What you need to know about monoclonal antibodies

First, we searched for effective methods to treat seriously ill patients with COVID-19. ICU teams across the country used drugs like remdesivir and treatments such as artificial ventilation to help thousands recover. Then, we anxiously awaited the development of a safe and effective COVID-19 vaccine. Now, we continue to strive to treat those who are at increased risk for severe illness from COVID-19, and monoclonal antibodies have been shown to play a key role.

Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight a particular infection, such as COVID-19. Research has shown that the risk of hospitalization or death was reduced by 85% among those who received sotrovimab, a monoclonal antibody that has been granted emergency use authorization by the U.S. Food and Drug Administration. Sotrovimab joins oral antiviral medications as one of the few treatments for mild to moderate COVID-19 that are effective against the omicron variant.

Studies have shown patients feel better and get back to work faster after receiving monoclonal antibodies. The administration of monoclonal antibodies also reduced the duration of symptoms in patients with COVID-19.

Who qualifies for monoclonal antibody treatment?
According to Dr. Ran Regev, a board-certified emergency medicine doctor affiliated with Sharp Chula Vista Medical Center, monoclonal antibodies are an appropriate treatment for people who are at least 12 years old and 88 pounds, and are at increased risk for severe illness from COVID-19. They must have recently tested positive for COVID-19 and be within 10 days of the onset of any COVID-19 symptoms, such as fever, cough, sore throat, headache, fatigue, muscle pain, stomach upset and loss of taste or smell.

People considered to be at high risk of severe COVID-19 illness include those who:

• Are age 65 or older

• Are overweight (body mass index over 25)

• Are pregnant

• Are currently receiving immunosuppressive treatment

• Have the following conditions:

  • Chronic kidney disease

  • Type 1 or Type 2 diabetes

  • Weakened immune system

  • Cardiovascular disease or high blood pressure

  • Chronic lung disease

  • Sickle cell disease

  • Neurodevelopmental disorders

  • Medical-related technological dependence

“To qualify for treatment, a patient at risk for severe illness with laboratory-confirmed COVID-19 infection must have mild to moderate COVID symptoms and not require supplemental oxygen or hospitalization,” Dr. Regev says.

What happens during treatment?
Once a patient meets the criteria for treatment, Dr. Regev reports that the care team will discuss the risks, benefits and alternatives to monoclonal antibody treatment with them.

The antibodies are administered through a 30-minute infusion or injection. Some people may experience mild bruising or irritation at the infusion or injection site.

Patients will be monitored for signs of an allergic reaction for one hour after receiving the treatment. Though rare, reactions can include:

• Fever

• Chills

• Nausea or vomiting

• Headache

• Shortness of breath

• Low blood pressure

• Wheezing

• Swelling of the lips, face or throat

• Rash or hives

• Itching

• Muscle aches

• Dizziness

Can monoclonal antibodies replace the need for vaccination?
While monoclonal antibodies provide an effective means to prevent the development of severe COVID-19 in those who have already been infected, Dr. Regev says that vaccination remains the best way to prevent infection, severe symptoms, hospitalization and death. “I cannot stress enough the importance of vaccination,” he says.

In San Diego County, the hospitalization rate for people who are not vaccinated is three times higher than those who are fully vaccinated, and the death rate is four times higher. This supports Dr. Regev’s and colleagues’ continued — and confirmed — assertions that the COVID-19 vaccines available in the U.S. are safe and extremely effective.

“I encourage everyone who qualifies for vaccination to vaccinate themselves and to encourage their loved ones to do the same,” Dr. Regev says. “This will not only significantly reduce their chance of morbidity and mortality from COVID, but also will likely help in ending the pandemic.”

If you have been recently diagnosed with COVID-19, talk with your doctor about whether you qualify for monoclonal antibody treatment. The County of San Diego offers treatment at several Monoclonal Antibody Treatment Centers and reports there is ample supply of treatment available, which is available at no cost, regardless of health insurance or immigration status. Additionally, your doctor's referral is not required.

For information about monoclonal antibody treatment in San Diego, call 619-685-2500 or email COVIDtreatment@sdcounty.ca.gov. Learn more about COVID-19 vaccination, testing and care resources at Sharp.

This story was updated in February of 2022.