel", "sequence": "additional" } ], "container-title": "Clinical Infectious Diseases", "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2024, 8, 8 ] ], "date-time": "2024-08-08T19:03:44Z", "timestamp": 1723143824000 }, "deposited": { "date-parts": [ [ 2024, 8, 8 ] ], "date-time": "2024-08-08T19:03:45Z", "timestamp": 1723143825000 }, "indexed": { "date-parts": [ [ 2024, 8, 9 ] ], "date-time": "2024-08-09T00:22:51Z", "timestamp": 1723162971034 }, "is-referenced-by-count": 0, "issued": { "date-parts": [ [ 2024, 8, 8 ] ] }, "language": "en", "license": [ { "URL": "https://academic.oup.com/pages/standard-publication-reuse-rights", "content-version": "am", "delay-in-days": 0, "start": { "date-parts": [ [ 2024, 8, 8 ] ], "date-time": "2024-08-08T00:00:00Z", "timestamp": 1723075200000 } } ], "link": [ { "URL": "https://academic.oup.com/cid/advance-article-pdf/doi/10.1093/cid/ciae408/58775511/ciae408.pdf", "content-type": "application/pdf", "content-version": "am", "intended-application": "syndication" }, { "URL": "https://academic.oup.com/cid/advance-article-pdf/doi/10.1093/cid/ciae408/58775511/ciae408.pdf", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "286", "original-title": [], "prefix": "10.1093", "published": { "date-parts": [ [ 2024, 8, 8 ] ] }, "published-online": { "date-parts": [ [ 2024, 8, 8 ] ] }, "publisher": "Oxford University Press (OUP)", "reference-count": 0, "references-count": 0, "relation": {}, "resource": { "primary": { "URL": "https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae408/7729969" } }, "score": 1, "short-title": [], "source": "Crossref", "subject": [], "subtitle": [], "title": "Single monoclonal antibodies should not be used for COVID-19 therapy: a call for antiviral stewardship", "type": "journal-article" }