{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:48:46Z","timestamp":1791917326933,"version":"4.3.4"},"reference-count":52,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T00:00:00Z","timestamp":1745539200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Anti-SARS-CoV-2\u00a0neutralizing\u00a0monoclonal antibodies (mAbs) have been shown to have clinical benefits in treating high-risk patients with mild-moderate COVID-19. SARS-CoV-2 RNA in serum (RNAemia), is usually associated with severe disease and deaths. This study evaluates real-life data on the effectiveness of mAbs therapies against SARS-CoV-2 infections by different viral variants, particularly in the presence of RNAemia, focusing on clinical outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>From March 2021 to May 2022, high-risk patients with PCR-confirmed mild-moderate COVID-19 were enrolled at the Clinic of Infectious Diseases, San Paolo Hospital in Milan. Patients received Bamlanivimab\/Bamlanivimab + Etesevimab\/Casirivimab + Imdevimab\/Sotrovimab based on Agenzia Italiana del Farmaco (AIFA) guidelines and prevalent SARS-CoV-2 variants. Nasopharyngeal swabs (NPS) and plasma samples were collected at infusion (t0) and after 7 days (t1). NPS viral loads and RNAemia were quantified using RT-qPCR, and variant typing was conducted. Clinical outcomes were evaluated, including time to symptom resolution and adverse effects.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Among 176 enrolled patients, treatment efficacy was observed in 96.6% with a median time to symptom resolution of 12 days (IQR 10\u201319). Viral load significantly decreased in both NPS and plasma by day 7 post-treatment (p&lt;0.001). At t0, RNAemia was present in 61.9% of patients and NPS viral loads were higher in patients with RNAemia (p=0.002). However, after treatment, no significant differences in viral loads and times to symptom resolution were noted between patients with and without RNAemia. Omicron-infected patients exhibited higher plasma viral loads compared to Alpha and Delta variants (p&lt;0.001) and the presence of RNAemia was significantly associated with Omicron (p&lt;0.001). Vaccinated patients achieved faster recovery regardless of variant type (p=0.001).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Early administration of anti-SARS-CoV-2 mAbs in high-risk patients significantly reduced viral loads in NPS and plasma and improved clinical outcomes. Despite the presence of RNAemia, these tailored mAb therapies led to\u00a0favorable\u00a0recovery times and minimal adverse effects.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0321356","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T17:25:21Z","timestamp":1745601921000},"page":"e0321356","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effectiveness of Anti-SARS-CoV-2 monoclonal antibodies in real-life: RNAemia and clinical outcomes in high-risk COVID-19 patients"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3421-9223","authenticated-orcid":true,"given":"Matteo 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