Several neutralizing monoclonal antibodies (mAbs) to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been developed and are now under evaluation in clinical trials. With the US Food and Drug Administration recently granting emergency use authorizations for neutralizing mAbs in non-hospitalized patients with mild-to-moderate COVID-19, there is an urgent need to discuss the broader potential of these novel therapies and to develop strategies to deploy them effectively in clinical practice, given limited initial availability. Here, we review the precedent for passive immunization and lessons learned from using antibody therapies for viral infections such as respiratory syncytial virus, Ebola virus and SARS-CoV infections. We then focus on the deployment of convalescent plasma and neutralizing mAbs for treatment of SARS-CoV-2. We review specific clinical questions, including the rationale for stratification of patients, potential biomarkers, known risk factors and temporal considerations for optimal clinical use. To answer these questions, there is a need to understand factors such as the kinetics of viral load and its correlation with clinical outcomes, endogenous antibody responses, pharmacokinetic properties of neutralizing mAbs and the potential benefit of combining antibodies to defend against emerging viral variants.

几种针对严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 的中和单克隆抗体 (mAb) 已经开发出来，目前正在临床试验中进行评估。随着美国食品和药物管理局最近授予中和单克隆抗体紧急使用授权，用于治疗轻度至中度 COVID-19 的非住院患者，迫切需要讨论这些新疗法的更广泛潜力并制定部署策略由于最初的可用性有限，它们在临床实践中有效。在此，我们回顾被动免疫的先例以及使用抗体疗法治疗呼吸道合胞病毒、埃博拉病毒和 SARS-CoV 感染等病毒感染的经验教训。然后，我们重点关注恢复期血浆和中和单克隆抗体的部署，以治疗 SARS-CoV-2。我们回顾了具体的临床问题，包括患者分层的基本原理、潜在的生物标志物、已知的危险因素以及最佳临床使用的时间考虑因素。为了回答这些问题，需要了解病毒载量动力学及其与临床结果的相关性、内源性抗体反应、中和单克隆抗体的药代动力学特性以及组合抗体防御新出现的病毒变体的潜在益处等因素。