The Efficacy of Bamlanivimab in Reducing Emergency Department Visits and Hospitalizations in a Real-world Setting
Corwin et al.,
The Efficacy of Bamlanivimab in Reducing Emergency Department Visits and Hospitalizations in a Real-world..,
Open Forum Infectious Diseases, doi:10.1093/ofid/ofab305
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 receive adjuvant
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. 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 [Liu, Sheward, VanBlargan].
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.
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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.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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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.
Abstract: Open Forum Infectious Diseases
BRIEF REPORT
The Efficacy of Bamlanivimab in
Reducing Emergency Department
Visits and Hospitalizations in a
Real-world Setting
Douglas S. Corwin,1 Peter T. Ender,2 Nitasa Sahu,1 Ryan A. Durgham,3
Dennis M. McGorry Jr.,4 Awan Rahman,1 Jill Stoltzfus,5 and Jeffrey A. Jahre2
1
Bamlanivimab, a monoclonal antibody targeting the spike protein
of severe acute respiratory syndrome coronavirus 2, is available
for ambulatory treatment of coronavirus disease 2019 (COVID19). 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.
Keywords.
bamlanivimab; COVID-19; treatment;
outcomes.
Limited ambulatory treatment options exist for coronavirus
disease 2019 (COVID-19), the syndrome caused by severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2), which contributes to the profound morbidity and mortality associated
with this illness [1, 2]. The striking number of people afflicted
with COVID-19 has resulted in a dramatic increase in health
care resource requirements. More than a third of Americans
live in locations with a critical bed shortage during a surge
of cases of COVID-19, including metropolitan areas in the
Middle Atlantic and Northeastern States [3]. This high degree
of health care utilization has led to concerns about the quantity
of resources available and ability to maintain a proper standard
of care.
In November 2020, bamlanivimab (LY-CoV555; Lilly), an
IgG1 monoclonal antibody that binds to the receptor-binding
Received 30 March 2021; editorial decision 1 June 2021; accepted 9 June 2021.
Correspondence: D.S. Corwin, MD, St Luke’s University Health Network, 709 Delaware Ave,
Fountain Hill, PA 18015 (douglas.corwin@sluhn.org).
Open Forum Infectious Diseases®2021
© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases
Society of America. This is an Open Access article distributed under the terms of the Creative
Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/
by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any
medium, provided the original work is not altered or transformed in any way, and that the
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DOI: 10.1093/ofid/ofab305
METHODS
St. Luke’s University Health Network (SLUHN) includes 12 hospitals, 76 primary care sites, and 18 urgent care centers in Eastern
Pennsylvania and Western New Jersey. Testing for COVID-19
occurred at dedicated outpatient testing sites and emergency departments within the St. Luke’s Network. The analysis included
patients treated with a single dose of 700 mg of bamlanivimab
infused over 60 minutes from November 23, 2020, until January
17, 2021. Due to limited seat availability for infusion, in the setting of a large surge of patients in the region, only patients who
were ≥65 years of age and/or had a BMI ≥35 with a positive
COVID-19 test by polymerase chain reaction (PCR) within
7 days of symptoms received bamlanivimab treatment. One
bamlanivimab infusion center is in Eastern Pennsylvania, and
the other is in Western New Jersey. Referral for treatment was
at the discretion of the primary care physician (PCP). A follow-up visit occurred 48 hours after the infusion with a PCP
within SLUHN to..
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