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Fauci on 'Highly Specific, Direct' Therapy for COVID-19

— Can monoclonal antibodies duplicate the success with Ebola in COVID-19?

MedpageToday
Dr. Anthony Fauci during a video conference from the National Institutes of Health

Monoclonal antibodies could hold promise in COVID-19 treatment and prevention if the results bear out in clinical trials for efficacy, the nation's leading infectious diseases expert told 51˶.

"There's a lot of activity and it's a highly concentrated, highly specific, direct antiviral approach to a number of diseases. The success in Ebola was very encouraging," said National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony Fauci, MD.

Most recently thrust into the spotlight as effective treatments for Ebola, monoclonal antibodies are currently being researched as a potential treatment for HIV, as well as COVID-19. This month, the NIH being conducted among several different COVID-19 patient populations: outpatients with COVID-19, patients hospitalized with the disease, and even a trial in household contacts of confirmed cases, where the therapy was used as prophylaxis.

Fauci explained how the mechanism of monoclonal antibodies "is really one of a direct antiviral."

"It's like getting a neutralizing antibody that's highly, highly concentrated and highly, highly specific. So, the mechanism involved is blocking of the virus from essentially entering its target cell in the body and essentially interrupting the course of infection," he said.

While Fauci noted the success of monoclonal antibodies to treat Ebola, he added that they are not practical for other viruses that only last a day or two, where the virus may already be cleared once the patient receives the treatment.

"If you have a disease that's serious enough and prolonged enough, such as what we saw with Ebola, and what we are currently seeing with COVID-19, then you have enough opportunities to get the monoclonal antibody to actually work," he added.

Monoclonal antibodies are currently being administered intravenously, though Fauci said if the treatment works, "you try to get it to a form where you can give it subcutaneously or intramuscularly," a much more convenient way of administering the therapy.

He also explained the difference between monoclonal antibodies and convalescent plasma, describing them as "extremely pure," due to their homogeneous nature. Therefore the recent published side effects seen in trials of convalescent plasma in COVID-19 patients may not apply.

"The difference between monoclonal antibodies and convalescent plasma is plasma has a lot of other things in it, which could lead to allergic and other reactions," Fauci said. "Theoretically, there are more complex factors in plasma than there are with a monoclonal antibody."

Ultimately, when asked if one of his patients asked him about monoclonal antibodies, Fauci said he would say they are a "promising form of therapy."

"Many of them are still in clinical trials and not available for routine use, but the data that has accumulated recently indicates they are a very promising form of prevention and treatment," he noted.

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    Molly Walker is deputy managing editor and covers infectious diseases for 51˶. She is a 2020 J2 Achievement Award winner for her COVID-19 coverage.