Monoclonal antibodies for the treatment of COVID-19 infection in children

ABSTRACT

Introduction

Monoclonal antibodies (mAbs) have been authorized for the treatment of COVID-19 in pediatric populations, however, there is a lack of evidence for their use in these populations.

Areas covered

We outline the evidence of mAbs for COVID-19, discuss their use in the treatment of COVID-19 infection for pediatric patients, and consider alternative treatment options and challenges to COVID-19 drug approvals.

Expert opinion

Limited evidence exists for the safety and efficacy of mAbs to treat COVID-19 in children as new variants emerge. In rare pediatric outpatient settings, such as profound immunodeficiency or severe pulmonary disease, the benefits of antiviral treatment for COVID-19 likely outweigh the relatively small risks. However, for the great majority of pediatric patients, mAb treatment is likely not indicated. Small molecule antiviral therapies are another potential treatment for COVID-19 in children in an outpatient setting, though neither mAb nor small molecule antiviral treatments have significant supporting evidence in children and developing a strong evidence base for these decisions will be challenging if not impractical. Ultimately, these decisions are likely to be made at the level of individual cases using expert opinion as the primary guiding principle.

KEYWORDS:

• Antiviral
• bebtelovimab
• children
• COVID-19
• mAbs
• monoclonal antibodies
• pediatric patients
• pediatric treatment
• SARS-COV-2

Article highlights

• Anti-SARS-CoV-2 monoclonal antibodies (mAbs) have emerged as a potential treatment option to prevent hospitalization and death related to COVID-19.

• Limited evidence exists for the use of monoclonal antibodies to treat COVID-19 in pediatric populations.

• Small molecule antivirals and mAbs both show strong efficacy against COVID-19, but with different benefits and limitations.

• In patients with severely compromised immune systems or severe pulmonary disease, the benefits of mAb treatment for COVID-19 likely outweigh the relatively small risks. However, for the great majority of pediatric patients, mAb treatment is likely not indicated.

• Numerous obstacles have influenced the approval of mAb treatment for COVID-19, thus developing a strong evidence base for use of antivirals in children will be challenging if not impractical.

Acknowledgments

K Ling and M Dougan would like to thank Keri Sullivan for the thoughtful insights and revision of the manuscript.

Declaration of interest

M Dougan has research funding from Eli Lilly; he has received consulting fees from Tillotts Pharma, ORIC Pharmaceuticals, Partner Therapeutics, SQZ Biotech, AzurRx, Eli Lilly, Mallinckrodt Pharmaceuticals, Aditum, and Moderna; he is a member of the Scientific Advisory Board for Neoleukin Therapeutics. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.