Using Monoclonal Antibodies in LTC

The FDA has given EUA (Emergency Use Authorization) for bamlanivimab (Lilly) or the “cocktail” of casirivimab and imdevimab IV infusions for mild to moderate COVID-19 patients.  These monoclonal antibodies block the binding of the spike protein to the ACE2 receptor on the human cell, which blocks viral attachment.  If given early (within 10 days of symptom onset), both medicines have been shown in high-risk adults to reduce the viral load and risk of progression to severe COVID-19, and reduce the necessity for ED visits and hospitalization.  However, they didn’t help those already hospitalized and outcomes were worse in those receiving high-flow oxygen or mechanical ventilation.  Experts suspect that infusions given within the first 3 days of symptoms will be more effective than when given later.  This is similar to what we have experienced with the use of oseltamivir (Tamiflu) in Influenza or antivirals with shingles.  

Our SNF residents may be the primary beneficiaries of these new medications.   Since early diagnosis is important, the use of POC (Point of Care) antigen testing in symptomatic residents may trigger a timely request for this infusion.  In most communities, these medicines have been distributed to hospitals, even though they are not indicated for hospitalized patients—and some hospitals have outpatient or ED-associated infusion areas that can accommodate these infusions.  Many of the larger long-term care dispensing pharmacies also have access, through CDPH, local health departments, Operation Warp Speed, or other sources.  Now is the time to request your in-house pharmacy supports their use on-site, thereby avoiding transfers to the ER.

Earlier this month, AMDA, The Society for Post-Acute and Long-Term Care Medicine, released a PowerPoint presentation on this subject by Dr. David Nace, which provides resources for safely providing this service on-site.   There is no cost to the infusions under the EUA, although the dispensing pharmacy may charge a fee for preparing the solution.  Also, facilities may bill $309 for providing the infusion under Medicare Part B.

Most facilities in our state have had outbreaks in the past year.  The option for an infusion of monoclonal antibodies would have been welcome.  Now at least on a limited basis, these infusions are available and being provided under the EUA in our facilities.  If you are interested in obtaining monoclonal antibodies in your building, contact your pharmacy, local health department, local hospitals, home infusion companies, or other potential sources.  CALTCM may be able to help if you are having problems.  Preparing your staff is crucial for these infusions to become a viable option.  To date, the biggest obstacle has been the lack of staff time to start the IV, hang the infusion, and monitor the patient for the one-hour infusion and for one hour afterwards.

Visit CALTCM COVID-19 Vaccine Documents Webpage
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Comments on "Using Monoclonal Antibodies in LTC"

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Ian Light - Monday, January 04, 2021

Consideration to give monoclonal antibodies pre and post exposure would allow more time to set up infusions in the highly at risk . These are the cases of both immunosuppressed at very high risk and not enough time for one vaccine to take an effect namely 7-14 days .

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