Individuals at High Risk for Severe COVID-19 Are Often Least Likely to Get mAbs

Monoclonal antibodies are highly effective at treating the virus, but they have often gone to the healthiest patients, instead of those over aged 65 years.

Individuals over aged 65 years old at the highest risk for severe COVID-19 have often been the least likely to receive monoclonal antibodies (mAbs) both across and within the United States, according to new research from investigators at the Harvard TH Chan School of Public Health and published in JAMA.

“Monoclonal antibodies should first go to patients at the highest risk of death from COVID-19, but the opposite happened; the healthiest patients were the most likely to get treatment,” Michael Barnett, assistant professor of health policy and management at Harvard Chan School, said in a statement. “Unfortunately, our federal and state system for distributing these drugs has failed our most vulnerable patients.”

Monoclonal antibodies are very effective at treating mild to moderate COVID-19 infection among non-hospitalized individuals. However, during the pandemic, mAbs have been in short supply.

Federal guidelines prioritize individuals at higher risk of being hospitalized or dying from COVID-19, including older individuals and those with chronic conditions.

Investigators aimed to learn how limited the supply of mAb therapy was allocated to individuals at highest risk for severe disease. They analyzed data from more than 1.9 million Medicare beneficiaries who had been diagnosed with COVID-19 between November 2020 and August 2021.

They compared the rates of receiving mAbs by age, ethnicity, race, region, number of chronic conditions, and sex.

Among Medicare beneficiaries who were not hospitalized or who did not die within 7 days of diagnosis, investigators found that just 7.2% received mAb therapy. The likelihood of receiving mAbs was higher among those with fewer chronic conditions, with 23.2% of those with no chronic conditions receiving mAbs, versus 6.3%, 6%, and 4.7% for those with 1 to 3, 4 to 5, and 6 or more chronic conditions, respectively. They also found that Black individuals were less likely to receive mAbs than white individuals at 6.2% compared with 7.4%, respectively.

Furthermore, there were significant differences among states when it came to mAb treatment.

For example, Rhode Island and Louisiana administered mAbs to the highest proportion of non-hospitalized individuals with COVID-19 at 24.9% and 21.2%, respectively, compared with Alaska and Washington, where the lowest proportion was administered, at 1.1% and 0.7%.

Southern states had the highest rates of mAb therapy at 10.6%, while states in the West had the lowest rates at 2.9%.

As for why mAb therapy failed to reach the highest risk individuals, higher risk individuals may have had difficulty navigating the multiple steps needed to receive mAbs, from receiving a timely diagnosis to referral and scheduling an infusion within 10 days, investigators said.

Additionally, the differences among states could suggest that mAb supply may have been lower or less used by physicians in some regions of the United States.

The National Institute of Aging and the Agency for Healthcare Research and Quality funded the study.

Reference

Those at highest risk for severe COVID-19 often least likely to get monoclonal antibodies. EurekAlert. News release. February 4, 2022. Accessed February 7, 2022. https://www.eurekalert.org/news-releases/942441