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Monoclonal antibody infusions therapy for COVID-19

written by PEPPER VAN TASSELL

Days before retired nurse Ruby Blahut contracted COVID-19, her daughter, Cathy Miles – a nurse at Meritus Medical Center – learned of a newly approved therapy offered at the Washington County hospital that ultimately helped save her mother’s life.

In the days after Thanksgiving, Blahut and Miles , who is clinical manager of the operating room at Meritus, contracted COVID-19. At the same time, Meritus Medical Center started offering monoclonal antibody infusions for the treatment of the virus. They were reserved for those with a mild to moderate infection, and who were at greater risk of serious illness or death from the disease. Blahut, an 82-year-old retired hospice nurse who suffers from chronic bronchitis, met the criteria and was treated within the first week.

“My daughter was scared, and so when this program – when that came up about the IV – she immediately had me call the doctor,” Blahut said. “I got arrangements to go in and, oh, I’m so thankful.”

One more tool

The U.S. Food and Drug Administration granted emergency-use authorization of bamlanivimab as a monoclonal antibody infusion therapy in early November, followed a few weeks later by the approval of more antibody treatments. Bamlanivimab, which was the first treatment Meritus offered, has since been discontinued as a single-use therapy due to its inefficacy against variants, but a mix of approved antibodies in combination therapies are being administered instead, said Dr. Aaron George, chief medical officer at Meritus.

“It gave us one more option to try to treat patients before they cross the threshold of our emergency room,” George said. “This just gave us one more opportunity to respond to this pandemic.”

Following FDA approval, states quickly identified hospitals to offer the infusions. Maryland selected four hospitals to launch the treatment, including Meritus to serve the western part of the state. There are now 20 such infusion sites throughout the state, he said.

“We had the ability to do it. We had the expertise in the center for it and we were geographically in an ideal place, as well,” George said.

Before the launch of the COVID infusion center, which is adjacent to the hospital, and separate from the hospital’s primary infusion center, hospital staff and the system’s doctors were apprised of the new treatment and its criteria – including a need for referrals, he said. In the infusion center’s first week, five people were treated. By year’s end, 199 patients received the infusion. A total of 1,070 patients had received the treatment as of May 12. As of May 7, Washington County recorded 14,532 confirmed cases of COVID-19 and 276 deaths, according to the Washington County Health Department website.

A ticking clock

George explained that the infusions slow disease progression by helping the body recognize the virus so it can’t replicate.

That is why patients must act within the first 10 days of illness to receive it. Those who have progressed to requiring hospitalization or oxygen therapy are not eligible. Anyone older than 12 with a moderate to severe risk of serious illness or death – with immunocompromising conditions, such as chronic kidney disease, diabetes, obesity and some underlying congenital diseases – are eligible, George said. Among the high-risk population, he said the infusions have helped create a 10% reduction in the need for hospitalization.

Soon after testing positive, Blahut developed a terrible cough, and Miles had her mother breathe into a spirometer to help open her lungs.

“She got very weak, and the cough got progressively worse, so that’s when I wanted to take her to the emergency room or the (monoclonal antibody infusion) clinic that just opened,” Miles said.

Immediately after the treatment, Miles noticed an improvement in her mother’s respiratory function.

Help for diabetics

Angie Butler heard of the treatment through a cousin who recovered from coronavirus following an infusion. In January – when Washington County was experiencing a surge in COVID-19 cases – Butler ’s twin 20-year-old daughters, Meghan and Caitlin, and her 17-year-old son, Aaron – all of whom worked at the same restaurant – started to get headaches almost simultaneously. On their third day of symptoms – some of which mimicked those of allergies – all three tested positive for the virus.

The 42-year-old mom tested positive for the virus four days after her children, developing cold symptoms and a bad cough.

“The exhaustion just pushed everything out, and you just didn’t know if you could deal with it,” Butler said.

Butler, who has Type 1 diabetes, began to worry about the progression of the disease in herself and Aaron, who has juvenile diabetes.

“For me – when I got it – I was most concerned for my son, but when I looked into it, I thought there is no reason not to do this,” she said.

Butler’s doctor, with approval from Aaron’s doctor, helped arrange for the two diabetics to go to Meritus for the infusion.

“I had asked before we left how quickly we’ll feel better,” Butler said. “He said, ‘This is more: You don’t want to get sicker. This should help you from getting sicker than you are now.’”

Butler received the infusion on her fourth day of illness, and Aaron got it on his seventh day.

“Aaron had been getting sicker,” Butler said. “It’s hard with diabetes. When you’re sick, you have to keep your sugar level. He was really exhausted. His sugar was going up and down, and he started having trouble tasting things. We were both going downhill more than anything else.”

A quick process

Within 30 minutes of arriving at the infusion center for the treatment, Butler said she and Aaron were hooked up to IVs, and 45 minutes after that, the infusions were finished. Blahut reported the same.

“When Aaron came home – shortly after – he never had another headache,” Butler said. At the time of the interview, 90 days had passed since Butler and Aaron received their infusions, making them eligible for vaccination. Butler said her family was planning to get the Pfizer vaccine the next day.

Blahut said she was thankful to receive a vaccine about 90 days after her infusion.

Butler said she wasn’t always planning on getting vaccinated, but her experience with COVID-19 changed her mind.

“I’m just ready for this whole thing to be over,” she said. “Too many people are getting sick, and it’s just getting terrible.”

Continued need

George said Washington County was about 30% fully vaccinated at the time of his May 12 interview, and that its older adult population was more than 70% fully vaccinated. As the vaccination rates go up, he said the number of people seeking infusion therapy goes down. He added, however, that the need for the infusion therapy has not changed.

When the hospital began offering the infusions, George said the daily average COVID-19 hospitalization rate was about 30 to 40 people a day, a number that reached a peak in December and January, with about 90 people hospitalized on average. The average now is about 15 to 20 people, he said.

“We’re not out of the woods yet,” he said. “We’ll keep using monoclonal antibodies as one way to respond to this, but really, I just want to continue to emphasize the need for everyone in our community to be vaccinated.”

Ruby Blahut receives a monoclonal antibody infusion.

Submitted photo