The world is facing up the most considerable vaccination effort in history to end the Coronavirus disease 2019 (COVID-19) pandemic. Several monoclonal antibodies (mAbs) direct against the Receptor binding domain of the S protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) received an Emergency Use Authorization for outpatient management of mild to moderate manifestation from COVID-19. MAbs could prevent the transmission SARS-CoV-2 infection and protect individuals from progression to severe disease. Under the pressure of different treatment strategies, SARS-CoV-2 has been demonstrated to select for different sets of mutations named “variants” that could impair the effectiveness of mAbs by modifying target epitopes. We provide an overview of both completed and unpublished, or ongoing clinical trials of mAbs used and review state of art in order to describe clinical options, possible indications, and the place in therapy for these agents in the treatment of COVID-19 with a particular focus on anti-spike agents. Then, we reassume the current evidence on mutations of the SARS-CoV-2 that might confer resistance to neutralization by multiple mAbs.

世界正面临着历史上最大规模的疫苗接种工作，以结束 2019 年冠状病毒病 (COVID-19) 大流行。几种直接针对严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) S 蛋白受体结合域的单克隆抗体 (mAb) 获得了紧急使用授权，用于门诊管理 COVID-19 轻度至中度表现。单克隆抗体可以预防 SARS-CoV-2 感染的传播，并保护个体免于进展为严重疾病。在不同治疗策略的压力下，SARS-CoV-2 已被证明会选择称为“变体”的不同突变组，这些突变可能会通过修改目标表位来损害单克隆抗体的有效性。我们概述了已完成和未发表的或正在进行的单克隆抗体临床试验，并回顾了最新技术，以描述临床选择、可能的适应症以及这些药物在治疗 COVID-19 中的地位，特别是重点关注抗尖峰制剂。然后，我们重新假设 SARS-CoV-2 突变的现有证据，这些突变可能会对多种 mAb 的中和产生抵抗力。