Though we have learned how to prevent the spread of COVID‑19 by wearing a mask, physical distancing and getting vaccinated, physicians and researchers are continuing to uncover the best ways to treat this disease.
Monoclonal antibodies are one treatment for early COVID‑19 infection in high-risk people that have shown to help prevent the disease from getting worse. Carla Garcia Carreno, M.D., an Infectious Disease Specialist at Children's Health℠, explains how this therapy works and who may benefit.
What are monoclonal antibodies, and how do they work?
Monoclonal antibodies are modified human antibodies that are made in a lab and can block certain diseases from affecting healthy cells. They have been used for years to treat different types of cancers and certain infections but are now being used to treat COVID‑19.
SARS CoV2, the virus that causes COVID‑19, uses a spike protein to bind to human cells before the virus infects the cells. Monoclonal antibodies block this spike protein so the virus can't infect the cells and reproduce.
As of January 24, 2022, there is one monoclonal antibody therapy that is authorized by the U.S. Food and Drug Administration (FDA) for use in certain COVID-19 patients. It is called sotrovimab. Previously, two other monoclonal antibody therapies (casirivinab and imdevimab (REGEN-COV) and bamlanivimab and etesevimab) were approved. These are no longer authorized because they are highly unlikely to be active against the Omicron variant, which accounts for the majority of all new COVID-19 cases in the U.S. as of January 2022.
Patients must go to a designated infusion center to receive monoclonal antibody treatment through an IV. Your physician can refer you to a designated infusion center if you qualify for monoclonal antibody therapy and they are available.
Do monoclonal antibody treatments work against COVID-19 variants?
At this time, sotrovimab is the only monoclonal antibody that seems to be effective against the Omicron variant. Currently, there is a limited availability of sotrovimab at the national and local level.
Who benefits from monoclonal antibody therapy for COVID‑19?
Monoclonal antibodies work best during the early stages of a COVID‑19 infection, within the first 10 days of showing symptoms. Not everyone with COVID‑19 symptoms need this antibody therapy. It might be beneficial to people at high risk of getting severe symptoms, such as those over age 65 and people with conditions like obesity, diabetes, heart disease or lung disease.
Monoclonal antibodies might also help people exposed to COVID‑19 who are at high risk of developing a severe infection. But they aren't helpful for people who are already severely ill.
"Other COVID‑19 treatments, like antivirals or anti inflammatory medicines, are recommended for hospitalized patients who have severe disease," says Dr. Garcia Carreno.
Can children receive monoclonal antibodies?
Sotrovimab is authorized for use in children 12 years and older who weigh at least 88 pounds and have risk factors for severe disease.
What are other treatments for COVID‑19?
Currently, there are a few available treatments for people hospitalized with severe COVID‑19. These include antiviral medications (remdesivir) and anti-inflammatory medications (dexamethasone).
There are two oral antiviral pills that are approved under emergency use authorization by the FDA:
- Pfizer's Paxlovid (nirmatrelvir tablets and ritonavir tablets) may be used to treat mild-to-moderate COVID-19 in high-risk adults and pediatric patients who are 12 years of age and older weighing at least 88 pounds.
- Merck's molnupiravir may be used for the treatment of mild-to-moderate COVID-19 in adults who are at high risk for progression to severe COVID-19.
Both must be prescribed and should be taken as soon as possible after diagnosis and within 5 days of symptom onset.
These oral antiviral treatments are not a substitute for vaccination.
If your child is exposed to COVID‑19 or tests positive for COVID‑19, it is important to monitor for signs of severe disease and know when to go to the ER.
The best tool available to prevent COVID‑19 infection and severe disease is vaccination.
Should my family still get vaccinated against COVID‑19?
While monoclonal antibodies and other authorized treatments may be helpful in treating early COVID‑19 infection in high-risk individuals, they are not a substitute for vaccination. Monoclonal antibodies don't offer robust, long-lasting protection from COVID‑19. That's why it's still important to get vaccinated.
With the increased number of cases and the spread of the Omicron variant, it is particularly encouraged to receive full vaccination, including a booster dose, when eligible. There is supporting data that booster doses provide adequate protection against variants of concern. Many of these increased cases are in children who are too young to be eligible for a vaccination against COVID-19.
"The best tool available to prevent COVID‑19 infection and severe disease is vaccination," says Dr. Garcia Carreno. "It's important for everyone who is eligible to get vaccinated. Vaccines are the answer to end this pandemic, and they are based on rigorous research and sound science."
If you have received monoclonal antibody treatment, you can still get vaccinated. However, you should wait 90 days after you receive monoclonal antibodies to get your COVID‑19 vaccine.
More COVID-19 resources
Children's Health is committed to remaining a trusted source of health information and care for you and your family during this time. See more resources to keep your family healthy at the Children's Health COVID‑19 hub.
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