Treating Kids with COVID Monoclonal Antibodies

While anti-SARS-CoV-2 monoclonal antibodies have an EUA for older, high risk children with COVID, they are not routinely recommended by most experts.

While you are likely used to hearing that there are no real cures or treatments for COVID, a few treatments do have emergency use authorization, including monoclonal antibody therapy.

“Monoclonal antibodies that target the spike protein have been shown to have a clinical benefit in treating SARS-CoV-2 infection. Preliminary data suggest that monoclonal antibodies may play a role in preventing SARS-CoV-2 infection in household contacts of infected patients and during skilled nursing and assisted living facility outbreaks.”

Anti-SARS-CoV-2 Monoclonal Antibodies

And they are available for use in kids who are at least 12 years old!

Treating Kids with COVID Monoclonal Antibodies

So why doesn’t everyone with COVID get treated with these monoclonal antibodies?

“Three anti-SARS-CoV-2 monoclonal antibody products currently have Emergency Use Authorizations (EUAs) from the Food and Drug Administration (FDA) 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.”

Anti-SARS-CoV-2 Monoclonal Antibodies

In general, they are mainly used in those older children (at least 12 years of age) and adults who are at high risk for severe disease.

“When using monoclonal antibodies, treatment should be started as soon as possible after the patient receives a positive result on a SARS-CoV-2 antigen or nucleic acid amplification test (NAAT) and within 10 days of symptom onset.”

Anti-SARS-CoV-2 Monoclonal Antibodies

Also, ideally, treatment with monoclonal antibodies should be started very early, but even more importantly, it involves an IV infusion. So it is not something that your pediatrician will likely be able to give your child in their office.

So where can you get these monoclonal antibodies?

“The federal government controls the distribution of monoclonal antibodies, and the regional infusion centers in Austin, El Paso, Fort Worth, San Antonio and The Woodlands have exhausted their supply of sotrovimab, the monoclonal antibody effective against the COVID-19 Omicron variant, due to the national shortage from the federal government. They will not be able to offer it until federal authorities ship additional courses of sotrovimab to Texas in January. People who had appointments scheduled this week will be contacted directly and advised. Other monoclonal antibodies have not shown to be effective against the Omicron variant, which now accounts for more than 90 percent of new cases. The infusion centers will continue to offer those antibodies as prescribed by health care providers for people diagnosed with a non-Omicron case of COVID-19.”

Statement on Monoclonal Antibody Availability

Monoclonal antibody therapeutic treatments have been distributed to hospitals and infusion centers around the country. You can hopefully find a treatment location nearby if you need to get your high risk child treated, keeping in mind that you likely want sotrovimab if you have COVID during the Omicron surge.

How do you know if your child is high risk?

People aged 12 or older may be considered at high risk for developing more serious symptoms—making them eligible for mAb treatment—depending on their health history and how long they’ve had symptoms of COVID-19.
People aged 12 or older may be considered at high risk for developing more serious symptoms—making them eligible for mAb treatment—depending on their health history and how long they’ve had symptoms of COVID-19.

Does your child who is at least 12 years old have chronic kidney disease, diabetes, heart problems, chronic lung disease, including moderate to severe asthma and cystic fibrosis, etc., sickle cell disease, a neurodevelopmental disorder, including cerebral palsy, or have a medical device (tracheostomy, gastrostomy, or positive pressure ventilation, etc.)? Are they immunosuppressed? Are they overweight, with a BMI above the 85th percentile for their age?

Talk to your pediatrician if you aren’t sure if your child is high risk and if you need help finding COVID monoclonal antibodies for your child.

“One dose of Evusheld, administered as two separate consecutive intramuscular injections (one injection per monoclonal antibody, given in immediate succession), may be effective for pre-exposure prevention for six months.”

Coronavirus (COVID-19) Update: FDA Authorizes New Long-Acting Monoclonal Antibodies for Pre-exposure Prevention of COVID-19 in Certain Individuals

Another monoclonal antibody, Evusheld (Tixagevimab Plus Cilgavimab) is available for pre-exposure prophylaxis of adults and children who are at least 12 years old with moderate to severely compromised immune systems due to a medical condition or due to taking immunosuppressive medications or treatments.

Treating Kids with COVID Monoclonal Antibodies?

You may also want to ask if getting your child treated with monoclonal antibodies is something you really should do…

“Currently, there is insufficient evidence for utility, safety, or efficacy to recommend the routine use of monoclonal antibody therapy for children and adolescents with COVID-19, even those considered to be at higher risk of hospitalization or severe disease. At this time, neither bamlanivimab nor casirivimab plus imdevimab should be considered standard of care in any pediatric population, even in patients who meet high-risk criteria. There are no data supporting safety and efficacy in children or adolescents, and the evidence supporting use in the adult population (including young adults) is modest and/or unpublished and has limited applicability to pediatrics or to many specified risk groups.”

Initial Guidance on Use of Monoclonal Antibody Therapy for Treatment of Coronavirus Disease 2019 in Children and Adolescents

And know, that while monoclonal antibody treatments do have EUA for older children, a panel of pediatric experts has recommended against their routine use.

So get your kids vaccinated and boosted now and don’t think you can rely on monoclonal antibodies if they get sick…

More on COVID Treatments

Last Updated on January 9, 2022 by Vincent Iannelli, MD

Author: Vincent Iannelli, MD

Vincent Iannelli, MD

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