ABSTRACT
Intro: Patients receiving B-cell depleting or inhibiting therapies (BCDT), such as anti-CD20 monoclonal antibodies (CD20-MAB), are at risk for severe COVID-19. BCDT decreases production of neutralizing antibodies, causing delayed viral clearance and prolonged viral shedding. Passive antibody therapy (PAT), including COVID-19 convalescent plasma (CCP) and monoclonal antibodies (MAB), is hypothesized to be an effective Findings: * At the time of treatment, all patients (19/19) receiving CCP were hospitalized compared with10/53 patients treated with MAB. 2/10(20%) hospitalized patients treated with MAB died, compared with 3/19(15%) treated with CCP. **5/43 patients treated outpatient with MAB were hospitalized for COVID following CCP/MAB treatment with no COVID related deaths. Conclusion(s): Our data suggest that patients with COVID-19 who received BCDT within the last year may have improved outcomes after treatment with MAB or CCP. Elderly patients with >3 comorbidities and underlying hematological malignancy who contracted COVID-19 within 30 days of last BCDT had increased morbidity and mortality. To improve clinical outcomes, passive antibody therapy should be administered prior to the development of severe disease requiring hospitalization. Further prospective studies and comparisons to COVID-19 patients that did not receive MAB or CCP are needed to help confirm this association.Copyright © 2023
ABSTRACT
Intro: COVID-19 the most notorious Public Health Emergency (PHE), changed the way we practice medicine and taught us important lessons. The most effective measures to control pandemic are early administration and equitable access to vaccines and treatments. Governmental Public Health Agencies (GPHA) at all levels should have a leading role in coordination and implementation of control measures. Partnership between GPHA and health systems (HS) may significantly impact the scope of provided services. Monkeypox was declared PHE during the COVID-19 pandemic. It provided an opportunity to apply learned lessons that mitigated COVID-19 pandemic. Method(s): Spectrum Health (SH) is a quaternary-care HS based in Grand Rapids, Michigan. We will describe SH's response to COVID-19 and how we used our COVID experience to handle the Monkeypox outbreak. Finding(s): In response to COVID, through the phased approach (Picture 1) and collaboration with internal departments and GPHA, we opened a new clinic. Clinic was initially intended for parenteral COVID treatments but gradually evolved into a full COVID treatment center. Within 18 months we treated 12666 patients. Clinic success, efforts made to establish it, and concerns about future pandemics defined the need for a permanent and scalable centralized department which would provide continual community support with a measured response to meet community needs while minimizing impact on hospital resources, thus Community Response Department (CRD) was born. When Monkeypox PHE was declared, CRD responded immediately and efficiently using its resources and established pathways and demonstrated its own utility. Monkeypox treatment and vaccine were available to patients through the CRD within 7 days from governmental approval.Copyright © 2023
ABSTRACT
Background. Strategies to combat COVID include vaccines and Monoclonal Antibody Therapy (MAB). While vaccines aim to prevent symptom development, MAB aims to prevent progression of mild symptoms to severe. Increasing numbers of COVID infections in vaccinated patients raised the question of whether vaccinated and unvaccinated patients respond differently to MAB. Methods. We performed a retrospective review of the medical charts to evaluate responses of MAB in vaccinated and unvaccinated COVID patients by measuring the number of emergency department (ED) visits, hospitalizations, and ICU admissions within 14 days and the 30-day mortality following MAB. We evaluated outcomes according to vaccination status using absolute risk reduction and used Chi-squared tests to assess statistical significance using an alpha of p< 0.05. We used multivariable generalized linear models with a log link and binomial distribution to estimate adjusted relative risk and 95% confidence intervals. Results. Based on the inclusion criteria, we found 4,128 patients from which 230 had missing vaccination information or dose. From 3898 included patients, 296 (7.59%) visited the ED, 154 (3.95%) were hospitalized, and 25 (0.64%) were in ICU within 14 days of infusion. 12 patients (0.31%) died within 30 days. 2009 (51.5%) were unvaccinated at the time of infusion. Demographics were similar in both groups except that most of the patients in both groups were Non-Hispanic Caucasians, raising the question of racial and ethnic disparities. All comorbidities except pregnancy were predominant in the vaccinated group. Unvaccinated patients were more likely to receive MAB after 7 days of symptoms and in the ER, suggesting that they may have had more severe disease at the time of infusion, despite having less comorbidities. Unvaccinated patients had more ED visits (11.2% vs 4.3%, p< 0.0001), hospitalizations (6.2% vs 2.1%, p< 0.0001), and deaths (1.1% vs 0.3%, p=0.005) following infusion. Adjusted for demographics and comorbidities, unvaccinated patients were 2.41 times more likely to seek help in the ED and 2.73 times to be hospitalized. chronic kidney disease, cardiovascular disease, lung disease, neurological disorders, and smoking) (Figure Presented) Conclusion. Our data confirms that immunization plays a key role in reducing COVID-related morbidity and mortality. It also supports MAB efficiency from clinical trials.
ABSTRACT
Background. Clinical trials of monoclonal antibodies therapy (MAB) for COVID-19 demonstrated the risk reduction of COVID related hospitalization and death of any cause if administered within the first 7 days from the symptom onset. The Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for MAB within 10 days from the symptom onset. Our objective was to evaluate how duration of symptoms before MAB affects disease outcome following therapy. (Figure Presented) Methods. We evaluated a relationship between symptoms duration prior to MAB and disease outcome following treatment by measuring number of emergency department (ED) visits, hospitalizations and ICU admissions within 14 days and number of deaths within 30 days of MAB. Based on the symptom duration, patients were classified in typical (1-7 days) and late group (8-10 days of symptoms). We evaluated outcomes according to the symptom duration using absolute risk reduction and used Chi-squared tests to assess statistical significance using an alpha of p< 0.05. Results. From 3898 patients, 3074 (78.9%) were treated within 7 days from the symptom onset. Demographics were similar in both typical and late group. Majority of treated patients in both groups were Non-Hispanic Caucasians suggesting racial and ethnic disparities potentially due to a lack of access to healthcare. All comorbidities were similar or higher in the typical group except for obesity that was more frequent in the late group. Compared with typical, late group had more ED visits (9.22% vs 7.16% p=0.04) and hospitalizations (4.98% vs 3.68%, p=0.08). Absolute risk of progression to severe disease measured through the number of ICU admissions and deaths was low across the groups, and difference was not statistically significant. Adjusted for demographics and comorbidities, patients from the late group were 1.35 times more likely to seek help in the ED and 1.72 times more likely to get hospitalized. (Figure Presented) Conclusion. Despite FDA EUA allowing for the use of MAB up to 10 days from the symptom's onset, our real-world findings suggest that patients benefit most when treatment is administered within 7-day from the symptom onset as consistent with clinical trials.