Skip to main content
U.S. flag

An official website of the United States government

Dot gov

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Https

Secure .gov websites use HTTPS
A lock () or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

This page is being revised. For updated information, please see the Panel’s statements on using available therapies in high-risk outpatients and on prioritizing patients for outpatient therapies.

Anti-SARS-CoV-2 Antibody Products

Last Updated: December 16, 2021

Summary Recommendations
Summary Recommendations

Anti-SARS-CoV-2 Monoclonal Antibodies for the Treatment of COVID-19

  • The COVID-19 Treatment Guidelines Panel (the Panel) recommends using 1 of the following anti-SARS-CoV-2 monoclonal antibody (mAb) products (listed alphabetically) to treat nonhospitalized patients with mild to moderate COVID-19 who are at high risk of clinical progression, as defined by criteria in the Food and Drug Administration (FDA) Emergency Use Authorizations (EUAs) for the products:
    • Bamlanivimab 700 mg plus etesevimab 1,400 mg administered as an intravenous (IV) infusion; or
    • Casirivimab 600 mg plus imdevimab 600 mg administered as an IV infusion or as subcutaneous (SQ) injections; or
    • Sotrovimab 500 mg administered as an IV infusion.
  • When using casirivimab plus imdevimab, the Panel recommends:
    • Casirivimab 600 mg plus imdevimab 600 mg administered as an IV infusion (AIIa).
    • If an IV infusion is not feasible or would cause a delay in treatment, casirivimab 600 mg plus imdevimab 600 mg can be administered as 4 SQ injections (2.5 mL per injection) (BIII).
  • The strength of the evidence for using anti-SARS-CoV-2 mAbs varies depending on the medical conditions and other factors that place patients at risk for progression to severe COVID-19 and/or hospitalization (see Anti-SARS-CoV-2 Monoclonal Antibodies). The ratings for the Panel’s recommendations for using anti-SARS-CoV-2 mAbs as treatment are based on the FDA EUA criteria for:
    • High-risk conditions represented in clinical trials (AIIa); and
    • Other medical conditions and factors with limited representation in clinical trials (BIII) except for immunocompromising conditions or receipt of immunosuppressive therapy, for which the rating is AIII.
  • When using anti-SARS-CoV-2 mAbs, treatment should be started as soon as possible after the patient receives a positive result on a SARS-CoV-2 antigen test or nucleic acid amplification test (NAAT) and within 10 days of symptom onset.
  • The use of anti-SARS-CoV-2 mAbs should be considered for patients with mild to moderate COVID-19 who are hospitalized for a reason other than COVID-19 if they otherwise meet EUA criteria for outpatient treatment.
  • Anti-SARS-CoV-2 mAbs are not currently authorized for use in patients who are hospitalized with severe COVID-19; however, they may be available through expanded access programs for patients who either have not developed an antibody response or are not expected to mount an effective immune response to SARS-CoV-2 infection.

Anti-SARS-CoV-2 Monoclonal Antibodies as Post-Exposure Prophylaxis for SARS-CoV-2 Infection

  • The Panel recommends using 1 of the following anti-SARS-CoV-2 mAb combinations as post-exposure prophylaxis (PEP) for people who are at high risk of progressing to severe COVID-19 if infected with SARS-CoV-2 AND who have the vaccination status AND exposure history outlined in the Prevention of SARS-CoV-2 Infection section:
    • Bamlanivimab 700 mg plus etesevimab 1,400 mg administered as an IV infusion; or
    • Casirivimab 600 mg plus imdevimab 600 mg administered as SQ injections (AI) or as an IV infusion (BIII).

COVID-19 Convalescent Plasma

  • The Panel recommends against the use of COVID-19 convalescent plasma for the treatment of COVID-19 in hospitalized patients without impaired humoral immunity (AI).
  • There is insufficient evidence for the Panel to recommend either for or against the use of COVID-19 convalescent plasma for the treatment of COVID-19 in:
    • Nonhospitalized patients without impaired humoral immunity; and
    • Hospitalized or nonhospitalized patients with impaired humoral immunity.

Anti-SARS-CoV-2 Specific Immunoglobulins

  • There is insufficient evidence for the Panel to recommend either for or against the use of anti-SARS-CoV-2 specific immunoglobulins for the treatment of COVID-19.
Rating of Recommendations: A = Strong; B = Moderate; C = Optional
Rating of Evidence: I = One or more randomized trials without major limitations; IIa = Other randomized trials or subgroup analyses of randomized trials; IIb = Nonrandomized trials or observational cohort studies; III = Expert opinion