Outpatient hydroxychloroquine prescribing at a large academic health system during the COVID-19 pandemic

To the Editor—The coronavirus disease 2019 (COVID-19) pandemic has attracted widespread attention to experimental treatments, including the antirheumatic drug hydroxychloroquine, raising concerns about its supply for patients already taking the drug for non–COVID-19 indications.1 Currently, multiple manufacturers have reported shortages of hydroxychloroquine.2 We report an exploratory analysis of hydroxychloroquine prescribing in outpatient and urgent care clinics of a large academic health system in northern California. The CDC guidance has recommended that patients request larger prescription drug quantities to minimize pharmacy visits.3 However, the American College of Rheumatology has suggested limiting outpatient prescription refills of hydroxychloroquine to a 30-day supply as a potential mitigation strategy for any supply disruptions in select circumstances.4 Our analysis was observational in nature, and further interpretation is limited by several factors. [...]these results are unique to practice paradigms of a single health system and are subject to regional epidemiology of COVID-19.

SARS-CoV-2 Neutralizing Monoclonal Antibodies for the Treatment of COVID-19 in Kidney Transplant Recipients.

Background: Morbidity and mortality associated with coronavirus disease 2019 (COVID-19) infection in kidney transplant recipients are high and early outpatient interventions to prevent progression to severe disease are needed. SARS-CoV-2 neutralizing mAbs, including bamlanivimab and casirivimab-imdevimab, received emergency use authorization in the United States in November 2020 for treatment of mild to moderate COVID-19 disease. Methods: We performed a retrospective analysis of 27 kidney transplant recipients diagnosed with COVID-19 between July 2020 and February 2021 who were treated with bamlanivimab or casirivimab-imdevimab and immunosuppression reduction. We additionally identified 13 kidney transplant recipients with COVID-19 who had mild to moderate disease at presentation, who did not receive mAbs, and had SARS-CoV-2 serology testing available. Results: There were no deaths or graft failures in either group. Both infusions were well tolerated. Four of the 27 patients treated with mAbs required hospitalization due to COVID-19. Four of 13 patients who did not receive mAbs required hospitalization due to COVID-19. Patients who received mAbs demonstrated measurable anti-SARS-CoV-2 IgG with angiotensin-converting enzyme 2 (ACE2) receptor blocking activity at the highest level detectable at 90 days postinfusion, whereas ACE2 blocking activity acquired from natural immunity in the mAb-untreated group was weak. Conclusions: Bamlanivimab and casirivimab-imdevimab combined with immunosuppression reduction were well tolerated and associated with favorable clinical outcomes in kidney transplant recipients diagnosed with mild to moderate COVID-19.