Evaluating the future of monoclonal antibody therapy for SARS-CoV-2

Abstract

A range of therapeutic options exist for those at high risk for developing severe coronavirus disease 2019 (COVID-19) infection. Monoclonal antibody (mAb) therapies and antiviral therapies are two major categories that have been relatively well-defined. However, few studies have directly compared these two forms of therapy. With the emergence of new variants of concern (VoCs), resistance to therapeutics has become an issue. The extensive mutations found on the Omicron variant has compromised many currently available neutralizing mAb therapies. Eli Lilly’s Bebtelovimab was recently authorized in the United States, but its clinical success has yet to be proven. This article will highlight the current role of mAb therapy in the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as well as its future use, focusing on 1) How does Bebtelovimab compare to other mAb therapies for SARS-CoV-2 and 2) What are the advantages and disadvantages of mAb therapy in comparison to antivirals for SARS-CoV-2? Answering these questions will help to strategize the development of novel therapeutic agents in targeting emerging VoCs in addition to investigating the benefits and limitations of each form of therapy. This article emphasizes the potential of Bebtelovimab as a broad-spectrum mAb while addressing the need to examine novel combination therapies targeting conserved epitopes in order to combat resistance. The comparison of mAbs to antivirals also exposes the challenge of manufacturing cost, drug supply, and distribution in the healthcare system, which has an impact on the long-term clinical feasibility and success of these therapeutics.