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| LETTER TO THE EDITOR |
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| Year : 2020 | Volume
: 7
| Issue : 2 | Page : 60-61 |
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Therapeutic Uses of Monoclonal Antibodies for COVID-19
Tarun Kumar Suvvari
Rangaraya Medical College, Kakinada, Andhra Pradesh, India
| Date of Submission | 04-Dec-2020 |
| Date of Decision | 10-Dec-2020 |
| Date of Acceptance | 16-Dec-2020 |
| Date of Web Publication | 31-Dec-2020 |
Correspondence Address:
Mr. Tarun Kumar Suvvari
Rangaraya Medical College, Kakinada, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/bmrj.bmrj_15_20
How to cite this article:
Suvvari TK. Therapeutic Uses of Monoclonal Antibodies for COVID-19. Biomed Res J 2020;7:60-1 |
Dear Editor,
The therapeutic management of COVID-19 is highly crucial, and extensive research is being carried across the globe. Numerous clinical trials for drugs such as dexamethasone, remdesivir, convalescent plasma, and anti-HIV drugs were taking place, but monoclonal antibodies (MABs) have received little attention even though it has shown a significant effect against past coronaviruses. MABs are laboratory-made proteins that protect against infectious diseases by mimicking one's immune system's ability to fight infections. MABs are also referred to as designer antibodies. MAB has shown remarkable outcomes than other immunotherapies such as intravenous immunoglobulins, serum therapy against infectious diseases. MABs restrict the virus entry by binding to the acetylcholine esterase-2 receptors and thereby blocking the receptor-binding domain (RBD) present on the spike (S) protein of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[1] In a study by Coughlin and Prabhakar, the MAB targeting the RBD region of S protein of SARS-CoV and MERS-CoV had shown promising results for both in vivo and in vitro studies.[2]
MABs are highly specific, can be rapidly isolated and manufactured, and can provide rapid protection against various infections. Bamlanivimab (LY-CoV555), casirivimab and imdevimab (REGN-COV2), AZD7442 (a combination of two long-acting antibodies), itolizumab (anti-CD6 IgG1 MAB), and tocilizumab (anti-interleukin-6 receptor) are MABs, currently in development for COVID-19 by Eli Lilly, Regeneron, AstraZeneca, Biocon Biologics and ACTEMRA, respectively.[3],[4],[5],[6]
Casirivimab and imdevimab got permission for emergency use authorization from the U.S. Food and Drug Administration on November 21, 2020.[7] They can be used to treat mild-to-moderate COVID-19 cases in adults and children above 12 years of age/minimum weight of 40 kg. Compared to placebo, they showed promising results in clinical trials by reducing hospitalization/requirement of emergency room (ER) among high-risk patients within 28 days after treatment.[4] Casirivimab and imdevimab should be administered through intravenous (IV) infusion only. These are not advised to be used in severe COVID-19 patients who require mechanical ventilation/high-flow oxygen associated with poor clinical outcomes.[4],[7]
Bamlanivimab, in combination with LY-CoV016 (another MAB), reduced symptoms, viral load, COVID-19 hospitalization, and ER visits.[3] More data are needed on bamlanivimab clinical trials to provide proper assurance. India's medical authorities approved itolizumab for emergency usage in COVID-19 patients with cytokine release syndrome.[6] According to clinical studies by Subramanian et al. and Díaz et al., itolizumab prevented the progression into the hyperinflammation phase (cytokine storm), coagulation, and organ failure in COVID-19 patients.[8],[9]
AZD7442 is a combination of two long-acting antibodies by AstraZeneca under phase 3 clinical trials. They are designed to reduce the risk of resistance for COVID-19 by reducing Fc receptor binding.[5] Tocilizumab has shown to be an effective treatment for COVID-19 patients by reducing body temperature, clinical symptoms, and C-reactive protein levels along with improved O2 saturation as observed in hospitalized patients receiving tocilizumab.[10]
MABs can be promising for COVID-19 prevention. These can provide immediate protection against viruses that could last weeks to months. MAB's major limitation is its cost where only high-income countries can use it as a therapeutic agent. The safety and efficacy of MABs should be evaluated thoroughly for potential quality control. A wide range of viral strains and escape mutants can be neutralized using a combination of MABs that can thus lead to effective disease prevention.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Shanmugaraj B, Siriwattananon K, Wangkanont K, Phoolcharoen W. Perspectives on monoclonal antibody therapy as potential therapeutic intervention for coronavirus disease-19 (COVID-19). Asian Pac J Allergy Immunol 2020;38:10-8.  |
| 2. | Coughlin MM, Prabhakar BS. Neutralizing human monoclonal antibodies to severe acute respiratory syndrome coronavirus: target, mechanism of action, and therapeutic potential. Rev Med Virol 2012;22:2-17. |
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| 8. | Loganathan S, Athalye SN, Joshi SR. Itolizumab, an anti-CD6 monoclonal antibody, as a potential treatment for COVID-19 complications. Expert Opin Biol Ther 2020;20:1025-31. |
| 9. | Díaz Y, Ramos-Suzarte M, Martín Y, Calderón NA, Santiago W, Viñet O, et al. Use of a humanized anti-CD6 monoclonal antibody (itolizumab) in elderly patients with moderate COVID-19. Gerontology 2020;66:553-61. |
| 10. | Xu X, Han M, Li T, Sun W, Wang D, Fu B, et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci U S A 2020;117:10970-5. |
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