Monoclonal Antibody Therapies Enter the Picture
Early in the pandemic, scientists were optimistic that monoclonal antibody therapies could prove useful for both prevention and treatment of COVID-19. These antibodies are laboratory-produced molecules that act like human antibodies in the immune system. The first monoclonal antibody therapy to receive an FDA emergency use authorization for COVID-19 was bamlanivimab developed by Eli Lilly. However, subsequent variants proved resistant to this first-generation antibody.
More promising have been combinations of monoclonal antibodies. Regeneron's cocktail casirivimab and imdevimab was granted EUA for treatment of mild-to-moderate COVID-19 in high-risk patients. Clinical trials showed it reduced the risk of hospitalization or death by 70% when given shortly after symptoms appear. Another monoclonal antibody treatment called sotrovimab developed by GlaxoSmithKline received EUA for treatment of mild-to-moderate COVID-19 in May 2021. It was found effective against variants of concern. The availability of monoclonal antibodies provides physicians with effective therapies for treating early-stage COVID-19, especially in immunocompromised patients.
Multiple Efforts Underway Targeting Different Stages of Illness
While progress has been made in treating hospitalized patients, additional drug development efforts are targeting different stages of COVID-19 illness. Early illness is being targeted by oral antivirals that could be prescribed like a normal antibiotic. Molnupiravir developed by Merck and Ridgeback Biotherapeutics has shown promise in reducing hospitalization rates when given early after symptom onset. Pfizer's paxlovid pill significantly reduced hospitalizations and deaths in trials. It works by inhibiting viral proteases essential for viral replication. Both could receive authorizations before the end of 2021.
Ongoing pharmaceutical company efforts also include new monoclonal antibodies with longer-lasting activity and potential to counter variants of concern. Another area of interest is drugs that could prevent or treat long COVID syndrome by reducing inflammation. Improved treatments are also sought for multisystem inflammatory syndrome in children, a rare but potentially life-threatening post-viral complication of COVID-19. Overall, a multi-pronged strategy targeting different stages of illness from mild to severe holds the best promise in controlling the pandemic as new variants continue emerging. While vaccination remains the primary prevention tool, new drug treatments will continue playing a supportive role.
In summary, significant progress has been made with drugs like remdesivir, dexamethasone and monoclonal antibodies against COVID-19. These have helped reduce mortality among hospitalized patients and provided options for outpatient treatment. However, no single magic bullet has yet appeared. Control of the pandemic will depend on a combination of preventive strategies including vaccination as well as curative therapies tailored to address different stages of disease. Multiple drug candidates are in testing and have the potential to expand the therapeutic armamentarium in the continual battle against SARS-CoV-2 virus. While promising data emerge regularly, rigorous evaluation in well-designed clinical trials remains essential to guide safe, evidence-based use of these treatments as the pandemic evolves.
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