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Hospitals offer antibody, antiviral treatments

MORGANTOWN – Mon Health System and WVU Medicine are making use of antibody and antiviral treatments to reduce hospitalizations and speed recovery of COVID-19 patients.

Mon Health is using two Monoclonal antibody treatments. The FDA defines monoclonal antibodies as “laboratory-made proteins that mimic the immune system’s ability to fight off harmful pathogens such as viruses.”

Mon Health Stonewall Jackson Memorial Hospital Pharmacy Director John Pope said staff there are using one of the two authorized treatments — Bamlanivimab, made by Lilly. The Mon Health system is also using the antibody treatment — Casirivimab/Imdevimab, produced by Regneron.

Both treatments neutralize the amount of COVID-19 in the patient’s body, Pope said, and help the immune system fight the virus. The treatment can lead to quicker recovery time for the patient and reduce hospitalizations.

“Due to limited availability of Bamlanivimab, certain high-risk criteria must be met to be given to a patient,” Pope said. “Those patients who are considered high-risk for severe illness will be considered for treatment. It is administered as a 60-minute infusion, then the patient will be monitored for 60 more minutes after the infusion for any type of reaction to the infusion, which is a low occurrence.”

At WVUM, Dr. Rebecca Reece, assistant professor of Infectious Diseases, said they’re just using Bamlanivimab for now. They’re in the works of getting the Regeneron product but haven’t run out of the other yet.

The antibodies, she said, bind to the virus’ spike protein to try and block the virus from getting into the cells. Both treatments operate in similar ways and have the same benefits, but Bamlanivimab is a single monoclonal antibody while the Regeneron is a cocktail of two separate antibodies that target the spike protein at different areas.

These treatments, Reece said, have to be used during the first 10 days of onset – the acute viral period. That’s when the virus is still replicating and infectious.

After that, during the secondary stage when the body’s immune response causes the lungs to become inflamed and the patient becomes hypoxic – meaning their oxygen level falls below 94% and they need supplemental oxygen – the virus isn’t replicating and the antibodies aren’t beneficial.

At Mon Health Medical Center, Director of Pharmacy Kathy Miller said, “Mon Health Medical Center has infused approximately 40 doses of monoclonal antibody therapy to date. Our Infectious Disease prescribers are ensuring that the patients with the highest risk are able to receive the therapy, and we do believe it is keeping patients from requiring hospitalization.”

Mon Health Preston Memorial Hospital Pharmacist Director Jennifer Cunningham said they’ve infused more 30 eligible patients with Bamlanivimab.

“We are seeing our targeted, high-risk patients respond very well to the monoclonal antibody infusions,” she said.

In Morgantown, WVUM is using its outpatient infusion center at the Physician Office Center, Reece said. They began using Bamlanivimab in November after it received its FDA Emergency Use Authorization. It took some time to get the word out, so in the last week of November through December they treated only 20 patients. It then picked up and since the start of January, they’ve treated 80.

Reece said it’s not yet known how the monoclonal antibodies will work when the COVID variants come to West Virginia. The variants are altering parts of their spike protein, and it’s not known if the antibodies will still be able to bind to the same areas and block the virus.

Mon Health said Remdesivir is a drug treatment for hospitalized patients. Unlike the monoclonal antibody infusions, it is an antiviral medication that aids in stopping the replication of COVID-19. Patients who are typically hospitalized with COVID-19 require supplemental oxygen, which is where this medication is used. Typically, a patient receives five days of treatment, however, that may be extended to 10 days depending on the severity of illness.

Reece said use of Remdesivir has evolved during the pandemic. They started using it last spring on people who were severely ill with high levels of oxygen support. But studies released in November and early December showed the one group that benefits from Remdesivir is those who are in the hospital and need oxygen – but only low-flow oxygen with a nasal cannula, not those on high-flow oxygen or on ventilators.

So WVUM changed how they use it since December, limiting it to people admitted and on a nasal cannula, within one week of symptom onset. In November, they used Remdesivir on 150 patients but only 30 in January.

“We certainly are using it less because there’s only that smaller group of people that seem to benefit from it,” she said. “It’s not going to be the savior drug for COVID-19 unfortunately, but it can be a tool in some patients.”

Reece said Remdesivir is administered intravenously, and it would be nice to have an oral antiviral to give on an outpatient basis in the first 48 hours; most patients aren’t hospitalized until after that.

Meanwhile, she said, WVUM is participating in four clinical trials looking for other drugs that will be useful. “The ones we have are great, but we certainly need more given that COVID is probably going to be around for a while, still.”

Regarding eligibility for monoclonal antibody treatment, Mon Health said patients with a positive diagnosis of COVID-19 with one mild or moderate symptom, who are 65 years and older can qualify for the medication within 10 days of being tested. Patients 18 to 64 can qualify if they have a condition that meets the criteria. There are separate requirements for pediatric patients. Patients should work with their medical providers to understand options and contact their primary care physician for more information.

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