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An underutilized COVID-19 treatment aims to keep patients out of the hospital

By Shelley Kofler

Edward Reyes’ first symptoms of COVID-19 began with chills in January. A test at a local clinic confirmed he had the virus, and the beginning of what could progress into more serious illness.

“They said, ‘Your chest x-ray is showing that you have damage to your lungs, but not to the point you need to be hospitalized,’ ” the U.S. Air Force veteran told KSAT-TV.

The clinic’s medical team told Reyes he was a candidate for a newly authorized treatment aimed at preventing the progression of COVID-19 in patients who had tested positive and had just mild-to-moderate symptoms. Reyes agreed to an intravenous infusion of the drug available at a field hospital set up in San Antonio’s Freeman Coliseum. He says it worked.

“I feel much, much better than I did going in,” Reyes said.

A COVID-19 treatment that keeps the virus from progressing

The infusion of bamlanivimab that Reyes received was one of several monoclonal antibody treatments the U.S. Food and Drug Administration has approved since November.

“Monoclonal antibodies are manmade proteins that work like your own antibodies in your system that the immune system creates to fight off allergens,” explains Elliott Mandell, senior vice president and chief pharmacy officer for University Health. In COVID-19 patients, they strengthen the body’s immune response and minimize illness by preventing the virus from entering into human cells.

The FDA has approved the use of monoclonal antibody treatments for the following:

  • COVID-positive patients age 12 and older who are at high risk for serious illness. High risk patients are those 65 and older, and people with chronic medical conditions including diabetes and heart disease.
  • Patients who are not hospitalized. A primary goal of the treatment is to prevent hospitalization.
  • Patients who recently developed symptoms, and have a doctor’s prescription for the treatment

In San Antonio, University Hospital serves as a collection point for allocations of monoclonal antibodies the federal government sends to healthcare systems throughout the city. In a sterile lab, pharmacists working with Mandell compound the drugs and package them for intravenous treatments at Freeman Coliseum.  At Freeman’s field hospital, COVID-19 patients can safely receive the IV treatment in a setting where they don’t mingle with others they might infect.

In the three months following this regional infusion center’s opening on Nov. 30, 2020, University Hospital’s pharmacy prepared 2,975 monoclonal antibody treatments for infected patients. Mandell believes the use of these drugs could grow further if physicians and patients become more aware of their availability and effectiveness.

An underutilized treatment with promising results

Mandell sees monoclonal antibodies as a valuable but underutilized weapon in the arsenal against COVID-19.

He says the timing of their approval is a big reason they are not used more widely. The FDA’s emergency use authorization for the first approved monoclonal antibodies came just as the initial shipments of the Pfizer vaccine were headed to communities around the country.

“The publicity surrounding monoclonal antibodies was way overshadowed with the publicity for the vaccines,” says Mandell. “This part of the therapy has been overlooked significantly. We are underutilizing these drugs.”

Keeping patients out of the hospital

While clinical research is still underway to measure the effectiveness of monoclonal antibodies, recent data show promise.

In January, pharmaceutical company Eli Lilly released the results of a study that combined bamlanivimab with etesevimab, another monoclonal antibody. According to the FDA, 518 non-hospitalized, high-risk adults with COVID-19 received the drug combination. Another 517 received a placebo. Only 2% or 11 patients among those who received the drug cocktail ended up in the hospital, compared to 7% or 36 patients who received the placebo.  All of the patients receiving the drugs survived, while 10 patients receiving the placebo died.

Pharmaceutical companies say they are exploring the addition of other monoclonal combinations to fight against COVID-19 variants that are emerging.

While preventing COVID-19 with vaccines is certainly a goal, vaccinating enough people to reach herd immunity takes time. Meanwhile, people are still being infected. For them, Mandell believes it is important to have effective treatments like monoclonal antibodies that limit the seriousness of the virus.

“Anything we can do to keep patients from being hospitalized makes sense,” he says.

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