Early monoclonal antibody combo for COVID-19 cuts hospital, death rates
Yesterday in the New England Journal of Medicine results from a phase 3 trial showed that a combination of bamlanivimab plus etesevimab monoclonal antibodies led to a lower incidence of COVID-19–related hospitalization and deaths.
The therapy also accelerated the decline in the SARS-CoV-2 viral load in patients who received the treatment, if administered within 3 days of diagnosis of mild to moderate COVID-19 in patients with at least one risk factor for developing serious disease.
The trial including 1,095 patients who either received a single intravenous infusion of either a neutralizing monoclonal-antibody combination agent (2,800 milligrams [mg] of bamlanivimab and 2,800 mg of etesevimab, administered together) or placebo within 3 days after a laboratory diagnosis of SARS-CoV-2 infection, the authors said.
By day 29 after infusion, 11 of 518 patients (2.1%) in the bamlanivimab-etesevimab group had a COVID-19–related hospitalization or death as compared with 36 of 517 patients (7.0%) in the placebo group (absolute risk difference, −4.8 percentage points; 95% confidence interval [CI], −7.4 to −2.3; relative risk difference, 70%; P < 0.001).
No deaths occurred in the monoclonal antibody group. In the placebo group, 10 deaths occurred, 9 of which were designated as caused by COVID-19.
“These results provide support for the potential of neutralizing monoclonal-antibody therapy to reduce both the risk of progression to severe disease and the severity of disease among high-risk patients with symptomatic Covid-19,” the authors concluded.
In an editorial audio interview, editors of the journal said though the results are positive, the use of the antibodies in a single intravenous infusion had limited real-world application for outpatients. And determining day 3 or 4 of infection was a difficult task with a virus that presents so differently across the patient population.
Jul 14 N Engl J Med study
Jul 14 N Engl J Med editorial
Learning disabilities tied to higher risk of COVID-19 hospitalization, death
Adults with learning disabilities who were diagnosed as having COVID-19 were five times more likely to be hospitalized and eight times more likely to die during England’s first COVID wave, according to a study in BMJ. The researchers noted that data from the second wave (September 2020 to early February 2021) showed similar results.
During the first COVID-19 wave, which ran from Mar 1 to Aug 31, 2020, the researchers looked at electronic health records for 14,312,023 adults 16 and older, of whom 90,307 (0.63%) were in the national learning disability register. Of this subgroup, 0.6% (538) were hospitalized for COVID and 0.25% (222) died from the disease, compared with 0.2% (29,781) of adults not on the registry who were hospitalized for COVID and 0.1% (13,737) who died from it. The adjusted hazard ratio for COVID hospitalization was 5.3 (95% confidence interval [CI], 4.9 to 5.8); for COVID-related death, it was 9.2 (95% CI, 7.2 to 9.4).
The researchers also found increased associated COVID-19 risks for children with learning disabilities (albeit in small absolute numbers) as well as adults with Down syndrome or cerebral palsy.
Adults on the register were more likely to be male, be younger, live in more deprived areas, and have diabetes, obesity, other neurologic disease, or a serious mental illness. About 82% were considered to have mild to moderate learning disability.
“We must work much harder to reduce the health inequalities exposed and amplified by the pandemic—including further training of all health and care staff about the needs of people with learning disabilities and the health inequalities they face,” write Ken Courtenay, MB BCh, and Vivien Cooper, CEO of the Challenging Behaviour Foundation, in a commentary that highlighted concerning no-resuscitation orders and the need for better vaccination priority.