Antibody infusion shows 80% effectiveness in nursing home patients

By , Daily Memphian Updated: January 23, 2021 7:43 PM CT | Published: January 23, 2021 4:00 AM CT

The monoclonal antibody treatment hospitals in Shelby County have been using since early November showed promising results in the latest batch of testing, done in nursing homes.

The drug, bamlanivimab, a synthetic antibody created by Eli Lilly and Co., reduced the risk of staff and residents contracting COVID-19 by about 57%. The effect among nursing homes residents alone was much greater at 80%, Lilly reported Thursday, Jan. 21.

“We are exceptionally pleased with these positive results, which showed bamlanivimab was able to help prevent COVID-19, substantially reducing symptomatic disease among nursing home residents, some of the most vulnerable members of our society,” said Dr. Daniel Skovronsky, Lilly’s chief scientific officer and president of Lilly Research Laboratories.

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Experts say it may be one of the biggest breakthroughs yet in COVID research because as an early-stage treatment, it has the power to keep people from getting sicker and needing to be admitted to a hospital.

“Anything we can do to prevent people from getting sick and needing hospitalization is a huge advantage,” says Dr. Todd Rice, head of the COVID intensive-care unit at Vanderbilt University Medical Center.

“This gives us another treatment in a population that didn’t have a treatment.”

He and other physicians expect the findings will increase demand for bamlanivimab, which is administered by an intravenous infusion that takes about an hour. Patients must stay for at least an hour afterward for observation.

“As we get more and more information and understand the benefits, more people will be more willing to do it,” Rice said.

The issue remains that people have to hear about it, find an infusion center, have a way to get there and do it in the early stage of disease, he said.

“If you are positive, that’s not a guarantee that you are going to get sick, and people know this,” Rice said. “Most people who get the virus are OK.

“If I told you, ‘You are going to be hospitalized if you don’t do this,’ people are likely to do it. But if it’s a one in 10 chance you’re going to be hospitalized, people say, ‘Well, the odds are still in my favor.’ ”

But for people with underlying conditions, the chances are higher, “especially if they have multiple conditions, which is common with these conditions,” Rice said.

The FDA approved bamlanivimab for emergency use in early November, limiting it to patients who had the greatest risk of becoming very ill with COVID, which were those 65 and older or younger people with specific underlying conditions, including chronic kidney disease, hypertension and obesity.

Lilly anticipates authorization now could be expanded to younger people.

Kitty King, 70, had the infusion Wednesday, Jan. 20, at Baptist Memorial Hospital-Memphis, on the advice of her husband’s physician, who was concerned that his underlying conditions would make him vulnerable to serious COVID if he became infected by her.

“I had not heard of the treatment,” King said. “I probably would not have done it on my own.”

King, from Slayden, Mississippi, was diagnosed with COVID on Sunday, Jan. 17. While she was feeling better when she came to Baptist for the infusion, “I know you can be OK at one point and an hour later, pretty bad. I would rather just be good than take a chance,” she said.

King would not have qualified due to her husband’s health issues, but she has diabetes. Part of the issue now is educating primary care physicians about the treatment, who qualifies and where the nearest infusion center is.

<strong>Dr. Stephen Threlkeld</strong>

Dr. Stephen Threlkeld

“Increasingly we hear from physicians,” said Dr. Stephen Threlkeld, who administers the treatment at Baptist-Memphis. “Many are very much in tune to this possibility … We also get people who come for the infusion but are already too sick. Their oxygen is low, and we have to send them to the hospital for other therapies.”

The treatment works by flooding the bloodstream with synthetic antibodies most effective at attacking the spike protein on the virus and preventing it from attaching and replicating.

There is no cost for the drug itself, although infusion centers may charge to administer it.

Bamlanivimab may work better than convalescent plasma because the level of antibody in the donor plasma depends on the severity of COVID illness that donor experienced.

“We’ve eliminated the variability by making the concentration of the most effective antibodies,” Threlkeld said. “Yes, in theory, it could be better than convalescent plasma.”

Baptist has used bamlanivimab to treat well over 200 people since November. Only eight of them later required hospitalization, a sign, Threlkeld said, of its promise.

But still, the demand has been up and down for bamlanivimab, both Threlkeld and Rice say, in part because it must be administered shortly after symptoms emerge and is targeted to the most vulnerable group expected to have serious disease.

It’s also not easy to be approved to administer the therapy. It requires a freestanding infusion center that can also accommodate people with contagious disease.

“When it first came out, there was big concern that there just wouldn’t be enough to go around,” Threlkeld said. “It turns out, not many were situated to give the drug.”

Baptist converted two rooms in an infusion center in Threlkeld’s practice at 6029 Walnut Grove Road. As a result, Baptist was among the first in the nation to be able to give the infusions.

Methodist Le Bonheur Healthcare later added the treatment. It did not respond to requests for the number of infusions it has given.

Public health officials have championed the therapy, including former chief of the Centers for Disease Control and Prevention, Dr. Robert Redfield, and local public health officials.

In mid-December, Redfield said states should be pushing to develop networks of infusion centers to aid the cause.

Seven infusion centers in the Memphis area are on a list provided by the state; five of them are in Baptist or Methodist facilities.

“Over the last week or so, there’s been less demand,” Threlkeld said. “Nationally, the drug has gone unused to a much larger degree than people had anticipated.”

The findings released on Thursday by Lilly were the first from a large-scale, randomized clinical trial. It was conducted by National Institute of Allergy and Infectious Diseases and the COVID-19 Prevention Network. It included 965 patients and staff with negative COVID tests and 132 with COVID.

The study was done in numerous nursing homes across the nation, rare for a clinical trial.

The results were consistent with the findings from two previous studies and were overseen by an independent data and safety monitoring board.

Lilly now has collected safety and efficacy data in more than 4,000 patients treated with bamlanivimab, either alone or administered with another antibody.

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bamlanivimab monoclonal antibodies synthetic Dr. Stephen Threlkeld Dr. Todd Rice Eli Lilly
Jane Roberts

Jane Roberts

Longtime journalist Jane Roberts is a Minnesotan by birth and a Memphian by choice. She's lived and reported in the city more than two decades. She covers healthcare and higher education for The Daily Memphian.

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