Monoclonal antibodies for COVID-19 are authorized for children as young as 12 years old. Do you have any concerns or suggestions that are specific to this age group?

Since children in general are at much lower risk for severe COVID-19, there are fewer kids overall who are at high enough risk of severe disease to justify using monoclonal antibodies. Those children who meet these limited criteria should receive antibody therapy as soon as possible after diagnosis, and I would not hesitate merely because of the age. This is the only means we have to prevent a patient from needing hospitalization. The treatment is generally well tolerated, and I am not aware of any known side effects that would be specific to pediatric patients, as opposed to patients of other ages.

Are there any absolute contraindications to use of monoclonal antibodies in particular types of patients with COVID-19?

The only absolute contraindication is hypersensitivity, which would imply that someone has received the antibody therapy before. That is a very rare situation.

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Can a person who has received antibody treatment get vaccinated against COVID-19?

According to the CDC,6 there are currently no data on the safety or efficacy of COVID-19 vaccines in people who have been treated with monoclonal antibodies. However, given evidence suggesting that reinfection is uncommon during the 90 days following an initial infection, the CDC recommends that vaccination should be deferred for at least 90 days following antibody treatment. The CDC regards this as a “precautionary measure” to avoid potential interference of the antibody therapy with vaccine-induced immune responses.

Do you think monoclonal antibody therapy is sufficiently prescribed for patients with COVID-19?

In my experience, antibody therapy for COVID-19 is underprescribed. One reason is lack of knowledge about this type of treatment approach. Hopefully that is changing as guidelines such as that of the IDSA recommend it, and as it becomes increasingly established.

Another reason for this underprescription is lack of awareness on the part of some practitioners about where to refer patients. Prescribers should be aware that the US Department of Health and Human Services offers a Web tool specifically dedicated to locating facilities that provide COVID-19 antibody treatment. The National Infusion Center Association similarly offers an infusion locator tool.

Encouragingly, availability of antibody treatment is expanding. At the end of March, the Biden administration pledged $150 million to expand access to antibody treatments, especially in underserved areas.7 This should go a long way toward making antibody treatment available in areas where it was not previously.

Is monoclonal antibody therapy costly for the patient?

Many clinicians are not aware that patients can receive antibody therapy at no cost to them. Medicare and Medicaid cover the treatment, as do most other insurance companies, under the FDA’s EUA.