{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:59:53Z","timestamp":1790837993900,"version":"4.1.0"},"reference-count":23,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T00:00:00Z","timestamp":1629331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>An Emergency Use Authorization was issued in the United States and in Europe for a monoclonal antibody monotherapy to prevent severe COVID-19 in high-risk patients. This study aimed to assess the risk of emergence of mutations following treatment with a single monoclonal antibody. Bamlanivimab was administered at a single dose of 700 mg in a one-hour IV injection in a referral center for the management of COVID-19 in France. Patients were closely monitored clinically and virologically with nasopharyngeal RT-PCR and viral whole genome sequencing. Six patients were treated for a nosocomial SARS-CoV-2 infection, all males, with a median age of 65 years and multiple comorbidities. All patients were infected with a B.1.1.7 variant, which was the most frequent variant in France at the time, and no patients had E484 mutations at baseline. Bamlanivimab was infused in the six patients within 4 days of the COVID-19 diagnosis. Four patients had a favorable outcome, one died of complications unrelated to COVID-19 or bamlanivimab, and one kidney transplant patient treated with belatacept died from severe COVID-19 more than 40 days after bamlanivimab administration. Virologically, four patients cleared nasopharyngeal viral shedding within one month after infusion, while two presented prolonged viral excretion for more than 40 days. The emergence of E484K mutants was observed in five out of six patients, and the last patient presented a Q496R mutation potentially associated with resistance. CONCLUSIONS: These results show a high risk of emergence of resistance mutants in COVID-19 patients treated with monoclonal antibody monotherapy.<\/jats:p>","DOI":"10.3390\/v13081642","type":"journal-article","created":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T04:13:54Z","timestamp":1629346434000},"page":"1642","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":53,"title":["Emergence of E484K Mutation Following Bamlanivimab Monotherapy among High-Risk Patients Infected with the Alpha Variant of SARS-CoV-2"],"prefix":"10.3390","volume":"13","author":[{"given":"Nathan","family":"Peiffer-Smadja","sequence":"first","affiliation":[{"name":"IAME, Inserm, Universit\u00e9 de Paris, UMR1137, 75018 Paris, France"},{"name":"Service des Maladies Infectieuses et Tropicales, H\u00f4pital Bichat Claude Bernard, AP-HP, 75018 Paris, France"},{"name":"Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, National Institute for Health Research, Imperial College London, London SW7 2AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Bridier-Nahmias","sequence":"additional","affiliation":[{"name":"IAME, Inserm, Universit\u00e9 de Paris, UMR1137, 75018 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentine Marie","family":"Ferr\u00e9","sequence":"additional","affiliation":[{"name":"IAME, Inserm, Universit\u00e9 de Paris, UMR1137, 75018 Paris, France"},{"name":"Service de Virologie, H\u00f4pital Bichat Claude Bernard, AP-HP, 75018 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Charpentier","sequence":"additional","affiliation":[{"name":"IAME, Inserm, Universit\u00e9 de Paris, UMR1137, 75018 Paris, France"},{"name":"Service de Virologie, H\u00f4pital Bichat Claude Bernard, AP-HP, 75018 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathilde","family":"Gar\u00e9","sequence":"additional","affiliation":[{"name":"Service des Maladies Infectieuses et Tropicales, H\u00f4pital Bichat Claude Bernard, AP-HP, 75018 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Rioux","sequence":"additional","affiliation":[{"name":"Service des Maladies Infectieuses et Tropicales, H\u00f4pital Bichat Claude Bernard, AP-HP, 75018 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aude","family":"Allemand","sequence":"additional","affiliation":[{"name":"Service des Maladies Infectieuses et Tropicales, H\u00f4pital Bichat Claude Bernard, AP-HP, 75018 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippa","family":"Lavall\u00e9e","sequence":"additional","affiliation":[{"name":"Department of Neurology and Stroke Center, H\u00f4pital Bichat Claude Bernard, AP-HP, 75018 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jade","family":"Ghosn","sequence":"additional","affiliation":[{"name":"IAME, Inserm, Universit\u00e9 de Paris, UMR1137, 75018 Paris, France"},{"name":"Service des Maladies Infectieuses et Tropicales, H\u00f4pital Bichat Claude Bernard, AP-HP, 75018 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Kramer","sequence":"additional","affiliation":[{"name":"Pharmacy Department, H\u00f4pital Bichat Claude Bernard, AP-HP, 75018 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Descamps","sequence":"additional","affiliation":[{"name":"IAME, Inserm, Universit\u00e9 de Paris, UMR1137, 75018 Paris, France"},{"name":"Service de Virologie, H\u00f4pital Bichat Claude Bernard, AP-HP, 75018 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yazdan","family":"Yazdanpanah","sequence":"additional","affiliation":[{"name":"IAME, Inserm, Universit\u00e9 de Paris, UMR1137, 75018 Paris, France"},{"name":"Service des Maladies Infectieuses et Tropicales, H\u00f4pital Bichat Claude Bernard, AP-HP, 75018 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9279-5538","authenticated-orcid":false,"given":"Benoit","family":"Visseaux","sequence":"additional","affiliation":[{"name":"IAME, Inserm, Universit\u00e9 de Paris, UMR1137, 75018 Paris, France"},{"name":"Service de Virologie, H\u00f4pital Bichat Claude Bernard, AP-HP, 75018 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,19]]},"reference":[{"key":"ref_1","unstructured":"(2020). 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