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Infectious Disease

Best Practices For Administering Monoclonal Antibody Therapy For Coronavirus (COVID-19) (Archived)

This article is made available for historical review, monoclonal antibody use is not currently indicated for this condition. COVID-19 illness is a clinical syndrome caused by a SARS-CoV-2 infection. It was first reported in Wuhan, China, in December 2019 and quickly spread to a pandemic level in 2020. A meta-analysis report stated that an estimated 18.2 million people died globally because of the COVID-19 pandemic between Jan 1, 2020, and the end of December 2021. SARS-CoV-2 or severe acute resp

v1 · Reviewed Nov 7, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • The clinical presentation varies from asymptomatic cases to severe disease with hypoxia and respiratory compromise.
  • Severe Illness: Hypoxia, Spo <94% on room air, a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO/FiO) <300 mm Hg, respiratory frequency >30 breaths/min, or lung infiltrates >50% to lung volume.
  • Critical Illness: Individuals who have respiratory failure, septic shock, and/or multiple organ dysfunction.
  • Identifying patients who are at high risk for severe disease is of prime importance, so patients may be offered therapies that can deter their progression to severe disease.
  • Asymptomatic or Presymptomatic Infection: positive testing for SARS-CoV-2 but no symptoms consistent with COVID-19.
  • Mild Illness: Individuals who have any of the various signs and symptoms of COVID-19 but do not have shortness of breath, dyspnea, or abnormal chest imaging.
  • Moderate Illness: The presence of lower respiratory disease without hypoxia (oxygen saturation (SpO) ≥94% on room air).
  • Severe Illness: Hypoxia, Spo <94% on room air, a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO/FiO) <300 mm Hg, respiratory frequency >30 breaths/min, or lung infiltrates >50% to lung volume.
  • Ritonavir-boosted nirmatrelvir. This is an oral medication that consists of protease inhibitors.
  • It has been shown to reduce hospitalization and death when given to high-risk, unvaccinated, non-hospitalized patients.
  • It must be given within 5 days of symptoms onset.
  • Remdesivir. This is a nucleotide analog that inhibits the SARS-CoV-2 RNA polymerase.
  • The recommended duration of therapy in this setting is 3 days.
Remdesivir
Not specified in source
Adult
Not specified in source
Renal
Not specified in source
Duration
3 days
  • Monoclonal antibodies are intended for the treatment of outpatient mild-moderate COVID-19 infections in patients with risk factors for progression to severe disease.
  • However, it must be noted that according to the National Institutes of Health (NIH), none of these monoclonal antibodies are recommended in 2023 for the treatment of COVID-19.
  • As of January 2023, all previously authorized monoclonal antibodies have lost their EUAs for the treatment of COVID-19 due to the resistance demonstrated by this variant.
  • Therefore, monoclonal antibody therapy is currently not indicated for the treatment of acute COVID-19 , even if they meet the criteria on their EUAs.
  • The FDA and the NIH advise against their use until further notice.
  • Molnupiravir. This is a mutagenic ribonucleoside antiviral agent.
  • Due to the risk of genotoxicity with this agent, it is not recommended in pregnant patients.
  • This agent should only be used if both of the above therapies are unavailable or cannot be given.
  • A potential complication of human mAbs use against viral pathogens is that it may promote selection for escape mutants.
  • When administering monoclonal antibodies, the interprofessional team must be prepared for adverse events such as transfusion reactions and anaphylaxis.
  • Patients must be observed for at least one hour after receiving a monoclonal antibody infusion to ensure patient safety.
  • The interprofessional healthcare team is also responsible for educating the patient on infection control measures.
  • After receiving monoclonal antibody therapy, the patient must continue self-isolating and use infection control measures such as social distancing, frequent handwashing, and wearing personal protective equipment.
  • Healthcare providers should also be aware of the resistance patterns of SARS-CoV-2 variants.
  • Up-to-date information regarding the use of authorized medications is essential to optimize clinical outcomes.
  • review
    Best Practices For Administering Monoclonal Antibody Therapy For Coronavirus (COVID-19) (Archived). StatPearls [Internet] — Hend Elsaghir, Ghufran Adnan — StatPearls Publishing, 2023

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov