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Neutralising mAbs, a form of anti-viral medicine, are being explored as an attractive option to treat symptoms of COVID-19 and in some cases prevent infection. But what are the pros and cons of this type of treatment and what should regulators consider before granting approval?

Monoclonal antibody

The sudden arrival and devastating impact of the SARS-CoV-2 (COVID-19) pandemic spurred a rush of international research to identify effective ways to limit the spread of infection and reduced the associated morbidity and mortality of the virus.  

Alongside the emerging vaccines that have been developed at accelerated speed, an arsenal of treatments to reduce the severity of symptoms, avoid hospitalisation and prevent progression to serious complications or death are being trialled. With some limited success, including the RECOVERY and PRINCIPAL trials at Oxford, attention is turning to neutralising monoclonal antibodies (mAbs), a new class of anti-viral treatment to combat the symptoms of COVID-19.     

Peter Taylor, Norman Collisson Professor of Musculoskeletal Sciences at NDORMS said: “mAb therapies have been tested for a number of diseases including RSV and Ebola and now have the potential to be used effectively for COVID-19. But while there are three mAb therapies that have been granted emergency use authorisation (EUA) for COVID-19 in the US, questions still remain about their clinical use. We have completed a review highlighting the relative value that neutralising mAbs can provide for patients and doctors and have examined the role of these agents among the spectrum of potential treatments for COVID-19.” 

Neutralising mAbs are proteins that can be derived from the B cells of COVID-19 patients.  Screening of donated plasma from a patient who has had an illness and recovered from it, allows for the discovery of antibodies, which can be given to other patients to target certain antigens and boost the ability to fight disease. Once identified, the specific antibodies can be engineered and mass produced as an mAb, making it a cost effective and readily available treatment.  

Published in Nature Reviews Immunologythe paper discusses the broader potential of these novel therapies, the lessons learned from their use to treat other viral infections, and the strategies to use them effectively in clinical practice. It raises, and attempts to answer, questions around who should receive treatment, what is the best dose and frequency, at what point in the infection they will be most effective, and the duration of the protection they provide. 

“Neutralising mAbs, particularly in combination with other medications, represent an attractive approach that has potential to be effective in both preventative and treatment settings,” said Professor Taylor. “So as COVID-19 continues to spread in different parts of the globe, there is a pressing need to increase research to understand the role of mAbs in countering the devastating impact of the virus in vulnerable populations and high-risk patients.” 

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