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COVID-19 Therapeutics

The spectrum of medical therapies to treat COVID-19 is rapidly evolving. Currently, Bamlanivimab/Etesevimab, Casirivimab/imdevimab, Sotrovimab, and Tixagevimab/Cilgavimab are therapeutic products available for Iowans that have received Emergency Use Authorizations (EUAs) from the Food and Drug Administration (FDA). These therapeutics are for the treatment of mild to moderate COVID-19 in nonhospitalized patients with laboratory-confirmed SARS-CoV-2 infection who are at high risk for progressing to severe disease and/or hospitalization. These medications are used at different times, including for the prevention and treatment of illness due to COVID-19.

Monoclonal Antibodies (mAbs)

Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight off harmful antigens. Three products have been granted Emergency Use Authorization by the Food and Drug Administration.

  • Bamlanivimab/Etesevimab - these are neutralizing mAbs that bind to different, but overlapping, epitopes in the spike protein of SARS-CoV-2. This is administered as an intravenous (IV) infusion and has a weight-based dosing.
  • Casirivimab/imdevimab - these are recombinant human mAbs that bind to non-overlapping epitopes of the spike protein RBD of SARS-CoV-2. This is administered as an IV infusion or as a subcutaneous injection.
  • Sotrovimab - these target an epitope in the RBD of the spike protein that is conserved between SARS-CoV and SARS-CoV-2. This is administered as an IV infusion.

Please note that the Omicron variant, with its numerous mutations in the spike protein, is not neutralized by Bamlanivimab/Eteseveimab or Casirivimab/imdevimab, the most frequently prescribed monoclonal antibody-based COVID-19 treatments. Despite some reduction in neutralization concentrations, Sotrovimab remains effective against all variants of concern, including Omicron. However, Sotrovimab is currently in limited supply, and its use should be prioritized for nonhospitalized patients with risk factors for progression to severe COVID-19, including individuals who are unvaccinated, have not received all vaccines and booster shots as recommended by CDC, individuals with clinical risk factors, older age (for example 65 years of age), and individuals not expected to mount an adquate immune response.

Oral Antivirals

Oral antiviral drugs are prescription medicines that fight against the COVID-19 virus in the body. Antiviral drugs are not sold over the counter, and can only be received from a licensed healthcare provider. Antiviral drugs are different from antibiotics, which fight against bacterial infections. Two products have been granted EUAs by the FDA.

  • Molnupiravir (Merck) - these are activated through metabolization in the body and disrupts the virus's reproduction. This is administered orally via a pill.
  • Paxlovid (Pfizer) - these work inside the cell inhibiting an enzyme that the virus makes to replicate itself. This is administered orally as a pill.

Pre-exposure Prophylaxis (PrEP)

Pre-exposure Prophylaxis (PrEP) is authorized for those individuals who are not currently infected with the SARS-CoV-2 virus and who have not been exposed to an individual infected with SARS-CoV-2. The authroization also requires individuals either  have: 

  • moderate to severely compromised immune systems due to a medical condition or due to taking immunosuppressive medications or treatments and may not mount an adequate immune response to COVID-19 vaccination (examples of such medical conditions or treatments can be found in the fact sheet for healthcare providers) or;
  • a history of severe adverse reactions to a COVID-19 vaccine and/or component(s) of those vaccines, therefore vaccination with an available COVID-19 vaccine, according to the approved or authorized schedule, is not recommended.

There is one product that has been granted Emergency Use Authorization by the FDA.

  • Tixagevimab/Cilgavimab (EVUSHELD) - these work by supplying antibodies to resist breakdown in cells. This is administered as an intramuscular injection.

Click the Chart below to access links to the EUAs and Fact Sheets

Questions

Contact the Combat COVID Monoclonal Antibodies Call Center at 877-332-6585