Monoclonal antibodies: Uses, most common brand names, and safety information

Medically reviewed by  Jamie Winn, PharmD

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Since the first monoclonal antibody (mAbs) was licensed for clinical use over 30 years ago, the industry has dramatically expanded and is now valued at billions of dollars. The first monoclonal antibody was generated in 1975 while the first one was approved by the FDA in 1986 for use to prevent kidney transplant rejection.

The first monoclonal antibody to treat cancer, Rituxan (rituximab) was approved in 1997 and it has improved outcomes in numerous forms of cancer.

Monoclonal antibodies are also approved to treat numerous conditions including autoimmune and inflammatory disorders (rheumatoid arthritis and Crohn’s disease), osteoporosis, asthma, migraines, and high cholesterol.

Recently the Food and Drug Administration (FDA) granted an emergency use authorization (EUA) for the treatment of Covid-19.

The list below includes the most common monoclonal antibodies and pricing:

List of monoclonal antibodies

Monoclonal antibodies used to treat Covid-19

So how do monoclonal antibodies work to treat Covid-19? After entering your body, they find and attach to the spike protein that sticks out of the coronavirus that causes COVID-19.

When monoclonal antibodies attach to the spike protein, they block the virus’s ability to enter cells — and slow down the infection.

Due to the public health crisis that arose because of Covid-19, the FDA granted emergency use authorization to the following mAbs treatment options:

• Casirivimab taken in combination with imdevimab is used for the post-exposure prevention of Covid-19 and the treatment of mild to moderate symptoms of Covid-19 in patients 12 and older who are at high risk for severe disease, including hospitalization and death.
• Another monoclonal antibody treatment combination that is authorized to treat mild to moderate Covid-19 in adults and some patients 12 years and older who have high-risk factors making them more likely to progress to severe Covid-19 is bamlanivimab and etesevimab. Some of these risk factors include chronic kidney disease, obesity, diabetes, and immunocompromised patients.
• Sotrovimab has shown activity against certain omicron subvariants and is approved under a EUA for use in patients 12 years and older with mild to moderate Covid-19 symptoms.
• Tixagevimab plus cilgavimab (Evusheld) has been given EUA for pre-exposure prophylaxis (PrEP) in certain patients. This treatment is not a substitute for the Covid-19 vaccine.
• Some other alternatives, specifically for outpatient or non-hospitalized use include remdesivir and Paxlovid (ritonavir-boosted nirmatrelvir)

Further clinical trials will be needed to gain full FDA approval.

What are monoclonal antibodies?

Antibodies are proteins produced by the immune system to fight antigens (foreign substances) and stick to them to destroy them. Monoclonal antibodies are a type of protein manufactured in a laboratory that mimics natural antibodies by binding to these antigens and creating an immune response.

How do monoclonal antibodies work?

Monoclonal antibodies affect the immune system to function in a variety of ways. Some examples may include:

• Flags cancer cells so the immune system’s cells can locate and destroy the targeted cells.
• Directly attacks cancer cells, causing them to self-destruct.
• Destroys the cell membrane of cancer cells.
• Blocks cell growth.
• Delivers radiation and other cancer treatments which can help minimize the radiation effect on healthy cells.
• Blocks inhibitors in the immune system to improve the body’s natural response to cancer cells.
• Blocks a virus from attaching to cells.

What conditions are monoclonal antibodies used to treat?

Monoclonal antibody therapy is used to treat a wide range of conditions, depending on the antigen it is targeting. These conditions include:

• Many types of cancers including breast cancer, leukemia, lymphoma, and cervical cancer, among others
• Autoimmune disorders, such as rheumatoid arthritis, multiple sclerosis, and lupus
• Organ transplant rejection
• Osteoporosis
• Infections, such as Covid-19
• Asthma, by preventing allergic reactions to the allergens

Note that indications may vary amongst products so speak with your healthcare provider for medical advice on which drug will work best for your medical condition.

Are monoclonal antibodies safe?

Monoclonal antibodies are used to treat many conditions and can also cause a wide variety of possible side effects. More than 1/3 of the commercially available products carry a black box warning which features the possible serious adverse events. These events range from allergic reactions to infections, autoimmune diseases, and cancers.

Can you take monoclonal antibodies while you are pregnant or breastfeeding?

There are not enough studies to recommend using monoclonal antibodies during pregnancy or while breastfeeding. They should only be used if the benefits outweigh the possible risks to the mother and baby.

What are the common side effects of monoclonal antibodies?

MAbs are typically given by intravenous or subcutaneous injections so you would expect injection site reactions to be one of the most common side effects. Some others include:

• Allergic reactions such as itching or hives
• Fever
• Chills
• Weakness
• Muscle aches and pains
• Nausea and vomiting
• Diarrhea
• Low blood pressure
• Skin rash
• Headache
• Shortness of breath

Some of the more serious side effects can include:

• Severe allergic reaction, which is very rare but could lead to death.
• Cancers
• Cardiovascular issues such as congestive heart failure and heart attack.
• Increased risk of lung disease
• Infections such as tuberculosis.
• Increased risk of bleeding.

This is not a complete list of side effects and we encourage you to consult with your healthcare provider for a complete list of side effects.

How much do monoclonal antibodies cost?

Monoclonal antibodies are very expensive with an average cost of around $100,000 per year. The mAbs used for cancer can be even more than the average while other conditions can be lower, but still cost about $20,000 per year.

You can purchase monoclonal antibodies for $49 per month from NiceRx if eligible for assistance. Prices at the pharmacy vary by your location, strength, and quantity, as well as your insurance status.

Related resources for monoclonal antibodies

• What are monoclonal antibodies? Combat Covid
• The history of monoclonal antibody development. National Library of Medicine
• Past, present, and future of rituximab. National Library of Medicine
• Monoclonal antibodies. National cancer institute
• What are monoclonal antibodies? Cleveland Clinic
• Anti-SARS-CoV-2 monoclonal antibodies. National Institutes of Health
• Monoclonal antibody therapy. Michigan government