Effectiveness and Safety of Outpatient Monoclonal Antibody Use for the Treatment of COVID-19 in Children and Adolescents: Single Center Study.

Monoclonal antibody therapy has been used to treat COVID-19, with paucity of literature about its use in children. This retrospective study sought to evaluate the effectiveness of preventing hospitalization and safety of monoclonal antibody (mAb) treatment (bamlanivimab-etesevimab and casirivimab-imdevimab) for COVID-19 in patients ≤18 years of age. Between January 1 and December 31, 2021, patients were selected for mAb therapy, based on the referring provider's clinical assessment of high risk for progression to severe COVID-19. The choice of mAb was determined by drug availability, compounding feasibility, and documented in vitro activity against circulating SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) variants. All patients received a single-dose infusion. Primary outcomes included hospital readmissions and emergency department (ED) visits within 90 days of treatment. The secondary outcome was safety/adverse events. Of 141 patients who received mAbs in 2021, only 3 experienced ongoing COVID-19 symptoms. Only 1 patient necessitated escalated care owing to persistent COVID-19 symptoms post infusion. There were no infusion-related side effects or hospitalizations in the 90 days post infusion. Monoclonal antibodies appear to be safe and effective in preventing hospitalizations in COVID-19-positive children.