Doses Of Antibody Drugs Remain Unused As They Present Various Challenges
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The federal government says it has delivered more than 300,000 doses of monoclonal antibody drugs to health facilities nationwide. They are designed to treat patients with mild to moderate COVID-19. The idea is, keep those patients out of the hospital. But many of those doses are sitting unused, due in no small part to the challenge of administering those drugs. NPR science correspondent Richard Harris looks at two health care systems that have overcome those hurdles and are seeing hopeful results.
RICHARD HARRIS, BYLINE: Monoclonal antibodies present all sorts of challenges. They're given to people who have active infections but who aren't hospitalized, so it's important to treat them without exposing other patients to risk. The drugs, by Regeneron and Eli Lilly, are also given by infusion, and that process takes a couple of hours.
HOWARD HUANG: So when you add all this up, it - you know, it's a - really a logistical challenge to deliver this therapy to a lot of people.
HARRIS: But Dr. Howard Huang at Houston Methodist Hospital says they've figured out how to do that. They've opened clinics around Houston, and doctors affiliated with the hospital are referring eligible patients - that is, people who are over 65 or who have health conditions that put them at high risk.
HUANG: So at this point, we're doing about 50 to 70 infusions a day. And patients are usually scheduled within a relatively short period of time. So from the time they call in to being infused, it's usually less than two days.
HARRIS: The timing is important because these drugs appear to be more effective early in the course of the disease. They mostly help people who aren't mounting their own strong immune reactions. And while medication sits unused in many locations around the country, that is not the case at his hospital, Huang says.
HUANG: Right now we're constrained more by the drug supply.
HARRIS: They use it as fast as they get it. Many doctors nationwide aren't so enthusiastic about these drugs, though. Treatment guidelines issued by the National Institutes of Health say there's actually not good evidence to know whether they work. That's because the Food and Drug Administration relied on studies of just a few hundred patients to grant these drugs emergency authorization.
HUANG: So these are very small numbers that under normal conditions, nobody would ever publish in a journal like New England Journal of Medicine. But yet this is, you know, kind of headline news. Welcome to COVID time, right?
HARRIS: But doctors are gaining experience. Houston Methodist has now treated more than 1,100 patients, Huang says.
HUANG: We're seeing results that are comparable to what was reported in the clinical trials by Eli Lilly and Regeneron.
HARRIS: About 6- or 7% of patients who are treated end up in the hospital or emergency room. He figures that without treatment, about 15% of the most high-risk patients could end up in the hospital or ER.
Doctors affiliated with the Mayo Clinic are also encouraged by their experience. They've dosed more than 2,000 patients in Minnesota, Wisconsin, Arizona and Florida. Dr. Raymund Razonable has done a preliminary analysis of the first thousand or so patients and finds low hospitalization rates.
RAYMUND RAZONABLE: More importantly, there is some signal that is also reducing death. But again, these are preliminary analysis. We have to kind of make sure that these are all vetted by peer review. But this is what we're seeing. That's why we're happy.
HARRIS: Unlike a clinical trial, this real-world experience doesn't have a careful comparison group, so doctors can't say for sure that these patients are faring better. Even so, these encouraging findings may be swaying doctors who weren't sure they wanted to refer their patients for treatment. Razonable says patients are also becoming less skeptical.
RAZONABLE: Initially, there were more declines than accepts, but now we're actually seeing more accept than declines.
HARRIS: And even though it takes a lot of person power to provide this treatment, Razonable and Huang believe they're actually reducing the overall workload by keeping patients out of the hospital.
Richard Harris, NPR News.
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