LVHN Offers New COVID-19 Treatment
Monoclonal antibody infusion can prevent the need for hospital care in infected people at highest risk
BY RICHARD LALIBERTE
Lehigh Valley Health Network (LVHN) has added an important weapon against COVID-19 in the form of a drug treatment that the Food and Drug Administration (FDA) recently authorized for emergency use in people who have mild-to-moderate symptoms caused by COVID-19 and are at risk for complications.
The investigational medication, called bamlanivimab, is a monoclonal antibody – a type of treatment also used in the drug casirivimab-imdevimab. This treatment was given to President Donald Trump when he was sick with COVID-19 in October.
But how does a monoclonal antibody work and how can it help COVID-19 patients in our community? Infectious diseases physician Amy Slenker, MD, Vice Chair of Quality and Patient Safety, Department of Medicine, LVHN, explains the medical technology behind bamlanivimab, who should get it, and how it can be safely administered.
What’s a monoclonal antibody?
Antibodies are proteins directed against something the immune system recognizes as an infection or ‘foreign’ to the body. Monoclonal antibodies are proteins made in a laboratory that mimic the immune system’s ability to fight off a harmful infection. In this case, the monoclonal antibody called bamlanivimab targets and attaches to the spike protein on the SARS-CoV-2 virus (the virus that causes COVID-19 infection). The spike protein allows the coronavirus to enter a healthy cell, infect it and cause COVID-19. By attaching to the spike protein, bamlanivimab prevents the virus from entering the healthy cell and helps the body’s immune system recognize the virus as an infection, almost like an indicator that says, ‘Hey, this is a problem and we need to start working.’
What happens when the drug takes effect?
This medication provides a key ingredient in the immune system’s fight against infection. The antibody attaches to the virus and prevents it from entering healthy cells. Ideally, the administration of this medication also jump-starts the immune system’s response to the infection.
What is the outcome of this treatment for COVID-19 patients?
The data is preliminary so far, but phase II clinical trials of both bamlanivimab and casirivimab-imdevimab reported that in people with mild-to-moderate cases of COVID-19 who were at high risk for progressing to severe COVID-19, these treatments substantially prevented hospital or emergency room visits compared to people who received a placebo. It’s always nice to see that similar drugs have similar effects in different trials.
What have you seen bamlanivimab do in LVHN patients?
We’ve only given it to a limited number of people, so our sample is small, and we need more information to say anything meaningful, but anecdotally, some of those who’ve received it have said they felt better almost right away.
How is bamlanivimab administered?
It’s an intravenous infusion that needs to be administered in a monitored health care setting where providers are prepared to manage side effects if they occur. There’s a small risk for an allergic-type reaction or an infusion reaction that can include flushing, low blood pressure and nausea – and these reactions can be severe in some cases. The infusion takes one hour, but you should be prepared to stay an extra hour for monitoring after the infusion is complete. You’re unlikely to experience a serious adverse effect after that.
Who should get this treatment?
People who have mild symptoms but are at high risk for progressing to severe COVID-19 infection. High-risk criteria include being obese with a body mass index of 35 or more; having chronic kidney disease, diabetes or an immunosuppressive disease; taking a medication that suppresses the immune system or being age 65 or older.
You wouldn’t give it to someone who is really sick?
No, treatment was not shown to be beneficial in people who are sick in the hospital. In fact, hospitalized patients may have worse clinical outcomes if they get a monoclonal antibody compared with those who don’t get one. Bamlanivimab is reserved for patients early in the disease – within three days of positive COVID-19 test results or within seven to 10 days of symptom onset. We really want to emphasize that earlier is better.
What does this drug’s availability mean to our region?
LVHN stays abreast of the newest technologies and medications, and when bamlanivimab received emergency use authorization, we immediately began working to provide a safe location to administer this novel treatment with maximal oversight to improve the health of high-risk people who previously had few treatment options available to them.