Analysis of immune escape variants from antibody‐based therapeutics against covid‐19: A systematic review

Abstract

The accelerated SARS‐CoV‐2 evolution under selective pressure by massive deployment of neutralizing antibody‐based therapeutics is a concern with potentially severe implications for public health. We review here reports of documented immune escape after treatment with monoclonal antibodies and COVID‐19‐convalescent plasma (CCP). While the former is mainly associated with specific single amino acid mutations at residues within the receptor‐binding domain (e.g., E484K/Q, Q493R, and S494P), a few cases of immune evasion after CCP were associated with recurrent deletions within the N‐terminal domain of the spike protein (e.g., ΔHV69‐70, ∆LGVY141‐ 144 and ΔAL243‐244). The continuous genomic monitoring of non‐responders is needed to better understand immune escape frequencies and the fitness of emerging variants.