Monoclonal Antibody Treatment, Prophylaxis and Vaccines Combined to Reduce SARS CoV-2 Spread
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Abstract
Background
Antiviral monoclonal antibodies (mAbs) developed for treatment of COVID-19 reduce the magnitude and duration of viral shedding and can thus potentially contribute to reducing transmission of the causative virus, severe acute respiratory coronavirus 2 (SARS-CoV-2). However, use of these mAbs in combination with a vaccine program has not been considered in public health strategic planning.
Methods
We developed an agent-based model to characterize SARS-CoV-2 transmission in the US population during an aggressive phase of the pandemic (October 2020 to April 2021), and simulated the effects on infections and mortality of combining mAbs as treatment and post-exposure prophylaxis (PEP) with a vaccine program plus non-pharmaceutical interventions. We also interrogated the impact of rapid diagnostic testing, increased mAb supply, and vaccine rollout.
Findings
Allocation of mAbs as PEP or targeting those ≥65 years provided the greatest incremental benefits relative to vaccine in averting infections and deaths, by up to 17% and 41%, respectively. Rapid testing, facilitating earlier diagnosis and mAb use, amplified these benefits. The model was sensitive to mAb supply; doubling supply further reduced infections and mortality, by up to two-fold, relative to vaccine. mAbs continued to provide incremental benefits even as proportion of the vaccinated population increased.
Interpretation
Use of anti-viral mAbs as treatment and PEP in combination with a vaccination program would substantially reduce SARS-CoV-2 transmission and pandemic burden. These results may help guide resource allocation and patient management decisions for COVID-19 and can also be used to inform public health policy for current and future pandemic preparedness.
Funding
Regeneron Pharmaceuticals.
Article activity feed
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SciScore for 10.1101/2021.05.21.21257624: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Study limitations include that these simulations reflect a specific time period of the US epidemic and that seasonal effects were not specifically considered. Another limitation is our assumption around vaccine effectiveness after the first dose, despite some recent studies suggesting that it may be higher.30,31 While our assumption was …
SciScore for 10.1101/2021.05.21.21257624: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Study limitations include that these simulations reflect a specific time period of the US epidemic and that seasonal effects were not specifically considered. Another limitation is our assumption around vaccine effectiveness after the first dose, despite some recent studies suggesting that it may be higher.30,31 While our assumption was based on data available at the time the model was developed, the sensitivity analysis on increased vaccine rollout provides additional evidence of both vaccine efficacy and the incremental benefits that may still be achieved with mAbs. In addition, our model assumed uniform mAb distribution throughout the simulation period, and we did not consider the potential for added benefit using a surge distribution paradigm temporally coinciding with a phase in which the rate of mortality is increasing (e.g., late October 2020 through January 2021; figure 2). We also did not consider potential VOC when simulating the impact of mitigation strategies on the pandemic. As mutated viruses are indicative of a form of rapid, multistage evolutionary jumps (saltational evolution), this is an important component that may need to be characterized in future model iterations as data become available. The modular nature of the ABM makes it amenable to the potential occurrence of saltational evolution in this and future pandemics, for example by inclusion of a “viral resistance module”. In conclusion, we present the results of an ABM, demonstrating how anti-viral mAbs...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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