Identifying Patient Barriers to Monoclonal Antibody Therapy for COVID-19

Monoclonal antibodies have been helpful in preventing severe illness in patients at increased risk, but barriers to receiving this therapy exist.

For much of the pandemic, monoclonal antibody therapy has been an important tool to prevent severe COVID-19 in patients with mildtomoderate disease who were at high risk of severe illness or hospitalization. A poster presented by Jennifer L. Rafferty, PharmD, at St. John Fisher College Wegmans School of Pharmacy/Rochester Regional Health in Rochester, New York at the American Society of Health-SystemPharmacists 2022 Summer Meeting and Exhibition, heldin Phoenix, Arizona, sought to catalog the barriers to monoclonal antibody therapy to discover areas for further educational need.

A single-center, retrospective chart review examined the real-world utilization of monoclonal antibody therapy. A patient was included if he or she had a positive COVID-19 test within 10 days of symptom onset, met the criteria set by the FDA emergency use authorization for monoclonal antibody therapy, and had been referred to a clinical pharmacist. Those who had been given oxygen therapy or had been hospitalized for COVID-19 before referral were excluded.

Patients were split into a non-monoclonal group, which included all eligible patients who had not received treatment within the 10-day window, and the monoclonal group that included patients who had documentation of administration within 10 days of symptom onset. Primary outcomes included the ratio of patients who did not receive therapy and the reasons for not receiving it.

There were 231 potential candidates for monoclonal antibody therapy were referred to clinical pharmacists, 197 of whom met the inclusion criteria. Just 33 patients were given treatment. Among the 164 who qualified but did not receive monoclonal antibody treatment, 55 declined therapy due to mild illness or improving symptoms. Twenty-two patients did not receive the therapy because the patient’s primary care provider did not order monoclonal antibody treatment. In this subset, 11 were not given treatment by the provider because of mild symptoms; the reason for denial was unknown for 7 patients, and 1 patient died within 30 days from complications of COVID-19.

Investigators concluded that despite of authorization for treating mildtomoderate illness in patients with a high risk of more severe outcomes, many did not use monoclonal antibodies because of the mild nature of their illness.

“As COVID-19 treatments are rapidly changing, this study has identified a need for education targeting patients at high risk for severe illness,” the author concluded.

Reference

Rafferty JL. Real-world utilization and outcomes of monoclonal antibody therapy in COVID-19: identifying barriers to care. Presented at American Society of Health-SystemPharmacists 2022 Summer Meeting and Exhibition; June 11-15, 2022; Phoenix, AZ. Poster 8-T.