Monoclonal Antibodies in Hospitalised Patients with COVID-19: The Role of SARS-COV-2 Serostatus in an Evolving Pandemic
Abstract Appropriately selected neutralising monoclonal antibodies (nmAbs) are an effective treatment for patients with mild or moderate coronavirus disease 2019 (COVID-19) who are at high risk of progression to severe disease. In contrast, the efficacy of nmAbs in patients hospitalised with COVID-1...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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Adis, Springer Healthcare
2023-02-01
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| Series: | Infectious Diseases and Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1007/s40121-023-00769-2 |
| _version_ | 1797863945722134528 |
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| author | François Raffi Robert L. Gottlieb |
| author_facet | François Raffi Robert L. Gottlieb |
| author_sort | François Raffi |
| collection | DOAJ |
| description | Abstract Appropriately selected neutralising monoclonal antibodies (nmAbs) are an effective treatment for patients with mild or moderate coronavirus disease 2019 (COVID-19) who are at high risk of progression to severe disease. In contrast, the efficacy of nmAbs in patients hospitalised with COVID-19 has been mixed, and clinical benefit has largely been restricted to seronegative patients [i.e. those lacking endogenous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies] in the trials with positive outcomes. This review summarises the major clinical trial data investigating nmAb treatment for hospitalised patients with COVID-19, and explores current definitions of seropositivity, what they mean in a late-pandemic context and discusses the current late-pandemic challenges associated with defining ‘seroprotection’ in a clinically meaningful way. We conclude that following widespread vaccination, increasing numbers of prior infections and emerging viral variants, seropositivity now reflects a range of immune coverage rather than a binary tool with which to aid decision-making on a clinically actionable timescale. Treatment decisions with nmAbs in a late-pandemic context would therefore likely best rely on information regarding clinical status, time since symptom onset, underlying patient condition(s) and the dominant circulating variant, should they be approved for future use in hospitalised patients with COVID-19. |
| first_indexed | 2024-04-09T22:44:50Z |
| format | Article |
| id | doaj.art-66d04e4ee93440c5986967b5b2d39894 |
| institution | Directory Open Access Journal |
| issn | 2193-8229 2193-6382 |
| language | English |
| last_indexed | 2024-04-09T22:44:50Z |
| publishDate | 2023-02-01 |
| publisher | Adis, Springer Healthcare |
| record_format | Article |
| series | Infectious Diseases and Therapy |
| spelling | doaj.art-66d04e4ee93440c5986967b5b2d398942023-03-22T11:56:20ZengAdis, Springer HealthcareInfectious Diseases and Therapy2193-82292193-63822023-02-0112373574710.1007/s40121-023-00769-2Monoclonal Antibodies in Hospitalised Patients with COVID-19: The Role of SARS-COV-2 Serostatus in an Evolving PandemicFrançois Raffi0Robert L. Gottlieb1Department of Infectious Disease, University Hospital of Nantes, CIC 1413 INSERMBaylor Scott and White HealthAbstract Appropriately selected neutralising monoclonal antibodies (nmAbs) are an effective treatment for patients with mild or moderate coronavirus disease 2019 (COVID-19) who are at high risk of progression to severe disease. In contrast, the efficacy of nmAbs in patients hospitalised with COVID-19 has been mixed, and clinical benefit has largely been restricted to seronegative patients [i.e. those lacking endogenous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies] in the trials with positive outcomes. This review summarises the major clinical trial data investigating nmAb treatment for hospitalised patients with COVID-19, and explores current definitions of seropositivity, what they mean in a late-pandemic context and discusses the current late-pandemic challenges associated with defining ‘seroprotection’ in a clinically meaningful way. We conclude that following widespread vaccination, increasing numbers of prior infections and emerging viral variants, seropositivity now reflects a range of immune coverage rather than a binary tool with which to aid decision-making on a clinically actionable timescale. Treatment decisions with nmAbs in a late-pandemic context would therefore likely best rely on information regarding clinical status, time since symptom onset, underlying patient condition(s) and the dominant circulating variant, should they be approved for future use in hospitalised patients with COVID-19.https://doi.org/10.1007/s40121-023-00769-2serostatusClinical trialCOVID-19HospitalisedNeutralising monoclonal antibodyPneumonia |
| spellingShingle | François Raffi Robert L. Gottlieb Monoclonal Antibodies in Hospitalised Patients with COVID-19: The Role of SARS-COV-2 Serostatus in an Evolving Pandemic Infectious Diseases and Therapy serostatus Clinical trial COVID-19 Hospitalised Neutralising monoclonal antibody Pneumonia |
| title | Monoclonal Antibodies in Hospitalised Patients with COVID-19: The Role of SARS-COV-2 Serostatus in an Evolving Pandemic |
| title_full | Monoclonal Antibodies in Hospitalised Patients with COVID-19: The Role of SARS-COV-2 Serostatus in an Evolving Pandemic |
| title_fullStr | Monoclonal Antibodies in Hospitalised Patients with COVID-19: The Role of SARS-COV-2 Serostatus in an Evolving Pandemic |
| title_full_unstemmed | Monoclonal Antibodies in Hospitalised Patients with COVID-19: The Role of SARS-COV-2 Serostatus in an Evolving Pandemic |
| title_short | Monoclonal Antibodies in Hospitalised Patients with COVID-19: The Role of SARS-COV-2 Serostatus in an Evolving Pandemic |
| title_sort | monoclonal antibodies in hospitalised patients with covid 19 the role of sars cov 2 serostatus in an evolving pandemic |
| topic | serostatus Clinical trial COVID-19 Hospitalised Neutralising monoclonal antibody Pneumonia |
| url | https://doi.org/10.1007/s40121-023-00769-2 |
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