Orders for monoclonal antibodies against COVID-19 rose from 27,000 doses per week being given in July, as reported by the New York Times, to 158,580 doses for the week of September 13.
Because of this increase in demand—and because a shortage may be looming—the Biden Administration has taken over the distribution of these treatments. Just last week, the administration announced it’d be instituting new restrictions on shipments, allocating doses based on case burden and demand for the treatment.
How Do COVID-19 Monoclonal Antibodies Work?
Monoclonal antibody treatments need to be given within 10 days of the first signs of symptoms.
They are the only available, effective therapy for anyone who is showing symptoms of COVID-19, Jason Gallagher, PharmD, clinical professor at Temple University School of Pharmacy and a fellow of the Infectious Disease Society of America, tells Verywell.
The treatment uses versions of antibodies that are made in the laboratory rather than naturally in the body. Like natural antibodies, they can fight invading pathogens such as the virus that causes COVID-19.Three monoclonal antibody products have received emergency use authorization (EUA) from the Food and Drug Administration (FDA) for use in people over age 12 who have been exposed to COVID-19, including:
A combination of bamlanivimab and etesevimabA combination of casirivimab and imdevimabSotrovimab
“The goal of these therapies is to keep someone from being hospitalized. Once they are hospitalized, we actually don’t use them,” he says. “The goal is to take someone who has a mild or moderate illness and keep them from getting sicker, so we don’t see them in the hospital later.”
Monoclonal antibody treatment is recommended for people in high-risk groups who have not been vaccinated and have been exposed to COVID-19, including people over age 65 and those with underlying conditions such as diabetes, according to guidelines from the Centers for Disease Control and Prevention (CDC).
It can also be used for people who have been vaccinated but who are immunocompromised and are less likely to make enough antibodies against COVID-19 on their own.
The FDA stresses that these products are not a substitute for getting vaccinated against COVID-19.
Treatment Poses Logistical Issues
These treatments present some logistical problems, Gallagher notes.
Monoclonal antibody therapy is not effective if given too late, which is more than 10 days after the onset of symptoms. After this time, the body will have developed its own antibodies, Arturo Casadevall, MD, PhD, professor of molecular microbiology and immunology at Johns Hopkins Bloomberg School of Public Health, tells Verywell.
Once your body forms its own antibodies, the inflammatory response will have already kicked in, he explains. Your body’s inflammatory response to the virus often determines how sick you’ll become.
A patient needs to realize they are sick, see their physician and get tested for COVID-19 before they can get a prescription and referral for the therapy. Once this process begins, they’ll also need to set an appointment for the infusion or injections—which may not be available for a few days—he says.
Any delay in the process can mean that the treatment comes too late to be useful, he says.
Additionally, existing outpatient infusion centers are not set up for dealing with patients who are infectious, Casadevall says. Infectious patients must be treated separately from patients receiving over types of infusion therapy.
To cope with the surge of COVID-19 patients needing intravenous antibodies, some states like Maryland have turned convention centers or hotel conference rooms into specialized infusion clinics, he says.
Infusion centers are mostly located in hospitals and are not spread evenly around the country. The distance and travel time to get to a center may be a limiting factor in some areas, Gallagher notes.
“I’m in New Jersey and I could name five or six places I could get to within 15 or 20 minutes, but I don’t think that’s the same in places that are more rural," Gallagher says.
Overall, awareness of monoclonal antibody therapy is lagging, Casadevall adds. The sooner the treatment, the better it works.
Still, antibody treatments are not a substitute for vaccination against COVID-19, Casadevall notes. “It is a second-best to vaccination,” Casadevall says. Vaccination jumpstarts the body into making antibodies against the virus and is a form of prevention, which is always preferred to treatment.
The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.
