Monoclonal Antibody Treatment for Children with COVID-19

Antibodies are made by the body’s immune system to help fight infections. An antigen is a substance your body doesn’t recognize, like the spike proteins on the virus that causes COVID-19. Antigens are what trigger your immune system to make antibodies to fight the infection.

Unlike other antibody products, such as intravenous immunoglobulin (IVIG) and convalescent plasma, that have many different antibodies targeting a wide variety of antigens, monoclonal antibodies specifically target one type of antigen. These specific antibodies can be copied thousands of times in the lab to help treat a specific infection, like the virus that causes COVID-19. These copied antibodies can be made into a drug to help your immune system fight the new coronavirus.

Monoclonal antibodies target an antigen on the COVID-19 virus, called the spike protein, that helps the virus infect human cells. By attaching to these spike protein antigens on the COVID-19 virus, these monoclonal antibodies can block the virus from entering and infecting healthy cells.

Scientific studies have shown that adult COVID-19 patients treated with monoclonal antibodies were significantly less likely to get very sick and/or need to be hospitalized compared to patients who did not receive the treatment. We are still learning about the effectiveness of this treatment in children; however, data demonstrate that the treatment is safe in eligible children.

At Children’s Colorado, your child will receive their treatment in a child-friendly environment with pediatric experts. COVID-19 monoclonal antibody treatments take place in our Infusion Center at our hospital on Anschutz Medical Campus.

Please note: When we confirm your appointment, we will also provide details for parking and check-in. When you arrive, you will need to call the Infusion Center from your car. A team member will then escort you to your appointment. The patient should be accompanied by one parent or legal guardian. Please review our visitation policies before your appointment.

Sotrovimab is given as a one-time intravenous (IV) infusion that takes approximately 30 to 60 minutes. Bebtelovimab is given as a one-time IV injection over 30 seconds. These infusions can only be given at designated hospitals and infusion centers.

Patients are required to stay in the Infusion Center for 1 hour of observation following the infusion.

The first several studies in adults suggest that these medications seem to be well-tolerated and safe. The most reported side effects included nausea (upset stomach), diarrhea (loose poop) and lightheadedness (dizziness). However, there are also extremely rare serious adverse reactions to monoclonal antibodies.

Patients receiving these medications must be carefully watched for infusion-related reactions such as low blood pressure, chills, fever, headache and vomiting. Occasionally, these infusions can cause an allergic reaction, and even anaphylaxis, that may require treatment. These reactions typically happen right after infusion. Patients must be closely monitored by trained staff for at least an hour after getting these medications.

If there are any concerns following the infusion, you should contact your child’s primary care provider or specialty team. While Children’s Colorado can provide the infusion, we rely on referring providers to guide any follow-up care. This is another reason why we strongly recommend working with your child’s healthcare team to determine if your child is a good candidate for this treatment and to make the referral.

Currently, the federal government is responsible for distributing these medications to hospitals and covers the cost of the actual drug. Additional costs associated with giving these medications (such as facility fees, nursing costs, etc.) may be sent to your insurance provider; however, there will be no direct cost to you if your child receives this treatment at Children’s Colorado.

Due to widespread transmission of the Omicron variant and subvariant BA.2 locally and nationally, bamlanivimab/etesevimab, casirivimab/imdevimab and sotrovimab are not currently recommended for treatment or post-exposure prophylaxis.

Not currently. Though the U.S. Food and Drug Administration (FDA) has not fully approved monoclonal antibodies for COVID-19, the FDA has authorized the following drugs for emergency use in certain patients who have mild or moderate COVID-19:

• Sotrovimab
• Bebtelovimab
• Bamlanivimab/etesevimab (no longer recommended due to spread of omicron)
• Casirivimab/imdevimab (no longer recommended due to spread of omicron)

Emergency use authorization allows doctors to give an investigational drug that may be effective in treating COVID-19 when no other alternatives exist.

Monoclonal antibody therapy is only available at designated sites. Unfortunately, most of the sites are not able to offer therapy to children. The Colorado Department of Public Health and Environment (CDPHE) website has a map of the designated sites and a phone number to call to help connect you to an appropriate infusion center. To request to be evaluated for this treatment at Children’s Colorado, please submit the mAb intake form.

Patients can receive a COVID-19 vaccine as soon as they recover and are no longer contagious. Please contact your primary care provider prior to scheduling a vaccine appointment to make sure the patient is no longer considered contagious and able to go to the clinic.

There is no need to delay other vaccines after getting COVID-19 monoclonal antibodies.

Yes, if they get COVID-19 and meet the EUA criteria for monoclonal antibody treatment, they can receive treatment regardless of vaccination status. Generally, patients who have received at least 2 doses of the COVID-19 vaccine, are at much lower risk for hospitalization than unvaccinated patients.

No, repeating the dose of vaccine is not recommended and this dose should be considered valid.

CDPHE lists additional locations for monoclonal antibody treatment on their website.

You can also find a map of locations that have received monoclonal antibody therapeutics through the U.S. Department of Health and Human Services (HHS) website.

HHS has videos, information on clinical trials and more on their web page, Monoclonal Antibodies for High-risk COVID-19 Positive Patients, through their Combat COVID program.

Please review the details for referring pediatric patients for COVID-19 monoclonal antibody therapy.