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Individuals with COVID-19 might not realize that they may qualify for a treatment that can lessen the severity of their illness via a simple infusion.
Monoclonal antibodies (mAbs) are laboratory-made protein molecules that fortify a person’s immune system as it fights the coronavirus. The Food and Drug Administration has granted emergency use authorization status to three treatments: bamlanivimab and etesevimab, made by Eli Lilly and Co.; casirivimab and imdevimab from Regeneron; and sotrovimab from GlaxoSmithKline and Vir Biotechnology. Medications are administered either by injection or IV infusion and are recommended within the first 10 days of illness.
These treatments are useful, says Dr. Brooke Rossheim, a public health specialist with the Virginia Department of Health, because they can prevent people with mild to moderate cases of COVID-19 from getting sicker.
“Across the board, there’s a 70% to 80% reduction in [negative] outcomes” when patients receive mAb treatments, Rossheim says. “That’s a win-win for everybody, because the patient doesn’t get worse [and] doesn’t end up in the hospital in intensive care. That’s especially important now as we are in the throes of a delta surge, with hospitals packed with COVID patients.”
In order to qualify for monoclonal antibody treatment, patients must have tested positive for COVID-19, be age 12 or older, weigh more than 88 pounds, not be hospitalized or require supplemental oxygen, and be defined as “high risk” for COVID complications. High-risk criteria include an age of 65 or older and a host of chronic conditions, including a body mass index of greater than 25. Men who are 6 feet tall and weigh 190 lbs. would qualify under that BMI guideline, as would women who are 5 feet 5 inches and weigh 150 pounds.
“That represents a large segment of the U.S. population,” Rossheim says.
“Once somebody gets their test, if it’s positive, I’d like to see their doctor pulling out the criteria sheet and working down the list,” he adds. “A lot of people are going to meet those criteria.”
In the Richmond region, monoclonal antibody treatments are available at Henrico Doctors’ Hospital and Johnston-Willis Medical Center, Bon Secours outpatient infusion centers, and Infusion Solutions, an independent infusion center.
Dr. Jake O’Shea, chief medical officer for the HCA Capital Division, which includes Henrico Doctors’ and Johnston-Willis, says demand for mAb treatments hasn’t been huge; 45 patients were treated in the second week of September, and up to 70 a week could be accommodated. “If we had overwhelming demand, we’d figure it out,” he says.
O’Shea says that the treatment is most effective when it’s given early, but not everyone realizes they have COVID. “It can be hard to tell, early on in the disease, and you can go very quickly to needing” more care, he says. “Get the diagnosis or positive test, then talk with your doctor.”
At Infusion Solutions, which opened in February with the intention to serve people who have autoimmune disorders, eight suites are dedicated to COVID-19-positive patients receiving monoclonal antibody treatments. The business is an offshoot of Clinical Research Partners RVA, a firm that conducted the largest AstraZeneca COVID vaccine trial in the world. Co-founder and CEO Annette Bennett says patients are being referred from same-day clinics, after receiving a positive test, as well as primary care physicians. Additionally, because doctors are on staff at Infusion Solutions, people can contact the location directly for an evaluation.
“Our doctor will see you, assess you and write the order, if you qualify,” she says. “This is one more way we can keep people out of the hospital.”
Dr. Bo Vaughan, Infusion Solutions’ infectious disease medical director, notes that there is often a reduced cost for infusions at a nonhospital location. “Hospitals have to mark up charges for overhead,” he says. “And it’s hard to go to a hospital [when you’re already sick] because you’re mixed in with other populations.”
The treatments have received emergency authorization from the Food and Drug Administration. O’Shea says the research indicates they are safe. “People should talk with their physician to help them navigate through the science,” he says. “I know several physicians who contracted COVID and immediately went to get mAb treatments. I would encourage any of my family members to get [the treatment].”
VDH’s Rossheim agrees. “The data we have is compelling that the benefit far outweighs the risks. That’s what medicine is about.”
Both Rossheim and O’Shea stress that while the treatments are useful and beneficial, they are a supplement to — not a replacement for — vaccination.
“We strongly encourage people who are not vaccinated to get vaccinated,” O’Shea says. Rossheim adds, “The whole idea is prevention. MAb is not a vaccine substitute; that is not how they are intended to be used. We don’t want you to get the disease in the first place.”
