Real World Utilization of Bamlanivimab at a Rural Community Hospital

Abstract

Introduction Although there were several proposed treatments for patients that were hospitalized with COVID-19, outpatient treatments for those with mild to moderate illness were limited prior to the emergency use authorization (EUA) of virus-neutralizing monoclonal antibodies. To assess the efficacy of outpatient monoclonal therapy, the investigators assessed the seven, 14, and 28-day emergency department and hospitalization rates of adult patients given bamlanivimab for the treatment of COVID-19 at a community hospital. Methods A retrospective chart review was performed of all adult patients given bamlanivimab within the emergency department or an outpatient infusion center from December 2, 2020 through January 8, 2021 for the treatment of mild to moderate COVID-19. Patients were compared to a set of controls who would have qualified for bamlanivimab treatment prior to its authorization in reverse temporal order from November 30, 2020 through August 1, 2020. Abstracted data included patient demographics, allergic reactions, emergency department presentations, and hospitalizations at seven, 14, and 28 days post-infusion due to COVID-19 and any in-hospital mortality in those admitted with a COVID-19 complication. Results A total of 136 patients received bamlanivimab during the study period with none having an allergic reaction during infusion. In those who received bamlanivimab, 84 (61.8%) patients included were aged 65 years or older. At 28 days, there was a statistically significant reduction in emergency department visits in those who received bamlanivimab (20 vs 36 patients; p = 0.03) but not at seven days (12 vs 20 patients; p = 0.18) or 14 days (17 vs 28 patients; p = 0.11). No statistically significant difference in emergency department returns was noted in those aged 65 years or older at seven (eight vs eight patients; p = 0.70), 14 (11 vs 10 patients; p = 0.83), or 28 days (13 vs 14 patients, p = 0.46). A total of six (4.4%) patients were hospitalized at 28 days following the bamlanivimab infusion with five (83.3%) being aged 65 or older. No statistical difference was noted for decreased hospitalizations at seven (four vs five patients; p = 0.79), 14 (five vs nine patients; p = 0.32), or 28 days (six vs nine patients; p = 0.49) post-infusion. No patients suffered from in-hospital mortality after infusion with bamlanivimab. Conclusion Outpatient infusion of bamlanivimab reduced the incidence of those with mild to moderate COVID-19 requiring subsequent care through the emergency department at 28 days but not hospitalizations within this time frame. No statistical difference was noted in either emergency department visits or hospitalizations in those aged 65 or greater who were treated as an outpatient with bamlanivimab for mild to moderate COVID-19.

Effects of bamlanivimab alone or in combination with etesevimab on subsequent hospitalization and mortality in outpatients with COVID-19: a systematic review and meta-analysis

“…The COVID variants of interest in the studies included 21C (Epsilon), 20E (EU1), and B.1.1.7 (Alpha). Seven additional studies were identified in January 2023, and these were included in our analysis ( Chilimuri et al, 2022 ; Cooper et al, 2021 ; Iqbal et al, 2021 ; Leavitt et al, 2021 ; Murillo et al, 2022 ; Rainwater-Lovett et al, 2021 ; Rubin et al, 2021 ).…”

Addressing COVID-19 Disparities Between Hispanic and Non-Hispanic White Populations of Arizona

“…Avoidance of public programs for fear of harming their immigration status was reported by Hispanic immigrants which coincided with a 2x increased delay of needed medical care 30 . This could have led to decreased utilization of COVID-19 monoclonal antibodies leading to increased hospitalization rates secondary to uninhibited viral replication [31][32][33] . Institutional disenfranchisement may further underly this reluctance as Arizona proposed vaccine policies prioritizing U.S. citizens and legal residents, a significant obstacle for undocumented Hispanics seeking protection with the COVID-19 vaccine 25 .…”