Spike Gene Evolution and Immune Escape Mutations in Patients with Mild or Moderate Forms of COVID-19 and Treated with Monoclonal Antibodies Therapies
Aude Jary, Stéphane Marot, Antoine Fayçal, Sacha Leon, Sophie Sayon, Karen Zafilaza, Emna Ghidaoui, Stéphanie Nguyen Quoc, Safaa Nemlaghi, Sylvain Choquet, Martin Dres, Valérie Pourcher, Vincent Cálvez, Helga Junot, Anne‐Geneviève Marcelin, Cathia Soulié
Abstract
We explored the molecular evolution of the spike gene after the administration of anti-spike monoclonal antibodies in patients with mild or moderate forms of COVID-19. Four out of the 13 patients acquired a mutation during follow-up; two mutations (G1204E and E406G) appeared as a mixture without clinical impact, while the Q493R mutation emerged in two patients (one receiving bamlanivimab and one receiving bamlanivimab/etesevimab) with fatal outcomes. Careful virological monitoring of patients treated with mAbs should be performed, especially in immunosuppressed patients.