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

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