The problems with spike MABs are many and unfortun

The problems with spike MABs are many and unfortunate.. they had the capacity to have a huge (in outcome if not # of doses), positive impact on this pandemic. The logistics of administering them were too challenging in a peak pandemic scenario. Also highlights challenges we saw here with CD10..

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there has been relatively little uptake by US physicians and their patients, says Angus.

One problem, he says, is that although results have been press released and submitted to the US Food and Drug Administration, companies have yet to publish data from key clinical trials in peer-reviewed journals. The drugs are also expensive and must be administered by infusion in a specialized facility, such as a hospital or outpatient-treatment centre — a difficult task when medical resources have already been stretched by a surge in cases.

Another challenge has been mixed messaging. Earlier in the pandemic, some key clinical trials involving people who had been hospitalized with COVID-19 found no benefit from monoclonal antibodies. Many researchers had anticipated that result: monoclonal-antibody therapy is expected to work best early in disease, and the late-stage symptoms of severe COVID-19 are sometimes driven more by the immune system itself than by the virus.
[LLMab would be the opposite; little effect visible in early stages, more benefit in late/immune stage]

The race to make COVID antibody therapies cheaper and more potent
Even so, those clinical-trial failures created a narrative that competed with positive results in studies of milder infections, says Angus, fuelling scepticism. “People would say, ‘But I thought it didn’t work,’” he says. “It’s totally getting in the way.”

And although studies in mild infections have shown promise, they are too small to allow researchers to draw definitive conclusions, says Saye Khoo, a pharmacologist at the University of Liverpool, UK, who is leading the UK AGILE Coronavirus Drug Testing Initiative. Only a small fraction of people with mild COVID-19 will progress to severe disease, meaning that although the trials have enrolled hundreds of participants, the number of those who were hospitalized or died was low.

But it will be a long wait until everyone is vaccinated, and monoclonal antibodies could provide an important bridge between vaccines and the treatments that have been found for people who are hospitalized, says Jens Lundgren, an infectious-disease physician at the University of Copenhagen and Rigshospitalet. “It is not a replacement for vaccines, but it is a plan B,” he says, adding that the drugs could be particularly important for those who cannot mount an immune response to vaccination.

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https://www.nature.com/articles/d41586-021-00650-7