Implementation and outcomes of a severe acute respiratory coronavirus virus 2 (SARS-CoV-2) monoclonal antibody treatment program at an academic medical center serving a high-risk patient population

To the Editor—Monoclonal antibodies directed against the spike protein component of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) became the first treatments approved for use in outpatients when bamlanivimab received emergency use authorization (EUA) in November 2020.1,2 Bamlanivimab has been associated with a decrease in coronavirus disease 2019 (COVID-19)–related hospitalization in patients at high risk for disease progression.3 However, the logistics of identifying patients suitable for these therapies and administering them in a timely fashion is challenging.4 Patients must be screened using eligibility criteria outlined in the EUA, including being within 10 days of symptom onset at the time of treatment and receiving an intravenous medication in a space that is safe for patients with COVID-19. Nearly half of the patients treated had 2 or more risk factors for progression to severe disease. [...]5 patients required an emergency department visit within 30 days of receiving bamlanivimab, 2 of whom were hospitalized for COVID-19 progression, and no patients in the cohort were intubated or died. (N=100) Age, median (IQR) 56 (42–64) Sex, female 50 Race and ethnicity Black, non-Hispanic 43 White, non-Hispanic 22 Non-White, Hispanic or Latino 30 Other or unknown 5 Body mass index, median (IQR) 30.1 (26.1–37.1) Employee of health system 10 Location of bamlanivimab administration Clinic 65 Emergency department 35 Risk factors for progressing to severe COVID-19a Body mass index >35 31 Chronic kidney disease 5 Diabetes 36 Immunosuppressive disease 14 Receiving immunosuppressive treatment 12 Age ≥65 y 24 Age≥55 y with the following comorbidity Cardiovascular disease 6 Hypertension 34 Chronic respiratory disease 6 Time from symptom onset to bamlanivimab administration, median d (IQR)b 4 (5–8) Emergency department visit or hospitalization due to worsening symptoms of COVID-19 within 30 d after bamlanivimab infusion 5 total patients with emergency department visit or hospitalization 3 of the 5 were admitted, 2 for direct complications of COVID-19 Note.