Is Monoclonal Antibody A Substitute for COVID-19 Vaccine?

• COVID-19 cases continue to surge throughout the United States
• Scientists are also developing monoclonal antibodies that target cancer cells
• Research suggests that certain monoclonal antibodies can reduce the risk of hospitalization and death in people with asymptomatic or mild COVID-19.

Lab-grown antibodies can help the immune system fight the coronavirus, but they’re no substitute for COVID-19 vaccination, reports an article published in HealthLine.

About COVID 19 Vaccination

As COVID-19 cases continue to surge throughout the United States, demand for monoclonal antibody treatments is spiking, in areas of the country with low vaccination rates.

According to the Food and Drug Administration (FDA), this experimental treatment uses “laboratory-made proteins that mimic the immune system’s ability to fight off harmful antigens such as viruses” like SARS-CoV-2.

What is monoclonal antibody?

A monoclonal antibody is a laboratory-produced protein that functions like the antibodies made by the immune system in response to infection.

It’s useful for people with weakened immune systems who may not generate a robust response to the COVID-19 vaccines, and for others at high risk of severe illness.

While monoclonal antibodies can start to clear the coronavirus within hours of being infused intravenously (IV) into the body, this treatment may not work for everyone. Therefore , experts recommend that people get fully vaccinated against COVID-19, which is known to prevent severe illness and hospitalization due to the disease.

Research suggests that certain monoclonal antibodies can reduce the risk of hospitalization and death in people with asymptomatic or mild COVID-19.

Developing monoclonal antibodies

Scientists are developing monoclonal antibodies that can target cancer cells.

Scientists sometimes develop monoclonal antibodies by isolating certain immune cells  called B cells, from a person who has successfully recovered from an infection. They use these isolated B cells to recreate monoclonal antibodies in a laboratory. This can be mass produced and given to people through an IV.

With COVID-19, “we looked in people who had a good antibody response to the virus and picked out the very best antibodies that they made,” said Robert Carnahan, PhD, associate director of the Vanderbilt Vaccine Center in Tennessee.

Working of monoclonal antibody

A monoclonal antibody targets a specific antigen on a virus or bacteria. 

Most of the monoclonal antibodies being developed to treat COVID-19 target the spike protein, which the coronavirus (SARS-CoV-2) uses to enter the host cells.

By binding to the spike protein, a monoclonal antibody can help prevent the virus from infecting human cells.

Several monoclonal antibodies have received emergency approval from the FDA

• REGEN-COV. This drug cocktail contains two monoclonal antibodies, casirivimab and imdevimab. It’s approved for people over age 12.
• Sotrovimab. This drug is authorized for adults and kids over 12 years old.
• Bamlanivimab/etesevimab. In June, the U.S. government paused distribution of these two monoclonal antibodies because tests showed that they did not work against the Beta and Gamma variants of the coronavirus. The FDA recommends that health professionals use other monoclonal antibodies instead.
• Actemra (tocilizumab) .This drug can be used for the treatment of COVID-19 in hospitalized adults and children 2 years and older. This monoclonal antibody reduces inflammation that occurs during COVID-19.

Regeneron’s antibody cocktail also has emergency approval for use in people at high risk of severe COVID-19 who were exposed to the coronavirus, but haven’t yet tested positive or developed symptoms.

All of these monoclonal antibodies received emergency approval for treatment of mild to moderate COVID-19 in people 12 years or older who tested positive for the coronavirus and are at high risk of severe COVID-19.

Importance of Vaccination

While monoclonal antibodies can reduce the risk of severe illness in these people, full vaccination is also important.

“If you are immunocompromised, I really hope you are already vaccinated,” Dr. Vincent Rajkumar, an oncologist at Mayo Clinic, wrote on Twitter.

“But in case you are not, the [recommendations] for monoclonal antibody still apply to you: If exposed to someone with COVID, or you get COVID, try and get monoclonal antibody treatment,” Rajkumar continued.

With the two-dose mRNA vaccines, full protection doesn’t occur until 2 weeks after receiving the second dose. By then, people might already be severely ill.

Shortly after exposure to the virus, “the vaccine’s probably not going to do someone any good. It won’t take effect soon enough for the person to be protected,” said Carnahan. “Whereas with antibodies, the protection is available within minutes to hours.”

The CDC still recommends that people who have had COVID-19 consider getting vaccinated. Some studies suggest that vaccination provides a stronger immune response than natural infection alone.

Although many infusion centers are ramping up around the country, experts emphasize that monoclonal antibody treatment is not a substitute for COVID-19 vaccination.

Monoclonal antibody treatment

Monoclonal antibody treatment has been used and tested  for Ebola , respiratory syncytial virus (RSV), as well as chronic illnesses .

Scientists are also looking at whether this treatment can reduce the risk of someone with COVID-19 transmitting the virus to others in their household.

Monoclonal antibody treatment is generally given within 10 days of a positive COVID-19 test.

“If the antibodies are given relatively soon in high-risk patients, then it can have an impact,” said Carnahan. However, “the later someone is in their disease course, the less likely that antibodies are going to be helpful.”

This is useful in situations where an unvaccinated person is exposed to COVID-19.

With the two-dose mRNA vaccines, full protection doesn’t occur until 2 weeks after receiving the second dose. By then, people might already be severely ill.

Shortly after exposure to the virus, “the vaccine’s probably not going to do someone any good. It won’t take effect soon enough for the person to be protected,” said Carnahan. “Whereas with antibodies, the protection is available within minutes to hours.”

Cost of Monoclonal Antibody Treatment

The cost of Regeneron’s two-drug cocktail is $1,250 per infusion, according to Kaiser Health News. The federal government currently covers this. Compared to the cost of a single dose of the COVID-19 vaccine ,about $20 ,which is also covered right now by the federal government.

The cost of GSK’s and Vir’s monoclonal antibodies costs about $2,100 per infusion. This is covered by a combination of government payments, reimbursements, and GSK’s copay program, reports USA Today.

Some infusion centers may charge treatment fees. These are covered by Medicare, Medicaid, and most private health insurances, although some plans may charge a copay.

If you’re uninsured or concerned about cost, ask the treatment center beforehand if you’ll be charged for the infusion.

Monoclonal antibody treatment is being offered at outpatient locations, hospitals, urgent care centers, and some physician’s offices throughout the country. The U.S. Department of Health and Human Services has an infusion location finder on its website.

“Because of their ease of delivery and low cost, the vaccines are going to outweigh monoclonal antibodies in many situations,” said Carnahan. “That’s why everyone should get vaccinated. The vaccines are going to provide — we hope — durable long-term immunity in an easy-to-distribute format.”

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Source: HealthLine

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