Monoclonal Antibodies for COVID-19 Treatment: Is It an Option in Indonesia?

Abstract

More than three years after Coronavirus disease 2019 (COVID-19), an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-COV2), was declared pandemic by World Health Organization, report of COVID-19 hospitalization and death have been decreasing. Even though COVID-19 as global health emergency has been declared end, research in finding and evaluating modalities that can decrease severity and mortality from COVID-19 infection are still on going.Until now, there have been more than 380,000 publications in Pubmed with search term “COVID 19”. Excessive inflammatory activation is an important part of COVID-19 pathogenesis which can be caused by interactions of the virus with the host and modulation of host immune response.² Better understanding on COVID-19 pathogenesis could improve the strategies to manage COVID-19 infection.  Monoclonal antibody is one treatment modality that can be used to target the virus itself or modulate dysregulated immune response in COVID-19.  Monoclonal antibodies (mAbs) can halt progression of COVID-19 in high-risk patients. However, considering the limited production and high cost, is this treatment modality an option in Indonesia?

Many things have been learned from this pandemic and can be a lesson for preparing the next pandemic or other emerging diseases. Various therapeutic developments to treat COVID-19 have been studied for hospitalized patients and outpatient setting, one of which is the use of variety monoclonal antibodies that showed overall moderate efficacy in decreasing severity and mortality from COVID-19 infection and also good safety. Unfortunately, besides variable efficacy across variants, the cost for monoclonal antibodies (MAbs) are still high which make the access for this treatment options for managing COVID-19 might be limited in low to middle income countries. Feasibility and economical sustainability of mAbs against SARS-CoV-2 seem to be optimal in localized epidemics or small outbreaks.