Hamilton Keith W, Hua Elvis, Dutcher Lauren, Fernandez Lynch Holly, Junker Paul, Doucette Abigail G, Werner Danielle, Kannel Ethan Z, Civitello Thomas, Gabriel Peter, Ahya Vivek N, Jacobs Dina A, Garfall Alfred, Pratz Keith, Degnan Kathleen O, Blumberg Emily A, Capozzi Donna, Craig Ethan, Takach Patricia, Payne Aimee S, Geara Abdallah, Koenig Helen, Holzman Lawrence, Tebas Pablo
Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Open Forum Infect Dis. 2024 Jul 10;11(8):ofae388. doi: 10.1093/ofid/ofae388. eCollection 2024 Aug.
During the COVID-19 pandemic, SARS-CoV-2 monoclonal antibodies for preexposure prophylaxis (SMA-PrEP) offered patients who were immunocompromised another option for protection. However, SMA-PrEP posed administrative, operational, and ethical challenges for health care facilities, resulting in few patients receiving them. Although the first SMA-PrEP medication, tixagevimab and cilgavimab, had its authorization revoked due to compromised in vitro efficacy, new SMA-PrEP medications are currently completing clinical trials. This article provides an operational framework for administrative organization, patient identification and prioritization, equitable medication allocation, medication ordering and administration, and patient tracking.
A retrospective cohort study evaluating our hospital's SMA-PrEP administration strategy was performed. Multivariable logistic regression was used to examine factors associated with receipt of SMA-PrEP.
Despite the barriers in administering this medication and the scarcity of resources, our hospital was able to administer at least 1 dose of SMA-PrEP to 1359 of 5902 (23.0%) eligible patients. Even with the steps taken to promote equitable allocation, multivariable logistic regression demonstrated that there were still differences by race, ethnicity, and socioeconomic status. As compared with patients who identified as Black, patients who identified as White (odds ratio [OR], 1.85; 95% CI, 1.46-2.33), Asian (OR, 1.59; 95% CI, 1.03-2.46), and Hispanic (OR, 1.53; 95% CI, 1.02-2.44) were more likely to receive SMA-PrEP. When compared with patients with low socioeconomic status, patients with high socioeconomic status (OR, 1.37; 95% CI, 1.05-1.78) were more likely to be allocated SMA-PrEP.
Despite efforts to mitigate health care disparities, differences by race/ethnicity and socioeconomic status still arose in patients receiving SMA-PrEP.
在新冠疫情期间，用于暴露前预防的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）单克隆抗体（SMA-PrEP）为免疫功能低下的患者提供了另一种保护选择。然而，SMA-PrEP给医疗机构带来了管理、操作和伦理方面的挑战，导致很少有患者接受此类药物。尽管首款SMA-PrEP药物替沙格韦单抗和西加韦单抗因体外疗效受损而被撤销授权，但新型SMA-PrEP药物目前正在完成临床试验。本文提供了一个关于行政管理组织、患者识别与优先级确定、公平药物分配、药物订购与给药以及患者追踪的操作框架。
开展了一项回顾性队列研究，以评估我院的SMA-PrEP给药策略。采用多变量逻辑回归分析与接受SMA-PrEP相关的因素。
尽管在使用这种药物时存在障碍且资源稀缺，但我院仍能够为5902名符合条件的患者中的1359名（23.0%）至少给药1剂SMA-PrEP。即使采取了促进公平分配的措施，多变量逻辑回归分析表明，在种族、族裔和社会经济地位方面仍存在差异。与自认为是黑人的患者相比，自认为是白人（优势比[OR]，1.85；95%置信区间[CI]，1.46 - 2.33）、亚洲人（OR，1.59；95% CI，1.03 - 2.46）和西班牙裔（OR，1.53；95% CI，1.02 - 2.44）的患者更有可能接受SMA-PrEP。与社会经济地位低的患者相比，社会经济地位高的患者（OR，1.37；95% CI，1.05 - 1.78）更有可能被分配到SMA-PrEP。
尽管努力减少医疗保健方面的差异，但在接受SMA-PrEP的患者中，种族/族裔和社会经济地位差异仍然存在。
