1. Patients from a large academic medical center with mild to moderate COVID-19 in receipt of the monoclonal antibody bamlanivimab had a lower 30-day rate of hospitalization.
Evidence Level Rating: 2 (Good)
Despite the extent to which SARS-CoV-2 has impacted the world and the delivery of medicine and pharmacotherapeutics, remdesivir, an RNA-dependent RNA polymerase, remains the only drug approved by the U.S. Food and Drug Administration (FDA) expressly for the treatment of COVID-19. Neutralizing monoclonal antibodies, such as bamlanivimab, bind to the virus’s spike protein and prevent attachment to human surface ACE2 receptors and have shown promise in some clinical trials. This study described the impact on hospitalization rate of bamlanivimab as monotherapy for mild to moderate COVID-19 infection among high-risk ambulatory patients. 218 patients who received bamlanivimab (median [IQR] age = 66 [57-74] years, 52.8% male) were matched with 185 patients who were referred for but ultimately did not receive bamlanivimab (median [IQR] age = 62 [50-72] years, 51.4% male). Of note, patients in receipt of bamlanivimab were more likely to be older, immunosuppressed, or have a chronic lung disease. Patient who were white and spoke English were also significantly more likely to receive bamlanivimab. The 30-day hospitalization rate, the primary outcome, was 7.3% in the bamlanivimab cohort and 20.0% in the control cohort (RR 0.37, 95% CI 0.21 to 0.64, p < 0.001), yielding a number needed to treat of 8 to prevent one hospitalization. In a multivariate analysis, not receiving bamlanivimab and a high total number of comorbidities were associated with a 4.19- and 1.68-times increased risk of hospitalization. The study was not sufficiently powered to assess the significance of ICU admission, intubation, or mortality at 30 days. In all, this study suggests that patients with mild to moderate COVID-19 who received bamlanivimab had a lower 30-day rate of hospitalization.
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