Which medications in the drug class Monoclonal Antibodies are used in the treatment of Coronavirus Disease 2019 (COVID-19)?

Updated: Jun 25, 2021
  • Author: David J Cennimo, MD, FAAP, FACP, FIDSA, AAHIVS; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Monoclonal Antibodies

Recombinant neutralizing human IgG1-kappa monoclonal antibodies (mAb) exert their effect by binding to various sites on the SARS-CoV-2 spike protein. All are indicated for mild-to-moderate COVID-19 disease in adults and adolescents who are at high risk for progressing to severe COVID-19 and/or hospitalization.

Casirivimab/imdevimab

FDA granted EUA November 21, 2020. Casirivimab and imdevimab IV solution are each supplied in individual single-dose vials and are admixed in the same IV bag. May also be administered SC when an IV infusion is not feasible. 

Sotrovimab

FDA granted EUA May 26, 2021. Binds to conserved epitope of the spiked protein of SARS-CoV-1 and SARS-CoV-2, thereby indicating unlikelihood of mutational escape. 

Etesevimab

FDA granted EUA February 9, 2021. Etesevimab can only be used with bamlanivimab by admixing each dose within the same IV bag. Etesevimab and bamlanivimab bind to different but overlapping epitopes in the receptor-binding domain of the S-protein. In clinical trials, bamlanivimab and etesevimab administered together resulted in fewer treatment-emergent variants relative to bamlanivimab administered alone. However, the proportion of SARS-CoV-2 variants of concern (VOCs) with reduced susceptibility to bamlanivimab plus etesevimab (P.1, B.1.351, and B.1.617) sequenced from U.S. residents continues to grow. As of June 11, at least 10 states have ceased using this combination and recommend prescribing casirivimab plus imdevimab or sotrovimab.

Bamlanivimab

FDA granted EUA November 9, 2020. Owing to the increase in variants of concern (VOC) in the United States, monoclonal antibodies that have gained emergency use authorization have been tested to evaluate activity against VOCs. As of March 24, 2021, distribution has ceased of bamlanivimab alone. Consider use of etesevimab plus bamlanivimab, casirivimab plus imdevimab, or sotrovimab in outpatients who qualify for monoclonal antibodies.


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