Adverse Events Associated with Monoclonal Antibodies Used for Treatment
of COVID-19: A systematic review and meta-analysis
Abstract
Aim: This review aimed to synthesise the evidence related to the
incidence of serious and non-serious adverse events with the use of
monoclonal antibodies (mAbs) among COVID-19 patients. Methods: Databases
were searched from January 2020 to September 2023 for randomized
clinical trials (RCTs) that used mAbs for the treatment of COVID-19
regardless of disease severity. Study screening, data extraction, and
data analysis were done independently by two reviewers. The Cochrane
risk of bias 1.0 tool was used for methodological quality assessment.
Results: Twenty-three studies were identified for analysis with 20,099
participants in the treatment arm and 20191 participants in the
controlled arm. Seven trials reported hepatoxicity and there was a
statistically significant increase in the chance of hepatoxicity among
patients treated with mAbs compared to those given standard of care
(SoC) or placebo with RR = 1.70, 95% CI 1.29 – 2.24. Five trials
reported neutropenia and there was a statistically significant
association of neutropenia with the use of mAbs compared to SoC or
placebo with RR = 4.03, 95% CI 1.74- 9.34. Ten trials reported any
disease-related serious adverse events related to disease and there was
a reduction of risk compared to SoC/placebo, but was not statistically
significant (RR = 0.88, 95% CI 0.70-1.11). Conclusion: The use of mAbs
was found to be associated with an increased risk of hepatoxicity and
neutropenia compared to SoC/placebo among COVID-19 patients with
moderate certainty of evidence. Long-term observational studies are
recommended to observe post-COVID adverse events related to mAbs.