Researchers evaluate the efficacy of monoclonal antibodies (mAbs) in treating coronavirus disease 2019 (COVID-19) caused by various viral variants in a recent study published in the Annals of Internal Medicine.
COVID-19 is being treated with mAbs.
The use of mAb treatment has been shown to decrease SARS-CoV-2 viral load and, as a result, lower rates of COVID-19-related hospitalization and death among high-risk patients when compared to those who did not receive the treatment. Patients over the age of 65 and those with a weakened immune system appear to profit the most from mAb treatment.
There is a scarcity of observational clinical data on the use of mAb products among COVID-19 patients, especially since the emergence of the Omicron variant. As a result, there is still a pressing need to test the efficacy of individual mAb products against new SARS-CoV-2 variants in order to find patient populations that will profit the most from mAb treatment.
Concerning the research
The current study aims to see if early outpatient mAb treatment is associated with a lower chance of hospitalization or death due to COVID-19 at 28 days.
To that end, health data from different clinical systems, including the electronic health record (EHR) and a clinical data warehouse, were analyzed. Every patient had sociodemographic information and medical history collected for both outpatient and inpatient cases. The research found 28-day deaths with hospital discharge dispositions for “ceased to breathe” obtained from the inpatient medical record system.
The present study included patients who tested positive for COVID-19 in the University of Pittsburgh Medical Center (UPMC) health system between December 8, 2020, and August 31, 2022. Patients aged 12 and up who had at least one emergency use authorization (EUA)-an eligible risk factor for severe disease, were not in the emergency department (ED) or hospital on the index date, were not pregnant, had at least one record in the EHR from the previous year, and had nearly-complete covariate information for analysis were also included.
Patients were divided into two groups: those who were treated and those who were not. Patients with COVID-19 were treated at an outpatient infusion facility with mAbs such as bamlanivimab, bamlanivimab-etesevimab, casirivimab-imdevimab, sotrovimab, or bebtelovimab. The risk of hospitalization or death within 28 days was the primary study outcome, while secondary outcomes included hospitalization, ED contact without hospitalization, a combined outcome of ED visits or hospitalization within 28 days, or death.
Results
The current research included 2,571 treated patients and 5,135 nontreated patients who were matched. After one, two, and three days of treatment, 10.3%, 6.1%, and 3.2% of non-treated patients received mAb therapy, respectively. Before 1:2 propensity score matching, the average age of treated people was 58.5 years, while the average age of nontreated patients was 49.3 years.
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Before matching, treated patients had a higher overall risk profile than nontreated control patients, including a higher incidence of diabetes, obstructive sleep apnea, cancer, and hypertension. Furthermore, more treated patients were immunocompromised than nontreated comparison patients.
With a risk ratio (RR) of 0.61, treated patients had a lower chance of hospitalization or death at 28 days than nontreated control patients. Patients who received treatment were also less likely to be hospitalized or perish, especially after seven days from the index date. The risk of hospitalization at 28 days and the risk of death at 28 days had reduced RRs associated with mAb treatment. The use of mAbs did not raise the likelihood of hospitalization or emergency department visits.
Patients who received mAb therapy during times of SARS-CoV-2 Alpha, Delta, or Omicron variant dominance had RRs of 0.55, 0.53, or 0.71, respectively. In addition, RR estimates for individual mAb product treatment showed a lower risk of hospitalization or death. The risk of hospitalization or mortality was 0.45 in immunocompromised patients, which was slightly lower than the risk of 0.58 in non-immunocompromised patients.
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Conclusions
Over a nearly two-year span, early treatment with five different mAb products was consistently associated with a lower chance of hospitalization or death. Because of the fast evolution of new SARS-CoV-2 variants, it is critical to conduct ongoing research on mAb and non-mAb treatment therapies.
