Effect of Neutralizing Monoclonal Antibody Treatment on Early Trajectories of Virologic and Immunologic Biomarkers in Patients Hospitalized With COVID-19

J Infect Dis. 2024 Mar 14;229(3):671-679. doi: 10.1093/infdis/jiad446.

Abstract

Background: Neutralizing monoclonal antibodies (nmAbs) failed to show clear benefit for hospitalized patients with coronavirus disease 2019 (COVID-19). Dynamics of virologic and immunologic biomarkers remain poorly understood.

Methods: Participants enrolled in the Therapeutics for Inpatients with COVID-19 trials were randomized to nmAb versus placebo. Longitudinal differences between treatment and placebo groups in levels of plasma nucleocapsid antigen (N-Ag), anti-nucleocapsid antibody, C-reactive protein, interleukin-6, and D-dimer at enrollment, day 1, 3, and 5 were estimated using linear mixed models. A 7-point pulmonary ordinal scale assessed at day 5 was compared using proportional odds models.

Results: Analysis included 2149 participants enrolled between August 2020 and September 2021. Treatment resulted in 20% lower levels of plasma N-Ag compared with placebo (95% confidence interval, 12%-27%; P < .001), and a steeper rate of decline through the first 5 days (P < .001). The treatment difference did not vary between subgroups, and no difference was observed in trajectories of other biomarkers or the day 5 pulmonary ordinal scale.

Conclusions: Our study suggests that nmAb has an antiviral effect assessed by plasma N-Ag among hospitalized patients with COVID-19, with no blunting of the endogenous anti-nucleocapsid antibody response. No effect on systemic inflammation or day 5 clinical status was observed.

Clinical trials registration: NCT04501978.

Keywords: COVID-19; anti-nucleocapsid antibody; inflammatory biomarkers; neutralizing monoclonal antibody; plasma nucleocapsid antigen.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Neutralizing
  • Biomarkers
  • COVID-19*
  • Humans
  • SARS-CoV-2

Substances

  • Antibodies, Neutralizing
  • Antibodies, Monoclonal
  • Biomarkers

Associated data

  • ClinicalTrials.gov/NCT04501978