Neutralizing Antibody Therapeutics for COVID-19

Viruses. 2021 Apr 7;13(4):628. doi: 10.3390/v13040628.


The emergence of SARS-CoV-2 and subsequent COVID-19 pandemic has resulted in a significant global public health burden, leading to an urgent need for effective therapeutic strategies. In this article, we review the role of SARS-CoV-2 neutralizing antibodies (nAbs) in the clinical management of COVID-19 and provide an overview of recent randomized controlled trial data evaluating nAbs in the ambulatory, hospitalized and prophylaxis settings. Two nAb cocktails (casirivimab/imdevimab and bamlanivimab/etesevimab) and one nAb monotherapy (bamlanivimab) have been granted Emergency Use Authorization by the US Food and Drug Administration for the treatment of ambulatory patients who have a high risk of progressing to severe disease, and the European Medicines Agency has similarly recommended both cocktails and bamlanivimab monotherapy for use in COVID-19 patients who do not require supplemental oxygen and who are at high risk of progressing to severe COVID-19. Efficacy of nAbs in hospitalized patients with COVID-19 has been varied, potentially highlighting the challenges of antiviral treatment in patients who have already progressed to severe disease. However, early data suggest a promising prophylactic role for nAbs in providing effective COVID-19 protection. We also review the risk of treatment-emergent antiviral resistant "escape" mutants and strategies to minimize their occurrence, discuss the susceptibility of newly emerging SARS-COV-2 variants to nAbs, as well as explore administration challenges and ways to improve patient access.

Keywords: COVID-19; SARS-CoV-2; bamlanivimab; casirivimab; etesevimab; imdevimab; neutralizing antibody; resistance.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antibodies, Monoclonal, Humanized
  • Antibodies, Neutralizing / therapeutic use*
  • Antiviral Agents / therapeutic use
  • COVID-19 Drug Treatment*
  • Humans
  • SARS-CoV-2
  • Spike Glycoprotein, Coronavirus
  • United States
  • United States Food and Drug Administration


  • Antibodies, Monoclonal, Humanized
  • Antibodies, Neutralizing
  • Antiviral Agents
  • Spike Glycoprotein, Coronavirus
  • spike protein, SARS-CoV-2
  • imdevimab
  • bamlanivimab
  • casirivimab
  • etesevimab