Table 1.

Summary of main monoclonal antibodies for prevention and therapy of viral infections.

	Action	Effect/ Efficacy	Indications	Dose	Half-Life	Cost	Potential Use
RSV prevention
Palivizumab (23–36)	Humanized mAB Target RSV F protein, site II	45-82% against RSV related hospitalizations in high risk infants	Infants <29 weeks of gestational age; chronic lung disease of prematurity; hemodynamically significant congenital heart defect; selected cases of pulmonary abnormalities, neuromuscular disorders and severe immunodeficiency	15 mg/kg once a month (max 5) during RSV season	Short (17-26 days)	Very high	Reduced (high risk groups only)
Nirsevimab (40–51)	Humanized mAB Target RSV prefusion F protein, site ϕ	Preterms: 70,1% reduction on RSV-associated MALRTIs, 2,6% vs 9,5% on RSV disease compared to placebo and 78,4% reduction on hospitalization rate due to RSV-associated MALRTIs. Preterm and Term Infants: 74,5% reduction on RSV-associated MALRTIs and 62,1% reduction on hospitalization	Universal indication (potential) on infants	Single dose: 50 mg IM in <5 kg and 100 mg IM in > 5kg	Extended half-life due to modified Fc region (≈150 days)	Potential favorable cost-effectiveness ratio	Universal use of RSV prophylaxis in children
Clesrovimab (52)	Humanized mAB Target RSV prefusion F protein, site IV	Studies ongoing
SARS-CoV-2 prophylaxis or therapy
Bebtelovimab (66–73)	Human IgG1 mAB Target SARS-CoV-2 S-protein. Active against Omicron BA.5 and Omicron BA.4.6/BF.7	Reduction on viral load on day 5 after treatment, compared to placebo. Time to sustained symptom resolution was reduced by a median of 2 days	Emergency use in adults and children >12 years of age and weighting >40 kg. Not authorized in hospitalized patients	175 mg IV	N/A	High	Patients with mild to moderate disease at high risk to progression.
Tixagevimab plus cilgavimab (78, 79)	Active against Omicron BA.5.	In vivo efficacy clearly evidenced only in patients infected by non-Omicron variants. i	Emergency use in adults and children >12 years of age and weighting >40 kg for pre-exposure prophylaxis in immunocompromised individuals or those who cannot be vaccinated or mount post-vaccination immune response	300 mg + 300 mg IM	N/A	Hugh	Post-exposition prophylaxis in selected patients with infection due to sensitive SARS-CoV-2 strains
HIV therapy
Ibalizumab (81–83)	Humanized mAB Target CD4 T cell extracellular domain 1 and 2	In vitro neutralizing activity against approximately 90% of a diverse panel of HIV strains. Very fast reduction of HIV-RNA levels. After 24 weeks of treatment 43% of participants achieve HIV RNA suppression	In adults as part of a combination antiretroviral regimen in heavily treatment-experienced patients with multidrug resistant (MDR) HIV-1 infection who did not respond to the current antiretroviral regimen	First dose: 2000 mg IV; maintenance doses 800 mg every 2 weeks	Extended half-life with high dose due to saturable elimination	Very high	Only in patients unresponsive to antivirals
Rabies prevention
Rabishield	Target a conformational epitope of the rabies G protein	It is as effective as serum derived hyperimmune IgG. It can fail against virus variants tat circulate in Africa and North America	It must be given together with vaccine within 7 days after exposure to rabies virus	3.33 IU/kg body weight		Less expensive than hyperimmune rabies IgG	Less recommended than preparations with two mABs
Miromavimab plus Docaravimab	Target the antigenic sites I and III of the rabies G protein	Combination is as effective as serum derived hyperimmune IgG	It must be given together with vaccine within 7 days after exposure to rabies virus	40 IU/kg body weight		Less expensive than hyperimmune rabies IgG	Extensive use

N/A, not applicable.