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The Efficacy of Bamlanivimab in Reducing Emergency Department Visits and Hospitalizations in a Real-world Setting

Corwin et al., Open Forum Infectious Diseases, doi:10.1093/ofid/ofab305

Jun 2021

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Bamlanivimab/etesevimab

20th treatment shown to reduce risk in May 2021

^*, now known with p = 0.00029 from 20 studies, recognized in 4 countries. Efficacy is variant dependent.

Lower risk for mortality, hospitalization, recovery, cases, and viral clearance.

No treatment is 100% effective. Protocols combine complementary and synergistic treatments. ^* >10% efficacy in meta analysis with ≥3 clinical studies.

4,000+ studies for 60+ treatments. c19early.org

Retrospective 780 bamlanivimab patients and 5,337 patients not receiving treatment, showing lower hospitalization and ER visits with treatment.

Confounding by treatment propensity. This study analyzes a population where only a fraction of eligible patients received the treatment. Patients receiving treatment may be more likely to follow other recommendations, more likely to receive additional care, and more likely to use additional treatments that are not tracked in the data (e.g., nasal/oral hygiene c19early.org, c19early.org (B), vitamin D c19early.org (C), etc.) — either because the physician recommending bamlanivimab/etesevimab also recommended them, or because the patient seeking out bamlanivimab/etesevimab is more likely to be familiar with the efficacy of additional treatments and more likely to take the time to use them. Therefore, these kind of studies may overestimate the efficacy of treatments.

Efficacy is highly variant dependent. In Vitro research suggests a lack of efficacy for omicron Haars, Liu, Pochtovyi, Sheward, VanBlargan.

1. c19early.org, c19early.org/p.c19early.org/p.

2. c19early.org (B), c19early.org/ph.c19early.org/ph.

3. c19early.org (C), c19early.org/d.c19early.org/d.

4. Haars et al., Prevalence of SARS-CoV-2 Omicron Sublineages and Spike Protein Mutations Conferring Resistance against Monoclonal Antibodies in a Swedish Cohort during 2022–2023, Microorganisms, doi:10.3390/microorganisms11102417.mdpi.com, doi.org.

5. Liu et al., Striking Antibody Evasion Manifested by the Omicron Variant of SARS-CoV-2, bioRxiv, doi:10.1101/2021.12.14.472719.biorxiv.org, doi.org.

6. Pochtovyi et al., In Vitro Efficacy of Antivirals and Monoclonal Antibodies against SARS-CoV-2 Omicron Lineages XBB.1.9.1, XBB.1.9.3, XBB.1.5, XBB.1.16, XBB.2.4, BQ.1.1.45, CH.1.1, and CL.1, Vaccines, doi:10.3390/vaccines11101533.mdpi.com, doi.org.

7. Sheward et al., Variable loss of antibody potency against SARS-CoV-2 B.1.1.529 (Omicron), bioRxiv, doi:10.1101/2021.12.19.473354.biorxiv.org, doi.org.

8. VanBlargan et al., An infectious SARS-CoV-2 B.1.1.529 Omicron virus escapes neutralization by several therapeutic monoclonal antibodies, bioRxiv, doi:10.1101/2021.12.15.472828.biorxiv.org, doi.org.

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risk of death, 80.5% lower, RR 0.20, p = 0.08, treatment 1 of 780 (0.1%), control 35 of 5,337 (0.7%), NNT 190.

risk of hospitalization, 39.4% lower, RR 0.61, p < 0.001, treatment 57 of 780 (7.3%), control 490 of 5,337 (9.2%), odds ratio converted to relative risk.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

Corwin et al., 10 Jun 2021, retrospective, USA, peer-reviewed, 8 authors, study period 23 November, 2020 - 17 January, 2021. Contact: douglas.corwin@sluhn.org.

This Paper Bamlaniv../e..All

The Efficacy of Bamlanivimab in Reducing Emergency Department Visits and Hospitalizations in a Real-world Setting

MD Douglas S Corwin, Peter T Ender, Nitasa Sahu, Ryan A Durgham, Dennis M Mcgorry Jr, Awan Rahman, Jill Stoltzfus, Jeffrey A Jahre

Open Forum Infectious Diseases, doi:10.1093/ofid/ofab305

Bamlanivimab, a monoclonal antibody targeting the spike protein of severe acute respiratory syndrome coronavirus 2, is available for ambulatory treatment of coronavirus disease 2019 . This real-world study confirms the efficacy of bamlanivimab in reducing hospital admissions and emergency department visits among high-risk outpatients with mild to moderate COVID-19 illness and reveals a trend toward improved mortality.

Author contributions. D.S.C., P.E., N.S., R.D., and J.S. drafted the initial manuscript. All authors reviewed, contributed to the revision and approved the final manuscript. D.S.C. had full access to manuscript and final responsibility to submit for publication.

References

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Goldhill, Hospitals in half the states are facing a massive staffing shortage, STAT

Gottlieb, Nirula, Chen, Effect of bamlanivimab as monotherapy or in combination with etesevimab on viral load in patients with mild to moderate COVID-19: a randomized clinical trial, JAMA

Halpin, Criner, Papi, Global initiative for the diagnosis, management, and prevention of chronic obstructive lung disease. The 2020 GOLD Science Committee report on COVID-19 and chronic obstructive pulmonary disease, Am J Respir Crit Care Med

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Leatherby, Keefe, Tompkins, There's no place for them to go': I.C.U. beds near capacity across U.S. The New York Times

O'hearn, Liu, Cudhea, Coronavirus disease 2019 hospitalizations attributable to cardiometabolic conditions in the United States: a comparative risk assessment analysis, J Am Heart Assoc

Wang, Nair, Liu, Increased resistance of SARS-CoV-2 variants B.1.351 and B.1.1.7 to antibody neutralization

Wickham, R packages for data science

Widera, Wilhelm, Hoehl, Bamlanivimab does not neutralize two SARS-CoV-2 variants carrying E484K in vitro

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