Monoclonal antibodies and oral pills for COVID-19: new possibilities for solid organ transplanted patients?

Since January 2020, the SARS-CoV-2 pandemic remains the leading health problem worldwide. In light of the use of DNA and RNA- based vaccines as a weapon to reduce the spread of the virus, an important question is the management of immunosuppressed patients such as those solid organ transplant recipients (SOTRs), who have not been included in the phase I-III clinical trials that considered immunosuppressive or immunodeficient state among main exclusion criteria during study subjects’ enrollment. This is the reason for which there are currently no consolidated scientific data to support the safety and efficacy of nucleic acid-based vaccines in organ transplant patients. Furthermore, this population has a reduced humoral immune response to DNA and RNA vaccines compared to the immunocompetent counterpart, thus remaining at high risk for COVID-19. Another emerging problem is the reduced seroconversion to SARS-CoV-2 in transplant recipients. These patients appear to be less likely than immunocompetent patients to develop neutralizing antibodies postinfection. Therefore, the immune-compromised patients need to maintain strict precautions for COVID-19 even postvaccination, and other therapeutic and preventive tools such as monoclonal antibodies and oral antiviral pills should be considered as an additional strategy against the virus in these patients. © 2022 EDIZIONI MINERVA MEDICA.