Health care providers are increasingly using monoclonal antibody treatment for COVID-19 with intent of avoiding downstream hospitalizations or serious complications for newly infected, high-risk COVID-19 patients. While the initial COVID-19 antibody treatments were authorized for emergency use based on limited clinical trial evidence, recently reported results from larger clinical trials have confirmed substantial benefits with little evidence of safety problems for patients who have not progressed to more severe symptoms. These studies show similar efficacy across available treatments, benefits with shorter infusion times, and benefits as potential prophylaxis in households and nursing homes; further studies are nearing completion and more products in development. A range of innovative infusion practices across a number of different care settings are contributing to increased access and use. And supplies are growing for the approved treatments—Eli Lilly’s bamlanivimab and bamlanivimab/etesevimab combination and Regeneron’s casarivimab/imdevimab combination—as well as other COVID-19 antibody treatments that could soon file for emergency use authorization.
However, a number of obstacles to routine use still remain. Setting up infusion sites requires a redesign of usual COVID-19 care, and many providers do not have systems in place to refer patients to nearby COVID-19 antibody treatment in a timely manner. Some providers are still not aware of how to access COVID-19 antibody treatment. Many patients and providers may not have adequate information or referral materials that can enable informed decisions to be made and access to treatments in a timely manner. Furthermore, in some care settings like in-home infusion for patients who cannot easily reach an infusion center, payment challenges are impeding access to these treatments at scale. An additional obstacle to more widespread use is the limited but improving evidence on COVID-19 antibody treatments; evidence issues and how to address them are the subject of a recent Duke-Margolis issue brief.
In this report, we highlight a range of promising practices and approaches to overcoming access and administration obstacles and summarize steps that a variety of actors within the patient care process can take to further improve use of COVID-19 monoclonal antibodies. These practices have been distilled from ongoing contributions from a multi-stakeholder working group, individual stakeholder interviews, and publicly available materials. They include a number of practical approaches that health systems, community providers, long-term care (LTC) facilities, testing sites, in-home infusion practices, payers, and others can take together to realize the potential of these treatments and significantly reduce serious complications for early-stage, high-risk COVID-19 patients.