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How do monoclonal antibodies work?

  • Casirivimab plus imdevimab: These are recombinant human mAbs that bind to nonoverlapping epitopes of the spike protein RBD of SARS-CoV-2.

The FDA has expanded the EUAs for bamlanivimab plus etesevimab and casirivimab plus imdevimab to authorize their use as post-exposure prophylaxis (PEP) for certain individuals who are at high risk of acquiring SARS-CoV-2 infection and, if infected, are at high risk of progressing to serious illness. See Prevention of SARS-CoV-2 Infection and the FDA EUA fact sheets for bamlanivimab plus etesevimab and casirivimab plus imdevimab for more information.

Who are they recommended for?

  • The FDA EUAs for the anti-SARS-CoV-2 mAbs include a list of specific conditions that place patients at high risk for clinical progression.

  • The strength of the evidence for using anti-SARS-CoV-2 mAbs varies depending on the medical conditions and other factors that place patients at high risk for progression to severe COVID-19 and/or hospitalization. 

  • Medical Conditions or Other Factors That Were Represented in Patients in Clinical Trials That Evaluated Anti-SARS-CoV-2 Monoclonal Antibodies

  • Aged ≥65 years 

  • Obesity (BMI >30) 

  • Diabetes 

  • Cardiovascular disease (including congenital heart disease) or hypertension 

  • Chronic lung diseases (e.g., chronic obstructive pulmonary disease, moderate-to-severe asthma, interstitial lung disease, cystic fibrosis, pulmonary hypertension)

  • Other Conditions or Factors That Had Limited Representation in Patients in Clinical Trials but Are Considered Risk Factors for Progression to Severe COVID-19 by the Centers for Disease Control and Prevention

  • An immunocompromising condition or immunosuppressive treatment. Many experts strongly recommend therapy for patients with these conditions, despite their limited representation in clinical trials.

  • Being overweight (BMI 25–30) as the sole risk factor 

  • Chronic kidney disease 

  • Pregnancy 

  • Sickle cell disease

  • Neurodevelopmental disorders (e.g., cerebral palsy) or other conditions that confer medical complexity (e.g., genetic or metabolic syndromes and severe congenital anomalies)

  • Medical-related technological dependence (e.g., tracheostomy, gastrostomy, or positive pressure ventilation that is not related to COVID-19)

What monitoring is needed?

What are the side effects?

  • The authorized anti-SARS-CoV-2 mAbs should be administered by IV infusion or SQ injections and should only be administered in health care settings by qualified health care providers who have immediate access to emergency medical services and medications that treat severe infusion-related reactions.

  • Patients should be monitored during the IV infusion or SQ injections and for at least 1 hour after the infusion or injections are completed.

  • Hypersensitivity, including anaphylaxis and infusion-related reactions, has been reported in patients who received anti-SARS-CoV-2 mAbs. Rash, diarrhea, nausea, dizziness, and pruritis have also been reported. Injection site reactions, including ecchymosis and erythema, were reported in clinical trial participants who received casirivimab plus imdevimab by SQ administration.

How can I schedule an appointment?

Call 414-269-2530 (9am-5pm, Mon-Fri) and consult with the pharmacist to consult and schedule an appointment.