What Is Monoclonal IV Therapy And How Does It Battle Covid?

When the pandemic started in 2019, doctors knew so little about the virus that they could do little to treat it. Like most other new diseases, they needed to learn more about the novel coronavirus to develop effective therapies to fight it. By mid-2020, the FDA started approving treatments and therapies for severe Covid-19-related illness, especially in individuals with life-threatening symptoms or underlying health issues. One such treatment was monoclonal antibody therapy, which is already extensively used in treating various cancers.

This article unpacks what monoclonal IV therapy for Covid-19 is and summarizes other key points, such as how it works and eligibility.

What is monoclonal antibody IV therapy?

Before explaining monoclonal IV therapy for Covid-19, it’s important to first understand how the body’s immune response works.
The body’s primary defense system uses antibodies to fight infection (including viruses, bacteria, and other foreign biomolecules). When an infectious agent enters the body, it produces specific antigens (proteins) unique to its DNA makeup.

The body detects these antigens and produces antibodies specific to that antigen that flood the body and hunt down the infection, either killing or incapacitating it.

The main challenge with natural immunity is a steep learning curve between when the body first detects the infection and when it can mount a formidable defense. If someone is at risk of falling seriously ill from a disease, they might not survive this learning curve.
Monoclonal antibody (mAb) therapy is one way to help the body skip the training and head straight to the battlefront.

What is monoclonal IV therapy for Covid-19?

Monoclonal antibody therapy uses manufactured antibodies that mimic the immune system’s method of fighting off harmful pathogens like viruses. In the case of Covid-19, these antibodies map onto the Covid-19 antigen, fighting them in the same way the body would.

Think of it as a small country with a standing army of 10,000 (natural immunity) requesting another bigger country for assistance, and that country sending 100,000 highly trained troops (monoclonal antibodies).

During monoclonal IV therapy for Covid-19, millions of these antibodies, identical to the ones the body would produce, enter the body through an IV drip. Once in, they travel through the bloodstream to all ‘corners’ of the body, creating a protective buffer between the infection (or potential infection) and the body’s natural immune system, which might be still learning how to fight Covid-19. Monoclonal antibodies can also provide support for immunocompromised individuals.

How does it treat Covid-19?

Now to the fun part: how monoclonal IV therapy combats the Covid-19 virus.

After infusion, the body now has millions of antibodies on standby. If the Covid-19 virus enters the body (or is already inside the body), two things happen:

• The monoclonal antibodies, which are already trained to recognize the virus’s antigen signature, attack the virus, destroying it.
• If not destroyed, the monoclonal antibodies lock into the virus’s spike proteins (the ones it uses to latch onto healthy cells), preventing the virus from latching onto healthy cells.

In these two scenarios, the monoclonal antibodies do the heavy lifting, leaving the body’s natural immune system to do the mopping up.

Is monoclonal IV therapy FDA approved?

The FDA has granted Emergency Use Authorization (EUA) to multiple Covid-19 monoclonal antibody therapies for use in mitigative cases (severely ill individuals) and, more recently, as a preventative measure.

Monoclonal IV therapy options

Currently, the FDA has given EUA status to one anti-SARS-CoV-2 mAb products to treat mild to moderate Covid-19: sotrovimab. Bamlanivimab plus etesevimab and casirivimab plus imdevimab were previously available for use under the FDA’s EUA, but that authorization is no longer in effect as of February 2022.

In addition, the three therapies listed above are approved as post-exposure prophylaxis (PEP) or preventative treatment for individuals at higher risk of getting SARS-CoV-2 infection (e.g., healthcare workers like nurses) and, if infected, are likely to progress to serious illness. Although the FDA has provided guidelines on the various dosages, healthcare providers can determine ideal dosages for specific cases.

How effective is monoclonal IV therapy in battling Covid-19 strains?

Monoclonal IV therapy for Covid-19 relies on decades of research into how this type of therapy can treat dozens of other illnesses.

For example, in cancer treatment, monoclonal antibodies are used to treat various cancers, and research is ongoing to codify even more cancers and target them with monoclonal therapy.

In Covid 19, all approved monoclonal antibody therapies are currently effective against the following Covid-19 strains:

• Alpha (B.1.1.7)
• Beta (B.1.351)
• Gamma (P.1)
• Delta (B.1.617.2, non-AY.1/AY.2)

Monoclonal IV therapy eligibility

According to FDA guidelines, healthcare professionals should only give monoclonal antibodies to individuals who fit its eligibility criteria. However, it is worth noting that these criteria cast a wide net, so a sizable portion of the population stands a high chance of being eligible.

Who is eligible?

• High risk* for developing severe Covid-19, AND
• Positive Covid-19 test and not yet admitted to the hospital, OR hospitalized for a diagnosis other than Covid-19, provided they have mild to moderate Covid-19 and are at high risk for progressing to severe illness, AND
• 12 years of age or older (and at least 88 pounds)

Preventive monoclonal antibody therapy is available to individuals who have been exposed AND who are:

• High risk* for developing severe Covid-19, AND
• Not fully vaccinated OR vaccinated but immunocompromised, AND
• 12 years of age or older (and at least 88 pounds)

*High-risk criteria include:

• 65 years of age or older
• Overweight (BMI over 25)
• Chronic kidney disease
• Pregnant
• Diabetes (Type 1 and Type 2),
• Receiving immunosuppressive treatment
• Immunocompromised
• Cardiovascular disease/hypertension
• Sickle cell disease
• Chronic lung disease
• Neurodevelopmental disorders

Who is not eligible?

Under provided EUAs, the FDA does not currently authorize the use of anti-SARS-CoV-2 monoclonal antibody therapy for the following:

• Those hospitalized for Covid-19
• Those needing oxygen therapy due to Covid-19
• Those on chronic oxygen therapy due to an underlying non-Covid-19-related condition and require increased oxygen due to Covid-19

Possible side effects of monoclonal IV therapy

Monoclonal antibody therapy uses components that are identical to those found in the body. As such, the most likely side effect of receiving the treatment is an allergic reaction, characterized by the following symptoms:

• Fever and chills
• Nausea
• Headache
  Shortness of breath
• Low blood pressure
• Wheezing
• Swelling of lips, face, or throat
• Muscle aches
• Hives or itchiness

Although an allergic reaction can be instantaneous, sometimes the symptoms might be delayed. That is the main reason your care team from Drip Hydration monitors you during and shortly after getting a monoclonal IV therapy infusion and advises you what to do if you get a delayed allergic reaction.

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