As the COVID-19 pandemic stretches into the fall and booster vaccine shots have been approved for some individuals, monoclonal antibodies (MA), a year-old COVID treatment, is making headlines.
MA treatment has gained popularity among vaccine-resistant Americans, despite the treatment not being approved beyond emergency use. It’s been championed by conservative radio hosts, podcaster Joe Rogan, and Florida Gov. Ron DeSantis. The treatment has also been used by former President Donald Trump, Texas Gov. Gregg Abbott, and former New Jersey Gov. Chris Christie. The Biden administration has also encouraged its use in states where vaccinations have been held up and cases are rising.
But the treatment, which takes hours to administer and can cost the government thousands of dollars a dose, is confusing some health officials, because while the treatment can shorten COVID symptoms, it does not prevent and reduce symptoms like the COVID vaccine.
The Times spoke with Barbara Rush, a nurse practitioner in Infusion at the Martha’s Vineyard Hospital, to learn about MA treatment.
What are antibodies?
Antibodies are proteins that stick to another specific protein called an antigen. An antibody seeks out an antigen. Antibodies are normally made by the human body. They are specifically part of our immune system designed to help keep us healthy. In a normal, healthy body, we’d get sick, our immune system would recognize that illness, and make an antibody that would seek out an antigen on the cell of the illness, attach to it. Another part of our immune system would see that attachment and kill the cell of the disease.
What are monoclonal antibodies (MA)?
MA are made in the lab. They’re created in a lab setting exposing a white blood cell to a particular viral protein, in this case the COVID virus. That white blood cell will make an antibody. Then in the lab, they clone that antibody and mass-produce them. Mono means singular, so we’re taking a single antibody, cloning it over and over again, and creating MA.
Are MA made at the hospital?
They are made in a lab off-Island, and arrive at the Martha’s Vineyard Hospital looking like many other medications. They are either powdered or a concentrated liquid that comes in a vial. Then the pharmacy at the hospital reconstitutes it into an infusion that can be given to a patient.
How many patients have received MA at the Martha’s Vineyard Hospital?
It’s only been a handful. We’ve given it less than 10 times so far.
Can someone receive MA if they have received a COVID vaccine?
Currently, yes. Whether you’re vaccinated or not does not come into the picture at all. It doesn’t matter whether you are or are not vaccinated.
Do MA cure COVID?
One important thing to know is MA is not a cure for COVID. They don’t cure the disease. What they do is reduce the patient’s risk for severe COVID by reducing the amount of viable or working COVID virus in the body.
How do you qualify to receive MA?
People you want to give MA to are at a high risk for developing severe COVID. High-risk eligibility has been determined by the Centers for Disease Control, so it’s people who have one of these risk factors: overweight, over 65 years of age, pregnant, diabetes, chronic kidney disease, immunosuppressed, high blood pressure, heart disease, lung disease, sickle cell disease, neurodevelopmental disorders, and those dependent on medical-related technology.
Should I get the vaccine or MA?
MA are not a replacement for vaccination at all. We have robust studies on vaccinations to the point that the Pfizer vaccine has already been FDA-approved. MA are still released only under emergency use, they are still considered experimental, we have really limited data on them. When I educate patients on MA, I say we have zero data on possible long-term adverse complications from receiving MA.
Are there studies on MA?
We have one very limited study on MA that we’re currently giving. It shows in an unvaccinated population, because the study was done on unvaccinated people, severe COVID occurred in 9 percent of people who didn’t receive MA, and only 3 percent of people who did. The only data we have is it reduces your risk of COVID by a small percentage. The vaccine can completely prevent COVID. We know from data on the vaccine that in a healthy individual with a competent immune system that gets the vaccine, they have better than a 90 percent chance of never getting COVID. Those who do get COVID, we call those breakthrough cases, the chance of it being severe is tiny. Vaccines are not only protecting you from getting a severe case of COVID, but they’re protecting you from even getting COVID.
How long does it take to administer MA?
MA is an IV infusion. It takes 30 to 60 minutes to infuse the drug, and the patient has to stay for an hour afterward, so we make sure they don’t have a severe reaction. We actually tell people to plan on the visit taking three to four hours. They have to get here, we have to assess them — MA can’t be given to patients with severe symptoms, because it’s risky for those patients. One thing we know about MA is after they get it, they get an inflammatory response from receiving it. So in patients with severe symptoms, it can make them worse, not better. We can only give it to people with mild or moderate symptoms. The pharmacy has to mix the drug, deliver it to us, and administer.
Who makes MA?
We are using a combination of two MA made by Regeneron. The two antibodies we are using are called Casirivimab and Imdevimab. They’re used together. We’re using those because currently that’s where the best data is. There’s not a lot of data on a lot of MA, but small studies that were done on each one of them, the results on this combination were the best. All of Mass General Brigham is using this combination, and truly it is what is being used nationwide.
How available are MA?
There is a shortage of it already because the COVID numbers, not in Massachusetts, but in so many states, are out of control right now. It’s being used extensively. There’s a shortage of MA, so MA are being distributed by the Department of Health and Human Services (DHHS). Previously we could buy MA directly from a company. Now DHHS is providing a set amount to each state.
I think the biggest thing for people to understand is, This is not a cure. It’s not like taking an antibiotic for a bacterial infection, and the antibiotic kills the bacteria, and you’re completely well after you finish your course of pills. All the MA can do is try to reduce the development of a severe case of COVID — which is also what the vaccine does, as well as prevent COVID altogether, the vaccine. It’s so much better to get the vaccine than the MA. We have robust data on vaccines, where the MA are only under emergency use authorization.