The emergence of SARS-CoV-2 and subsequent
COVID-19 pandemic has resulted in a significant global public health burden, leading to an urgent need for effective therapeutic strategies. In this article, we review the role of SARS-CoV-2
neutralizing antibodies (nAbs) in the clinical management of
COVID-19 and provide an overview of recent randomized controlled trial data evaluating nAbs in the ambulatory, hospitalized and prophylaxis settings. Two nAb cocktails (
casirivimab/imdevimab and
bamlanivimab/etesevimab) and one nAb monotherapy (
bamlanivimab) have been granted Emergency Use Authorization by the US Food and Drug Administration for the treatment of ambulatory patients who have a high risk of progressing to severe disease, and the European Medicines Agency has similarly recommended both cocktails and
bamlanivimab monotherapy for use in
COVID-19 patients who do not require supplemental
oxygen and who are at high risk of progressing to severe
COVID-19. Efficacy of nAbs in hospitalized patients with
COVID-19 has been varied, potentially highlighting the challenges of
antiviral treatment in patients who have already progressed to severe disease. However, early data suggest a promising prophylactic role for nAbs in providing effective
COVID-19 protection. We also review the risk of treatment-emergent
antiviral resistant "escape" mutants and strategies to minimize their occurrence, discuss the susceptibility of newly emerging SARS-COV-2 variants to nAbs, as well as explore administration challenges and ways to improve patient access.