This week, the Food and Drug Administration revoked the emergency use authorization for COVID-19 antibodies from Regeneron and Eli Lilly, a regulatory action that was expected as the two drugmakers discovered that the infusion drugs are less able to target the omicron due to strain. changes.
So what should people who test positive for COVID and who are at high risk of serious illness do? Chicago’s top doctor says there are options in the city.
“We haven’t used these two for weeks here in Chicago, knowing that most of what we had was omicron,” said Dr. Allison Arwady, commissioner of the Chicago Department of Public Health.
Instead, many Chicago hospitals have begun administering Sotrovimab, another monoclonal antibody treatment that has been shown to be effective against the now-dominant omicron strain.
The omicron variant is now thought to be responsible for more than 99% of COVID infections in the city.
“It needs to be given intravenously, and it needs to be used within the first ten days of the onset of symptoms, so you can get the most out of it and it provides pre-made antibodies to fight the infection,” said Dr. Shivanjali Shankaran, an assistant professor of infectious diseases at Rush University Medical Center.
Dr. Shankaran also oversees a new COVID infusion clinic in Rush. The clinic opened last week to offer treatment options to patients who may have mild or moderate covid infection, but are at high risk of serious illness.
“We can see up to nine [patients] per day,” Dr. Shankaran said. “The infusion takes about 30 minutes, and then patients need to be monitored for an hour afterwards. So the whole [process] lasts about two and a half hours.
The hospital also administers Remdesivir, an antiviral and the first drug approved by the FDA to treat COVID, in the infusion clinic. Like sotrovimab, remdesivir is time-sensitive and should be given within ten days of the onset of symptoms, experts say.
Clinics like Rush’s are also popping up elsewhere. AMITA Health has seen a surge in interest in monoclonal antibodies over the past six weeks, and the health system is currently administering Sotrovimab.
“We probably did about 300 to 350 infusions a week because of the surge,” said Dr. Ana Gephart, chief medical officer at AMITA Health St. Joseph’s Hospital in Elgin. “They’ve been very successful. People feel much better after the treatment. But of course it’s not a substitute for the vaccine itself.”
Healthcare providers also have new, easier-to-administer tools in their arsenal, though some treatments are rare.
In December, the FDA granted EUA to Pfizer’s Paxlovid antiviral pill and Merck’s Molnupiravir.
The pills, distributed by the federal government, require a doctor’s prescription and can be picked up at a pharmacy and taken at home, but officials warn that treatments can be hard to come by.
Supply is extremely limited and there is a risk of side effects for some patients, experts say.
“Paxlovid, the oral one that people are most interested in, has a lot of drug interactions. Some of the people who take the most drugs may not qualify,” Arwady said. “And [Molnupiravir] cannot be taken if someone is pregnant, you need to do additional tests.”
The pills are not currently available to everyone due to supply shortages. For now, many healthcare providers are following advice from the National Institute of Health to prioritize patients, especially those who are immunocompromised.
“Basically, it’s risk-based. The people who are at the highest risk, statistically, of having a bad outcome, getting seriously ill or ending up in intensive care, we give them the first advice, if you will,” Shankaran said. “We also created a scoring system based on several other items based on diabetes, vaccination status, heart disease, pregnancy.”
Dr Shankaran says the most important thing to do if you have symptoms is to test early because oral medications only work for the first five days.
“They need to be given during the multiplication process. That’s why we need to start them within the first five days. Getting tested very, very quickly is going to be key,” she said.
A prescription and a positive COVID test are required to receive the treatment. Pharmacies have limited quantities at this time, although the hope is to increase access to more patients when supplies are more readily available.
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