Monoclonal Antibodies against SARS-CoV-2: Potential Game-Changer Still Underused

Even several months after the start of a massive vaccination campaign against COVID-19, mortality and hospital admission are still high in many countries. Monoclonal antibodies against SARS-CoV-2 are the ideal complement to vaccination in infected subjects who are at high risk for progression to severe disease. Based on data of the Italian Ministry of Health, in the period April–August 2021, monoclonal antibodies were prescribed to 6322 patients. In the same period, 70,022 patients over 70 years old became infected with SARS-CoV-2. Even considering that all monoclonal antibodies were prescribed to this category of patients, we calculated that only 9% of these subjects received the treatment. Moreover, using efficacy data provided by clinal trials, we estimated the potential benefit in terms of reduction of hospital admissions and deaths. Considering utilisation of monoclonal antibodies in half infected patients over 70 years, we estimated that hospital admissions and deaths might have been reduced by 7666 and 3507, respectively. Finally, we calculated the economic benefit of monoclonal use. In the same scenario (50% use of monoclonal antibodies to patients over 70), we estimated potential savings of USD 117,410,105. In conclusion, monoclonal antibodies were used in a small proportion of patients over 70 in Italy. A more extensive use might have resulted in a marked decrease in hospital admissions, deaths and in conspicuous saving for the health system.

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Monoclonal antibodies against SARS-CoV-2: potential game-changer still underused

10.1101/2021.09.27.21264191 ◽

2021 ◽

Author(s):

Ivan Gentile ◽

Alberto Enrico Maraolo ◽

Antonio Riccardo Buonomo ◽

Mariano Nobile ◽

Prisco Piscitelli ◽

...

Keyword(s):

Monoclonal Antibodies ◽

High Risk ◽

Hospital Admission ◽

Hospital Admissions ◽

Severe Disease ◽

Vaccination Campaign ◽

Potential Game ◽

Combining Data ◽

Game Changer ◽

The Ideal

AbstractEven several months after the start of a massive vaccination campaign against COVID-19, mortality and hospital admission are still in considerable numbers in many nations. Monoclonal antibodies are the ideal complement to vaccination in high-risk subjects who have been infected by SARS-CoV-2 and are at high risk of developing severe disease. Combining data provided by clinal trials and demographics of SARS-CoV-2 infections, this analysis tries to predict the benefits of an extensive use of monoclonal antibodies to reduce hospital admissions, deaths, and costs.

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Effective use of monoclonal antibodies for treatment of persistent COVID-19 infection in a patient on rituximab

BMJ Case Reports ◽

10.1136/bcr-2021-243469 ◽

2021 ◽

Vol 14 (8) ◽

pp. e243469

Author(s):

Carlos X Rabascall ◽

Becky X Lou ◽

Brianne Navetta-Modrov ◽

Stella S Hahn

Keyword(s):

Monoclonal Antibodies ◽

Symptom Onset ◽

Severe Disease ◽

Therapeutic Window ◽

Immunosuppressed Patient ◽

Unique Case ◽

Risk Of Progression ◽

Immunosuppressed Patients ◽

Effective Use ◽

Potential Use

As we are over a year into the COVID-19 pandemic, we have made many forward strides in therapeutics. These treatments, such as monoclonal antibodies, have help mitigate the detrimental and often fatal consequences of COVID-19. The current indication for the use of monoclonal antibodies is mild to moderate COVID-19 infection within 10 days of symptom onset in those who are at high risk of progression to severe disease. However, their role in patients with prolonged symptoms is not clear. We present a unique case of monoclonal antibodies use after 54 days of symptom onset in an immunosuppressed patient with persistent COVID-19 infection despite standard treatment. This case illustrates the potential use of monoclonal antibodies outside of the current recommended therapeutic window in immunosuppressed patients, who may have difficulty with viral clearance.

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Collateral impact of COVID-19: why should children continue to suffer?

European Journal of Pediatrics ◽

10.1007/s00431-021-03963-x ◽

2021 ◽

Cited By ~ 1

Author(s):

Prasad Nagakumar ◽

Ceri-Louise Chadwick ◽

Andrew Bush ◽

Atul Gupta

Keyword(s):

Young People ◽

Large Scale ◽

Hospital Admissions ◽

Severe Disease ◽

Children And Young People ◽

Collateral Effects ◽

Rsv Infection ◽

Syncytial Virus ◽

Set Up ◽

The Uk

AbstractThe COVID-19 pandemic caused by SARS-COV-2 virus fortunately resulted in few children suffering from severe disease. However, the collateral effects on the COVID-19 pandemic appear to have had significant detrimental effects on children affected and young people. There are also some positive impacts in the form of reduced prevalence of viral bronchiolitis. The new strain of SARS-COV-2 identified recently in the UK appears to have increased transmissibility to children. However, there are no large vaccine trials set up in children to evaluate safety and efficacy. In this short communication, we review the collateral effects of COVID-19 pandemic in children and young people. We highlight the need for urgent strategies to mitigate the risks to children due to the COVID-19 pandemic. What is Known:• Children and young people account for <2% of all COVID-19 hospital admissions• The collateral impact of COVID-19 pandemic on children and young people is devastating• Significant reduction in influenza and respiratory syncytial virus (RSV) infection in the southern hemisphere What is New:• The public health measures to reduce COVID-19 infection may have also resulted in near elimination of influenza and RSV infections across the globe• A COVID-19 vaccine has been licensed for adults. However, large scale vaccine studies are yet to be initiated although there is emerging evidence of the new SARS-COV-2 strain spreading more rapidly though young people.• Children and young people continue to bear the collateral effects of COVID-19 pandemic

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The Patient Level Cost of Asthma in Adults in South Central Ontario

Canadian Respiratory Journal ◽

10.1155/1998/362797 ◽

1998 ◽

Vol 5 (6) ◽

pp. 463-471 ◽

Cited By ~ 19

Author(s):

Wendy J Ungar ◽

Peter C Coyte ◽

Kenneth R Chapman ◽

Linda MacKeigan ◽

Keyword(s):

Cost Of Illness ◽

Hospital Admissions ◽

Severe Disease ◽

Indirect Costs ◽

Provincial Government ◽

Multiple Perspectives ◽

Drug Plan ◽

Medication Costs ◽

South Central

OBJECTIVE: To assess the annual cost of asthma per adult patient from the perspectives of society, the Ontario Ministry of Health and the patient.DESIGN: Prospective cost of illness evaluation.SETTING: Ambulatory out-patients residing in southern central Ontario.POPULATION STUDIED: Nine hundred and forty patients with asthma over 15 years of age studied between May 1995 and April 1996.OUTCOME MEASURES: Direct costs, such as respiratory-related visits to general/family practitioners, respiratory specialists, emergency rooms, hospital admissions, laboratory tests, prescription medications, dispensing fees, devices and out-of-pocket expenses, were calculated. Indirect costs, such as absences from work or usual activities, and travel and waiting time, were studied.MAIN RESULTS: Unadjusted annual costs were $2,550 per patient. Hospitalizations and medications each accounted for 22% of the total cost and indirect costs 50% of the total costs. More severe disease, older age, smoking, drug plan availability and retirement were significant predictors of costs. Annual costs per patient varied from $1,255 (95% CI $1,061 to $1,485) in young nonsmokers with no drug plan and mild disease to $5,032 (95% CI $4,347 to $5,825) in older smokers with drug plans and severe disease. Clinically important reductions in the quality of life occurred with increasing severity.CONCLUSIONS: Interventions aimed at reducing productivity losses, admissions to hospital and medication costs may result in savings to society, the provincial government and the patient. The quality of policy and allocation decisions may be enhanced by cost of illness estimates that are comprehensive, precise and incorporate multiple perspectives.

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Mesenchymal Stem Cells and Their Extracellular Vesicles: A Potential Game Changer for the COVID-19 Crisis

Frontiers in Cell and Developmental Biology ◽

10.3389/fcell.2020.587866 ◽

2020 ◽

Vol 8 ◽

Author(s):

Dina H. Kassem ◽

Mohamed M. Kamal

Keyword(s):

Stem Cells ◽

Mesenchymal Stem Cells ◽

Extracellular Vesicles ◽

Potential Game ◽

Game Changer

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P488 The COVID19 pandemic impact on Inflammatory Bowel Disease Patients Management in a Romanian Tertiary Gastroenterology Centre

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.611 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S474-S475

Author(s):

R Costache ◽

R Iacob ◽

R Vadan ◽

T Stroie ◽

L Gheorghe ◽

...

Keyword(s):

Patient Management ◽

Biological Therapy ◽

Hospital Admissions ◽

Severe Disease ◽

Time Frame ◽

Biological Agent ◽

Significant Shift ◽

Newly Diagnosed ◽

Aminosalicylic Acid ◽

Significant Difference

Abstract Background The IBD patients management has been challenging during the ongoing COVID-19 pandemic, due to lockdowns, limitation of access to medical facilities and new recommendations regarding patient management. The implications of the COVID-19 pandemic on IBD patient’s management were assessed in our Tertiary Gastroenterology Centre in Bucharest, Romania. Methods Using the hospital’s medical system, records of IBD patients admitted between 15th of March and 15th of August 2020 have been retrospectively reviewed and compared to a control cohort of consecutive IBD patients admitted to our unit during the corresponding period of 2019, registering the epidemiological features, patient management and the incidence of COVID-19 infection. Results 410 individual IBD cases were managed in our unit in 2020 compared to 532 in 2019, with a significant shift towards one-day hospitalization: 1059 admissions (9% ward hospitalizations, 91% one-day hospitalizations) compared to 1327 cases in the corresponding period of 2019 (17.8% ward hospitalizations, 82.2% one day hospitalizations). There was no statistically significant difference between the distribution of patient’s gender, IBD phenotype or newly diagnosed IBD cases between the two periods. A significantly lower proportion of admitted patients received 5-aminosalicylic acid (29% vs. 41.2%, p=0.0001), whereas a substantially higher number pf patients were prescribed biological therapy in 2020 in comparison to the corresponding 2019-time frame (79.5% vs 57.9%, p<0.0001). The distribution of the biological agent used was significantly different, mainly due to the increase of vedolizumab prescription in 2020 (p<0.0001). Among the newly diagnosed cases 50.0% had a severe disease requiring a biological agent (vs 30.2% in 2019, p>0.05). Moreover, from our previously diagnosed patients, 7.1% needed the initiation of biological therapy due to disease flare-up (vs. 4.3% in 2019, p=0.003). During the study period in 2020, seven IBD patients (1.7%) were diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection, all of them with mild symptoms without impact on the IBD course. Conclusion The COVID-19 pandemic led to reorganizing medical care, restricting the hospital admissions in favour of severe IBD cases, favouring telemedicine for mild disease and optimization of treatment for moderate to severe IBD with an increased use of biologicals aimed to maximize the risk/benefit ratio. Incidence of SARS-Cov2 infection during the first wave of COVID-19 infection in our study group was 1.7% and did not adversely impact the IBD disease course.

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