Moving monoclonal antibody treatments for COVID from hospital to home


(HealthDay)-Antibody infusion helps keep high-risk COVID-19 patients away from the hospital, but can be difficult to get treatment for. A US healthcare system has found a creative way to address this issue. It is a home infusion managed by an emergency medical institution. They injected antibodies into 144 COVID-19 patients at home three months earlier this year.

Most (about 95%) avoided hospitalization to exacerbate the symptoms of COVID-19.

Although COVID-19 hospitalizations have declined recently, according to the US Centers for Disease Control and Prevention, there are still an average of more than 6,600 new hospitalizations per day for infectious diseases in the United States.

If a person at high risk of severe COVID-19 is infected with the virus, there are ways to reduce the chances of going to the hospital. injection monoclonal antibody..

Monoclonal antibodies are laboratory-designed proteins that are similar to the antibodies that the immune system releases to fight infection. The one used for COVID-19 is designed to recognize the SARS-CoV-2 virus peplomer.

These three drugs are licensed for use in the United States. It is given to patients with mild COVID-19 who are at high risk of developing severe illness. Clinical trials have shown a 70% reduction in the risk of hospitalization.

The catch is that the monoclonal antibody must be injected by a medical professional.

“The hard part is the need for human resources,” said Dr. Anurag Marani of St. Joseph Mercy Hospital in Ann Arbor, Michigan.

Infusions can be delivered to the medical system in a variety of ways, including emergency rooms and outpatient clinics. During the COVID-19 surge, it can strain medical facilities and sick patients also need to travel.

It can be a special barrier for low-income patients, Marani said.

“Sometimes people don’t have transportation — they have to get on the bus,” he said. “Or, relatives may need to take a break from work to drive them.”

So St. Joseph’s medical system tried additional options. House injection.

Between February and May, 144 patients received home injections in three counties in Michigan. This approach worked with almost no problems. Three patients were hypersensitive to the infusion and had to be taken to the hospital.

After all, most patients avoided COVID hospitalization. According to a recently published report online, eight were eventually hospitalized for worsening COVID-19 symptoms, but did not require a ventilator and all survived. JAMA network open..

Not all COVID-19 patients are eligible for monoclonal antibody therapy, but a significant number are. Some of them are adults over the age of 65. Pregnant woman Overweight Medical condition Chronic lung diseases such as diabetes, heart disease, hypertension and asthma.

The key is to get eligible patients to be referred to monoclonal antibody therapy early, said Dr. Richard Wadas of the University of Pittsburgh Medical Center (UPMC).

This means that people with potential COVID-19 symptoms need to be tested immediately.

Monoclonal antibodies should be given within 10 days of the first symptoms, the sooner the better.

At the UPMC, Wadas said efforts to expand access to monoclonal antibodies began shortly after approval. This included the establishment of numerous outpatient sites where patients in the surrounding area could receive infusions.

“I didn’t want this to be available only in downtown Pittsburgh,” Wadas said.

However, household infusions are also available. UPMC works with local home infusion institutions to provide them to patients who are unable to see outpatients due to, for example, a medical condition or disability.

Wadas said he “praised” the innovative tactics of Michigan’s healthcare system. “Paramedics do have the skills to do this,” he said.

But in the UPMC area, emergency medical services are currently so tense that there is no “bandwidth” for extra and time-consuming work, Wadas said.

Different tactics work differently Medical systemMarani said hiring emergency personnel to provide home fluids may be a good option for some.

The cost is free for monoclonal antibody drugs. But there is still a cost to provide them. The St. Joseph patient who received a home injection was not charged, Marani said. Medicare paid for the beneficiaries, and the healthcare system paid for patients who did not use Medicare.

And in the meantime Monoclonal antibody Wadas emphasized that hospitalization can be prevented, they are not a substitute for vaccination.

“If you are vaccinated, your body will already know what to do when it is exposed to the virus,” he said. “You need to be vaccinated.”

Monoclonal antibody therapy and COVID-19

For more information:
The US Department of Health and Human Services Monoclonal antibody therapy for COVID-19..

Anurag N. Malani et al, Administration of Monoclonal Antibodies to COVID-19 in Patients’ Homes, JAMA network open (2021). DOI: 10.1001 / jamanetworkopen.2021.29388

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