Monoclonal Antibody Therapy for COVID-19: What the COPD Community Needs to Know

Posted on December 13, 2021   |   

This article was written by Michael W. Hess, MPH, RRT, RPFT.

Throughout much of the first year of the COVID-19 pandemic, there was little clinicians could do for people who tested positive for the virus but did not need hospitalization. People simply had to wait and see if they could manage their symptoms at home…or if they would get sick enough to be hospitalized and placed in intensive care. There was no easy way to predict which way people might go, no way to change the odds. That all started to change beginning in November 2020 when the U.S. Food and Drug Administration (FDA) started to issue emergency use authorizations for treatments using monoclonal antibodies.1

(NOTE: Because of the rapidly changing conditions of the pandemic, on Jan. 24, 2022, the FDA placed a hold on some of these authorizations. Due to the mutations of the Omicron variant, two of the mAb treatments that have been developed were found to be less effective. Because they are less effective, their emergency use authorizations were indefinitely withdrawn and distribution stopped. Please visit the U.S. Department of Health and Human Services for more information: https://aspr.hhs.gov/COVID-19/Therapeutics/Pages/default.aspx)

What are Monoclonal Antibodies?

Your body's immune system naturally produces proteins called antibodies to fight off infections, including viruses like COVID-19. Antibodies recognize foreign substances called "antigens" that cause illnesses. As they travel through the body, antibodies act like flags that tell the immune system to destroy infected cells. They can stop a virus from infecting new cells by blocking its ability to latch on to them. It usually takes time for the immune system to develop antibodies especially in people with a weak immune system because of disease, cancer treatments or old age. Vaccines make it easier and faster for the immune system to develop antibodies. But even with vaccines, it takes time for the immune system to develop a strong antibody response.

Modern research can sometimes provide a shortcut. Scientists can pinpoint antibodies that recognize specific antigens (like SARS-CoV-2 virus, which causes COVID-19) and can mass-produce them in a lab. These lab-made antibodies are called monoclonal antibodies (mAbs). Once the mAb can be produced in large quantities, it can be given to people in the form of an injection or infusion. Since these antibodies are already programmed to recognize the virus quickly, they can help the immune system fight infection right away.

While the pandemic is the first time many people have ever heard of mAbs, they actually have a fairly long and established history of use. The first mAb on the market was approved in 1986 after nearly 10 years of research & development.2 It was designed to help reduce the risk of organ rejection in people after kidney transplants. Since then, mAbs have been used safely in a wide variety of medical conditions including various cancers, asthma, macular degeneration, rheumatoid arthritis, and even infection with the Ebola virus.3

mAbs and COPD

So why should the COPD community be aware of these mAbs? Well, while we know that vaccination continues to be our best tool to avoid getting and spreading COVID-19, mAbs represent an important therapy for the COPD community. People with COPD have consistently been shown to have worse outcomes if they come down with COVID-19, including a higher risk for being hospitalized, a higher risk of respiratory failure, and a higher overall risk of dying.4

During the course of the pandemic, FDA has authorized the use of both individual mAbs and combinations (sometimes called 'cocktails') to help protect people who have tested positive for some variants of COVID-19, or who have been exposed to the virus that causes COVID-19 and are at high risk for worse outcomes. includes people 65 and older and people with chronic conditions like obesity, diabetes, heart disease, and lung diseases like COPD. Unfortunately, we've also seen situations where FDA has withdrawn authorization, because we're finding that some mAbs and cocktails aren't effective against some virus variants (like Omicron). Scientists are constantly researching new mAbs and combinations, as well as testing how they work against current and emerging variants.

It's a relatively simple procedure which usually consists of spending a few hours at an infusion center, or sometimes even a primary care office or urgent care center. The actual administration of the mAbs takes about an hour, and there is some observation time after the infusion to make sure there are no reactions. It's important to note that the sooner after exposure mAb therapy starts, the more effective it's likely to be! If treatment is delayed and more severe symptoms begin (like added shortness of breath or low oxygen levels), mAbs can't help. The US Department of Health and Human Services has set up a website to help you learn more information.

How can I find out how to get mAb therapy?

The answer depends on where you live. Many local health care systems have telephone referral lines where people can get more information on scheduling and find out if antibody treatment is right for them. Some states have also started setting up infusion centers to help take some of the load off from strained hospitals and clinics. The National Infusion Center Association website (https://covid.infusioncenter.org/) can also help you find a location near you. Even at these centers, people still need a prescription for mAb therapy, so be sure to contact your clinician before setting up an appointment. It's also important to remember that since mAbs that are effective against Omicron are in very limited supply, states and local hospital systems may have different rules for who is eligible to receive them. Finally, as evidence about how effective specific mAbs are against different variants changes, FDA authorization may change which ones are available. The COPD Foundation encourages everyone to continue to rely on other methods to stay healthy, including vaccines and boosters, wearing an appropriate mask, and social distancing.

With the uncertainty and frustrations of the pandemic, it's easy to forget there's a light at the end of every tunnel. While the world is not yet out of the woods, monoclonal antibodies are leading the way to lowering the risk of severe COVID-19 cases, especially for those at the highest risk, and even for those who are already vaccinated. That's a double dose of great news for everyone in the COPD community!

PLEASE NOTE: Best practices for the COVID-19 pandemic are changing rapidly, and we are working hard to keep up with the most accurate information. This post was last updated on May 4, 2022.


This blog post was supported by Regeneron.


References

  1. Coronavirus (COVID-19) Update: FDA Authorizes Monoclonal Antibody for Treatment of COVID-19 | FDA. Accessed November 11, 2021. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-monoclonal-antibody-treatment-covid-19
  2. Liu JKH. The history of monoclonal antibody development - Progress, remaining challenges and future innovations. Ann Med Surg. 2014;3(4):113-116. doi:10.1016/j.amsu.2014.09.001
  3. Shepard HM, Phillips GL, Thanos CD, Feldmann M. Developments in therapy with monoclonal antibodies and related proteins. Clin Med J R Coll Physicians London. 2017;17(3):220-232. doi:10.7861/clinmedicine.17-3-220
  4. Higham A, Mathioudakis A, Vestbo J, Singh D. COVID-19 and COPD: A narrative review of the basic science and clinical outcomes. Eur Respir Rev. 2020;29(158):1-13. doi:10.1183/16000617.0199-2020

15 Comments



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  • Mike, thanks for the explanation; I learned a lot, especially about the availability of the therapy and why it's not available or even mentioned to many people. My daughter tested positive for COVID just before Thanksgiving; she was fully vaccinated and due for a booster the Saturday after the holiday. While she doesn't have COPD, she does have a history of both respiratory/allergy/smoking related and GI issues. The respiratory symptoms, while very bad at first, soon subsided into typical allergy type symptoms, but her GI issues went rampant, with a very inflamed colon that required both antibiotics and prednisone to get under control. I know I'm extrapolating beyond the scope of this article, but I wonder if monoclonal therapy might have helped. All these auto-immune issues seem to be linked in weird ways..........
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  • Yes, thank you, Mike for this excellent article!
    My son-in-law was fully vaccinated (2-Pfizer shots before the booster became available) and found through an at-home COVID test, that he'd come down with break-through COVID. He was able to go, within a day, to our community hospital, get a test to confirm that he was positive for COVID, and get the monoclonal antibody infusion immediately after that. After that, he continued having relatively mild symptoms and was up and about within a couple days. We are fortunate to have this available at our community hospital. Their mAbs clinic is very busy.
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  • Appreciated the article and comments folks, I was one of the people who had never heard of this therapy before. Thanks for teaching me something new again! I will look for more info on the accessibility in my part of the world in case the need arises.
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  • Well done Mike. Thank you for posting this important information.
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  • Wonderful blog article Mike!
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  • Thanks Mike for the article. i had the bamlanivimab end of March here at my hospital after being diagnosed with covid. I drove out to Er and drove home. I felt pretty good till a few days later my o2 was dropping so daughter took me to ND to my pulmonologists. I was admitted to the covid unit. Was mainly my o2 had dropped was the concern. I think I would have been very very sick if not for the bam iv I had here. Although I did have the remdesivir iv's in the covid unit also.
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  • Thank you for this information! I will pass this along to all of my patients in pulmonary rehab.

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  • Some good general points about monoclonal antibodies contained within. However, I would add a few caveats to the information presented. First and foremost, COVID is extremely variable from person to person and even within the same person across time, month to month, week to week and day to day and often even minute to minute , so most things COVID can be considered a “maybe” at best. Monoclonal antibodies are no different. They don’t work as effectively or consistently as say Narcan in a drug overdose. I have seen many patients that seem to have been helped by MCAs and many others in whom it is hard to know if they have any impact at all. And while we would all like to believe that we see a light at the end of the tunnel, it has been and still remains a long, dark tunnel so don’t cue up “happy days are here again” just yet. As COVID relates to the COPD community, I am happy to report that of the hundreds of COVID patients I have seen, very few have had underlying COPD (my personal experience). I would like to believe that this is because as a community, we have been preparing for this pandemic for decades. In fact, many of the same techniques that we use to prevent the common cold, flu and pneumonia are also effective against COVID. Vaccinations and Boosters, masks, frequent hand washing, avoiding crowds and sick people, etc. have been part of our teachings in this community forever AND THEY WORK. And our community heeded the warnings because we know that we have a lot more at stake than those that are younger and healthier than the average patient with COPD, or so we thought until we started to hear about COVID Long Haulers, most of whom are young and previously healthy individuals, mostly women in their 20’s, 30’s, 40’s and 50’s as compared to those that we initially thought would have the greatest risk profile, older patients with pre-existing conditions. That being said, when people with respiratory conditions like COPD and other complex medical conditions do get COVID, it has the potential to be much more severe. For that reason, prevention is always the best plan of action. There is also a difference in how sicker patients recover as compared to younger, “healthier” Long haulers. Whereas people with complex medical conditions can have a much slower course, they often have a more steady recovery (again, albeit slow) similar to a classic critical medical patient. Long haulers tend to have a less severe acute bout of COVID but then a far less predictable and more random course and post-COVID recovery, more reminiscent of the recovery from a multi-system trauma. Again, the key points are that while of course it’s better that we have access to monoclonal antibodies, they are not a fail safe and should not be considered a safety net. People with COPD are still at enormously high risk if they do contract COVID and our behaviors and prevention efforts should reflect that.
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    • I agree that having monoclonals does not mean that the pandemic is over and that people should stop using precautions.

      I believe that we are at a much better place relative to last year; we have vaccines, monoclonals and antivirals and are better informed on how to prevent infection and treat those who succumb to infection…(Remember being told to bleach grocery bags?).

      If we learned anything from past pandemics: small pox, polio, and influenza , it is that with research and education, we beat them!

      Let’s keep the faith that together, we will beat SARS-COV2!
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    • I Agree that prevention efforts efforts are always the first line of defense ( An ounce of prevention is worth a pound of cure, a Stitch in time saves nine).

      We are also in a much better place now relative to 12 or 18 months ago ( and I believe a version of this will remain with us for years to come)

      I would rank the strategies as:
      1. Up to Date vaccinations (including the current booster and subsequent boosters)
      2. Respiratory protection ( masks) in appropriate situations to decrease the risk of respiratory infections
      3. Social distancing in appropriate situations - I do not envision a return to "lockdowns" but I do think we need to be smart about where we go - i.e.- avoid crowded indoor venues where the likelihood of viral spread is enhanced.
      4. Antiviral therapies ( such as the monoclonals and the new oral agents that are close to approval)
      5. Therapy of the complications of severe Covid infection ( and these have gotten better over the past 18 months)

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  • Thank you, Mike for this important information. While I have heard of monoclonal antibody treatment, I have learned more from you with this post than I have been exposed to in the media. Thank you so much for all you do.
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  • Mike, thank you so much, I have learned so much from this article. I was wondering if this is like the Gamagoblin injection the Dr.s' used to give people with low immunities?
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  • I have been following Dr John Campbell from the UK for several months and he keeps stressing the importance of Vitamin D3 and zinc to protect and reduce symptoms. I take both daily now. I am new to this site so forgive me if I have missed discussions on this. I have COPD, bronchiectasis. After my second vax of Astrazeneca, I had a flare up that lasted five weeks after a couple of years reprieve whilst using a daily preventative Trelegy puffer. I had to resort to prednisolone to bring it under control. I am nervous about getting a booster in case I get another flare up worse than before. My GP is very non committal about it. So staying safe, wondering if the novavax is the answer when it gets approved in Australia or just let omicron get me eventually and be glad of the reports that acquired immunity from it protects against getting Delta and is many times more protective than any vaccines to date.
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  • Mike, thank you for the detailed explanation. My husband was vaccinated, but came down with a breakthrough case of COVID. He had the monoclonal antibodies last week. He felt better within two days. I am happy to say that he had a very mild case which I am sure the monoclonal antibodies were responsible.
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  • Thanks Mike. Great explanation.
    Reply