Cross-reactive Antibody Response to mRNA SARS-CoV-2 Vaccine After Recent COVID-19-Specific Monoclonal Antibody Therapy

Abstract

The efficacy of coronavirus disease 2019 (COVID-19) vaccines administered after COVID-19-specific monoclonal antibody is unknown, and "antibody interference" might hinder immune responses leading to vaccine failure. In an institutional review board-approved prospective study, we found that an individual who received mRNA COVID-19 vaccination <40 days after COVID-19-specific monoclonal antibody therapy for symptomatic COVID-19 had similar postvaccine antibody responses to SARS-CoV-2 receptor binding domain (RBD) for 4 important SARS-CoV-2 variants (B.1, B.1.1.7, B.1.351, and P.1) as other participants who were also vaccinated following COVID-19. Vaccination against COVID-19 shortly after COVID-19-specific monoclonal antibody can boost and expand antibody protection, questioning the need to delay vaccination in this setting.

Trial registration: The St. Jude Tracking of Viral and Host Factors Associated with COVID-19 study; NCT04362995; https://clinicaltrials.gov/ct2/show/NCT04362995.

Keywords: COVID-19; SARS-CoV-2; antibody; bamlanivimab; vaccine failure.

Figure 1.

A, Timeline of events. MAb, COVID-19-specific monoclonal antibody therapy (Bamlanivimab, Eli Lilly, Indianapolis, Indiana, USA); Vaccine, mRNA COVID-19 vaccine (BNT162b2, Pfizer-BioNTech, Philadelphia, Pennsylvania, USA). B, Antibody responses against receptor binding domain for common SARS-CoV-2 variants after infection/monoclonal antibody therapy and COVID-19 vaccine show increases in variant-specific antibodies after vaccination. V1 and V2, administration of first and second doses of mRNA COVID-19 vaccine (BNT162b2 OD490, RBD-specific antibody level measured by ELISA as optical density at 490 nm. Abbreviations: COVID-19, coronavirus disease 2019; ELISA, enzyme-linked immunosorbent assay; MAb, monoclonal antibody; PCR, polymerase chain reaction; RBD, receptor binding domain; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

Figure 2.

Vaccination with COVID-19 vaccine after treatment of COVID-19 with monoclonal antibody is associated with similar RBD antibody responses to vaccination following COVID-19 alone. OD490, RBD antibody levels by ELISA measured as optical density at 490 nm; Red dot, Participant vaccinated with mRNA COVID-19 vaccine following natural infection and monoclonal antibody therapy (Postvaccine dose #1, sample collected 21 days after vaccine and 41 days after symptom onset; Postvaccine dose #2, sample collected 40 days after vaccine and 81 days after symptom onset); Gray dots, participants with vaccination following natural infection only (Postvaccine dose #1, sample collected 14–21 days after vaccine; Postvaccine dose #2, sample collected 23–56 days after vaccine; Dashed line, median. Abbreviations: COVID-19, coronavirus disease 2019; ELISA, enzyme-linked immunosorbent assay; RBD, receptor binding domain.