Are monoclonal antibodies effective against COVID-19? What you need to know.
As the delta variant surges in North Carolina, the use of monoclonal antibodies, a treatment for patients who have already contracted COVID-19, has increased rapidly.
Since late June, the number of patients treated with monoclonal antibodies has increased 18-fold statewide, the N.C. Department of Health and Human Services reported Friday.
But what are monoclonal antibodies? How effective are they in treating COVID-19? Here is what you need to know.
What are monoclonal antibodies?
Monoclonal antibodies are a treatment for COVID-19 intended to prevent severe disease in high-risk patients who have tested positive for the virus.
The treatment was first authorized for emergency use by the Food and Drug Administration last November.
Dr. David Wohl, infectious disease specialist at the University of North Carolina in Chapel Hill, said typical antibodies, not monoclonal, are proteins naturally produced by the body to fight off diseases.
“What they can do is just by attaching and coding a germ with these antibodies, they can make that germ neutralized. They can neutralize that germ and prevent it from hurting us,” Wohl said. “This is a really important part of our immune system.”
Monoclonal antibodies are copies of other antibodies, made in a lab, from people whose immune system successfully fought off COVID-19.
“There are people who survive COVID, who have great antibodies. We can identify that in the lab, copy those, and then infuse them into people. And almost instantaneously, that person now has antibodies that are extremely well-suited for fighting COVID-19,” Wohl said.
How do they work?
Monoclonal antibodies are given to COVID-19 patients as an infusion through an IV or through a shot at an outpatient center.
The treatment is not authorized for someone who has not tested positive for SARS-CoV-2, the virus that causes COVID-19.
Early evidence suggests that the antibodies can reduce the amount of virus in the body. Lowering this viral load can reduce severe symptoms and make hospitalization more unlikely, according to DHHS.
In order for the monoclonal antibodies to work, the patient must receive them within 10 days of when symptoms start.
The antibodies are unlikely to be effective if given when symptoms have already become severe, according to health officials.
“It’s definitely not something that somebody should get positive and wait a week and see if they start feeling better,” said Dr. David Kirk, critical care specialist at WakeMed. “As soon as they’re diagnosed, they should look for therapy.”
In its authorization, the FDA said monoclonal antibodies are not a replacement for the COVID-19 vaccine. DHHS officials said the vaccine remains the best measure to prevent a severe case of COVID-19.
“Vaccination allows your entire immune system to be charged, not just your antibody system. Antibodies are just a small part of your immunity. The vaccine puts in every part of your immunity, so your natural response you get from a vaccine is always going to be superior to monoclonal antibodies,” Kirk said.
Are they effective?
In the FDA’s authorization of the treatment, the agency reported that studies showed 9% of patients who didn’t receive monoclonal antibodies were hospitalized. Among those who did receive treatment, 3% were hospitalized, a reduction of about 70%.
In the first surge of hospitalizations due to COVID-19 over the winter, Kirk said, WakeMed was treating 10 to 15 patients per day with monoclonal antibodies.
He said the treatment prevented as many as 100 hospitalizations during that time.
“When you’re talking about a hospital that’s already really packed, keeping 80 to 100 patients out of the hospital helps the hospital,” Kirk said. “But more importantly, we kept 100 patients in our community out of the hospital and from a risk of death.”
Dr. Thomas Holland at Duke Health recommended the treatment to any eligible patient.
“If you’re ... at elevated risk of progression to severe disease, then I think it is advisable to get the monoclonal antibody treatment,” Holland said.
Are there side effects?
Wohl said that UNC Health has given monoclonal antibodies to over 3,300 patients. Among those, he said doesn’t know of a severe reaction to the treatment.
He said some may react negatively to the infusion treatment, but that is easily handled if it occurs.
“Other than that, there’s been no side effects. This is a really very safe therapy,” Wohl said.
Kirk said other side effects can include fatigue and cold-related symptoms. But he said since these are the same symptoms as COVID-19, it’s difficult to determine if they are actually side effects of the treatment.
Who is eligible for them?
The treatment is for anyone who tests positive for the coronavirus and has at least mild symptoms for no more than a week.
Patients must be 65 or older or have a chronic health problem that puts them at risk for severe COVID-19. That includes obesity, diabetes, lung disease and heart disease among others.
Some high-risk patients who have been exposed, even if they don’t have symptoms, can be eligible.
Health officials recommended that patients talk to their doctor if they are considering treatment.
Where are they available?
Those considering monoclonal antibody treatment can visit covid.infusioncenter.org.
Wohl said UNC Health has nine infusion centers across North Carolina, including one in Pittsboro for the Chapel Hill area.
Duke Health has a center at its Duke University Hospital.
Kirk said they have clinics at WakeMed campuses in Raleigh and Cary and any emergency center operated by WakeMed.
This story was originally published August 20, 2021 at 4:30 PM.