Rubin Emily B, Liu Mofei, Giobbie-Hurder Anita, Canha Lauren A, Keleher C Elizabeth, Sullivan Keri M, Dougan Michael
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Division of Biostatistics, Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Open Forum Infect Dis. 2022 Apr 12;9(6):ofac182. doi: 10.1093/ofid/ofac182. eCollection 2022 Jun.
Several monoclonal antibodies (mAbs) have been shown to reduce rates of hospitalization in patients with coronavirus disease 2019 (COVID-19) who have risk factors for severe disease. Due to capacity constraints, many health systems have been unable to provide mAbs to all eligible patients. There is little evidence regarding the performance of triage protocols for allocation or the relative effectiveness of subcutaneous administration vs intravenous infusion.
This was a retrospective cohort study of 1063 patients with COVID-19 consecutively referred for monoclonal antibody therapy in a single large academic health care system, who were prioritized for mAb therapy using an allocation protocol grouping patients by risk.
A triage protocol prioritizing patients who were not fully vaccinated and were at high risk of severe COVID-19 and patients who were heavily immunosuppressed performed well in terms of differentiating between groups of patients by risk of severe disease. The number needed to treat (NNT) to prevent 1 hospitalization was 4.4 for the highest priority group, 8.5 for the next highest priority group, and 21.7 for the third highest priority group. There was no significant correlation between route of administration and hospitalization for symptoms related to COVID-19 (odds ratio, 1.26 in the intravenous group compared with the subcutaneous group; 95% CI, 0.56-2.8; = .58).
This study demonstrates that triaging mAbs for patients with COVID-19 by risk can optimize benefit in terms of reducing rates of hospitalization and that rates of hospitalization may be no different between patients treated with subcutaneous injection and patients treated with intravenous infusion.
几种单克隆抗体（mAb）已被证明可降低患有2019冠状病毒病（COVID-19）且有重症风险因素患者的住院率。由于能力限制，许多医疗系统无法为所有符合条件的患者提供单克隆抗体。关于分配的分诊方案的效果或皮下给药与静脉输注的相对有效性，几乎没有证据。
这是一项对在一个大型学术医疗系统中连续转诊接受单克隆抗体治疗的1063例COVID-19患者的回顾性队列研究，这些患者使用按风险对患者进行分组的分配方案被优先给予单克隆抗体治疗。
一种优先考虑未完全接种疫苗且有严重COVID-19高风险的患者以及严重免疫抑制患者的分诊方案，在按重症风险区分患者组方面表现良好。预防1例住院所需治疗人数（NNT），最高优先级组为4.4，次高优先级组为8.5，第三高优先级组为21.7。与COVID-19相关症状的给药途径与住院之间无显著相关性（静脉组与皮下组相比，优势比为1.26；95%CI，0.56 - 2.8；P = 0.58）。
本研究表明，按风险对COVID-19患者进行单克隆抗体分诊可在降低住院率方面优化获益，并且皮下注射治疗的患者与静脉输注治疗的患者住院率可能没有差异。
