SARS-CoV-2 coronavirus: Pathogenesis, Pharmacotherapy and Treatment with Monoclonal Antibodies

ABSTRACT

The COVID-19 disease first appeared in 2019 and has spread widely. The SARS-CoV-2 virus that causes it is a member of the coronavirus family and is rapidly transmitted, primarily by droplets. In the disease, there is increased secretion of pro-inflammatory cytokines. There are several diagnostic methods, with RNA-qPCR-based detection being the most important and reliable. Vaccination is required to prevent the disease. COVID-19 Vaccines use viral vectors, the mRNA of the virus, certain subunits of the virus such as spike protein (S), and the inactivated virus itself. Some drugs that have been used for other diseases can be used for treatment, but one promising avenue is the use of monoclonal antibodies. Neutralizing monoclonal antibodies primarily target the SARS-CoV-2 spike protein (S). Most monoclonal antibodies have been identified to recognize the S1 fragment of SARS-CoV2. The receptor binding domain (RBD) in the S1 subunit is the most important target for SARS-CoV-2 because monoclonal antibodies can block the interaction of RBD and ACE2 of the receptor. If anti-SARSCoV-2 mAbs are used, treatment should be initiated as soon as possible after receiving a positive diagnostic result and within 10 days of symptom onset. Currently, three monoclonal antibody products are approved for COVID-19, namely bamlanivimab/etesevimab, casirivimab/imdevimab, and sotrovimab. Understanding their pharmacokinetics and pharmacodynamics is essential for selecting the right antibody, dose and treatment regimen for the target indication. In this context, this study provides a comprehensive overview of the pharmacology, pharmacokinetics and dosing regimens of monoclonal antibodies against SARS-CoV-2 virus.