Monoclonal antibody levels and protection from COVID-19

Eva Stadler; Martin T Burgess; Timothy E Schlub; Shanchita R Khan; Khai Li Chai; Zoe K McQuilten; Erica M Wood; Mark N Polizzotto; Stephen J Kent; Deborah Cromer; Miles P Davenport; David S Khoury

doi:10.1038/s41467-023-40204-1

Monoclonal antibody levels and protection from COVID-19

Nat Commun. 2023 Jul 28;14(1):4545. doi: 10.1038/s41467-023-40204-1.

Authors

Eva Stadler¹, Martin T Burgess², Timothy E Schlub³, Shanchita R Khan¹, Khai Li Chai⁴, Zoe K McQuilten^{4

5}, Erica M Wood^{4

5}, Mark N Polizzotto^{6

7}, Stephen J Kent^{8

9}, Deborah Cromer¹, Miles P Davenport¹⁰, David S Khoury¹¹

Affiliations

¹ Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
² School of Mathematics and Statistics, University of New South Wales, Sydney, NSW, Australia.
³ Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
⁴ Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
⁵ Department of Clinical Haematology, Monash Health, Clayton, VIC, Australia.
⁶ Clinical Hub for Interventional Research, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia.
⁷ Department of Clinical Haematology, Canberra Region Cancer Centre, The Canberra Hospital, Canberra, ACT, Australia.
⁸ Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
⁹ Melbourne Sexual Health Centre and Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia.
¹⁰ Kirby Institute, University of New South Wales, Sydney, NSW, Australia. m.davenport@unsw.edu.au.
¹¹ Kirby Institute, University of New South Wales, Sydney, NSW, Australia. dkhoury@kirby.unsw.edu.au.

Abstract

Multiple monoclonal antibodies have been shown to be effective for both prophylaxis and therapy for SARS-CoV-2 infection. Here we aggregate data from randomized controlled trials assessing the use of monoclonal antibodies (mAb) in preventing symptomatic SARS-CoV-2 infection. We use data on the in vivo concentration of mAb and the associated protection from COVID-19 over time to model the dose-response relationship of mAb for prophylaxis. We estimate that 50% protection from COVID-19 is achieved with a mAb concentration of 96-fold of the in vitro IC50 (95% CI: 32-285). This relationship provides a tool for predicting the prophylactic efficacy of new mAb and against SARS-CoV-2 variants. Finally, we compare the relationship between neutralization titer and protection from COVID-19 after either mAb treatment or vaccination. We find no significant difference between the 50% protective titer for mAb and vaccination, although sample sizes limited the power to detect a difference.

Publication types

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

MeSH terms

Antibodies, Monoclonal / therapeutic use
Antibodies, Neutralizing
Antibodies, Viral
COVID-19* / prevention & control
Humans
SARS-CoV-2
Sample Size

Substances

Antibodies, Monoclonal
Antibodies, Viral
Antibodies, Neutralizing

Supplementary concepts

SARS-CoV-2 variants