Monoclonal antibodies for prophylaxis and treatment of respiratory viral infections

Purpose of review Monoclonal antibody (mAb) administration represents an important strategy for preventing and treating respiratory viral infections in vulnerable populations, including immunocompromised individuals. The purpose of this review is to provide an overview of mAbs in clinical use against respiratory viruses, highlight factors that modulate mAb clinical efficacy, and provide a perspective on future innovations in the field. This review focuses on publications from the last year. Recent findings Historically, clinical development of a single mAb has taken over a decade. The COVID-19 pandemic has demonstrated that this timeframe can be reduced to less than a year and has catalyzed rapid innovations in the field. Several novel mAbs against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have received emergency use authorization by the Food and Drug Administration (FDA) for the early treatment of mild to moderate COVID-19. However, the majority of these mAbs have ultimately failed due to the emergence of variants, highlighting an important lesson about predicting and countering resistance. Novel mAbs are also in clinical use or in late-stage development for the prevention of infection by SARS-CoV-2 and respiratory syncytial virus (RSV) in vulnerable populations. Several factors can be modulated to improve the clinical efficacy of mAbs. For example, Fc modifications can extend mAb half-life and increase respiratory tract bioavailability, both of which are attractive properties for achieving protection against respiratory viruses. The mAb landscape is rapidly evolving with numerous examples of success and failure. The armamentarium of clinically-available mAbs to protect vulnerable populations is expected to undergo continued growth.

Automated summary

Monoclonal antibody administration is an important strategy for preventing and treating respiratory viral infections in vulnerable populations. Recent innovations have led to the development of novel mAbs against viruses like SARS-CoV-2, although the emergence of variants poses challenges. Clinical efficacy of mAbs can be improved by modulating factors such as Fc modifications to increase bioavailability and half-life. The landscape of mAbs for respiratory viruses is evolving rapidly with both successes and failures, but the armamentarium of available mAbs is expected to continue growing.