II. Indications

  1. FDA Emergency Use Indications (none are FDA approved for routine use in December 2020)
    1. Confirmed positive COVID-19 testing AND
    2. High Risk Patients for Serious Complications (see High Risk Factors in Covid-19 Infection) AND
    3. Patient NOT hospitalized for COVID-19 AND
    4. Patient not requiring Supplemental Oxygen for COVID-19
      1. No increase in Supplemental Oxygen if chronic use (e.g. oxygen dependent COPD)

III. Preparations (Outpatient Infusions)

  1. Indications
    1. Age>=12 years old AND weight >=40 kg AND
    2. Mild to moderate COVID-19 (non-hypoxic) and risk for severe disease or in unvaccinated, significant exposure
      1. Recommended as soon as possible (within 10 days of symptom onset)
  2. General
    1. Rare Hypersensitivity Reactions have occurred
    2. As of January 2021, many insurers in U.S. are covering doses
    3. Defer Covid-19 Vaccination for at least 90 days after Monoclonal Antibody dose
      1. These monoclonal antibodies may interfere with Vaccine immune response
  3. Combination Casirivimab and Imdevimab (Regen-COV)
    1. Casirivimab 600 mg and Imdevimab 600 mg infused over 1 hour (or divided over 4 SQ injections)
    2. https://www.covid19treatmentguidelines.nih.gov/therapies/anti-sars-cov-2-antibody-products/anti-sars-cov-2-monoclonal-antibodies/
    3. Indicated in mild to moderate COVID-19, age >12 years with increased risk for severe disease
    4. Also indicated for unvaccinated (or partially vaccinated) exposed patients
      1. Exposure within 6 feet for >15 minutes OR
      2. High risk of exposure to COVID-19 positive patient in institutional setting (e.g. Nursing Home)
  4. Other monoclonal Antibodies under investigation
    1. Combination: Bamlanivimab and Etesevimab
      1. Early data with possible mortality reduction of 2%
      2. (2021) Presc Lett 28(4):20-1
    2. Bamlanivimab (Lilly product, LY-COV555)
      1. Bamlanivimab 700 mg in 20 ml infused over 1 hour
      2. Replaced by combination product with Etesevimab
      3. https://www.covid19treatmentguidelines.nih.gov/statement-on-bamlanivimab-eua/

IV. Efficacy

  1. Monoclonal Antibody helps prevent SARS-CoV-2 from entering the cell
  2. Seemed very promising for COVID-19 treatment as of December 2020
    1. Treatment results have been surprisingly mediocre
      1. https://emcrit.org/pulmcrit/bamlanivimab/
  3. Casirivimab and Imdevimab appear very effective in Post-exposure Prophylaxis
    1. NNT dose within 96 hours of exposure: 18 to prevent 1 case of COVID-19 within 28 days
    2. Shortens COVID-19 symptoms by 2 weeks in those who do develop COVID-19
    3. Reduces COVID-19 hospitalizations and mortality
    4. (2021) Presc Lett 28(9): 49-50
    5. O'Brien (2021) N Engl J Med 385:1184-95 [PubMed]

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