Long-term anti-SARS-CoV-2 antibody trajectories after neutralizing monoclonal antibody treatment

PMCID: PMC12176123

PMID: 40531973

DOI: 10.1371/journal.pone.0325561

Journal: PloS one

Publication Date: 2025-6-18

Authors: Munroe ES, Grandits GA, Hyzy RC, Prescott HC, Barrett TW, et al.

Key Points

• nMAb treatment did not compromise the body's natural immune response in hospitalized COVID-19 patients
• Sustained anti-spike neutralization activity was 7.1-7.2% higher in treatment groups at 28 and 90 days (p<0.001)
• Neutralizing antibody therapies can be administered without concern about long-term immune system suppression

Summary

This pooled analysis of the ACTIV-3/TICO trials investigated the impact of neutralizing monoclonal antibodies (nMAbs) on the immune response in hospitalized COVID-19 patients. The study examined whether nMAb treatment could potentially suppress the endogenous humoral immune response by comparing anti-spike and anti-nucleocapsid antibody levels across multiple nMAb treatments and placebo groups.

The research analyzed 2,254 participants across four neutralizing monoclonal antibody trials, tracking antibody responses at baseline, day 1, day 3, day 5, day 28, and day 90. Critically, the study found that nMAb treatment did not decrease long-term anti-nucleocapsid response compared to placebo. Anti-spike neutralization activity remained significantly higher in the treatment groups at both day 28 (mean difference 7.1%, p<0.001) and day 90 (mean difference 7.2%, p<0.001), suggesting that neutralizing therapies do not suppress the endogenous humoral immune response in hospitalized COVID-19 patients.