The Emergence of Escape Mutations in COVID-19 Following Anti-Spike Monoclonal Antibody Treatment: How Do We Tackle It?

Treatment-emergent resistance to anti-Spike monoclonal antibody (mAb) was a largely unexpected and dramatic finding along the COVID-19 pandemic. Emergence of resistant strains was particularly common in immunocompromised patients, who often harbored very high SARS-CoV-2 loads when treated with mAb monotherapies. Concerns were raised regarding the risk for some of those resistant variants to propagate in communities. In this review, we will summarize the experience thus far and suggest recommendations to prevent and manage mAb treatment-emergent resistance such as comboing and reliance over polyclonal immunoglobulins.