Effect of monoclonal antibody therapy on the endogenous SARS-CoV-2 antibody response

• Published in: Clinical immunology (Orlando, Fla.) Vol. 236; p. 108959
• Main Authors: Kim, Paul S., Dimcheff, Derek E., Siler, Andrew, Schildhouse, Richard J., Chensue, Stephen W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2022; Academic Press
• Subjects: Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Antibodies, Neutralizing; Antibodies, Viral; Antibody Formation; COVID-19; Humans; Humoral immunity; Monoclonal antibody; Passive immunization; Retrospective Studies; SARS-CoV-2; eGFR; IMD; anti-S; FDA; CDC; anti-N; Monoclonal antibody; BAM; VHA; mAb; COVID-19; EUA; ACE2; SARS-CoV-2; CAS; ETE; Passive immunization; Humoral immunity; BMI
• ISSN: 1521-6616; 1521-7035; 1521-7035
• DOI: 10.1016/j.clim.2022.108959

Monoclonal antibody treatment of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has been widely implemented. Effects of treatment on the endogenous primary humoral response to the virus are unknown. A retrospective cohort study performed at a Veterans Health Administration medical center compared serologic responses of treated and untreated COVID-19 patients at high risk for severe outcomes. Three anti-viral spike protein IgG monoclonal treatments were used during the study period, 1) bamlanivimab, 2) casirivimab with imdevimab, and 3) bamlanivimab with etesevimab. Data were analyzed at acute (0–9 days), seroconversion (10–19 days), and maximum antibody (20–39 days) stages. SARS-Cov-2 infection induced a dynamic primary humoral response with anti-spike IgM and anti-nucleocapsid IgG seroconversion occurring after 9 days with maximum serologic indices achieved by 20–39 days. All monoclonal antibody treatments suppressed the endogenous anti-spike IgM response by 85–90% with minor effect on the anti-nucleocapsid response. Thus, passive immunization therapy may cause immunologic interference. •Acute stage SARS-CoV-2 infection can be confirmed by combined laboratory testing modalities•Anti-SARS-CoV-2 monoclonal antibodies administered in the acute stage suppresses the endogenous anti-viral primary IgM humoral response•While clinically beneficial, anti-SARS-CoV-2 monoclonal antibody therapy should be followed with vaccination after antibody clearance