Ohio State Wexner Medical Center surpasses 1,100 monoclonal antibody infusions

The Ohio State University Wexner Medical Center is eclipsing many health systems nationally in terms of volume and successful outcomes related to monoclonal antibody infusions. Clinical research currently indicates that 10% of COVID-19 patients with certain risk factors are at risk of severe illness that is likely to require hospitalization, but administering monoclonal antibodies reduces the hospitalization and emergency room visit rate to 3%. At the Ohio State Wexner Medical Center, with more than 1,100 infusions administered to date, doctors are pleased to report that just over 2% of recipients have needed hospitalization.

“We received our first shipment of monoclonal antibody doses on Nov. 16, 2020, and we infused our first patient that same day,” says Carlos Malvestutto, MD, MPH, co-chair of the COVID-19 Outpatient Monoclonal Antibody Program and assistant professor, Division of Infectious Diseases at The Ohio State University College of Medicine. “By administering an average of eight to 15 infusions each day, this novel therapy has likely reduced admission of patients who otherwise would have progressed to more severe disease, and has increased the Ohio State Wexner Medical Center’s overall inpatient capacity, allowing us to treat an additional 160 patients in need of high-intensity, time-sensitive hospital care since mid-November.”

The U.S. Food & Drug Administration (FDA) has mandated that monoclonal antibody infusions occur within 10 days from the onset of COVID-19 symptoms, however the Ohio State Wexner Medical Center’s criteria is seven days, given that data from clinical trials show the efficacy of this therapy beyond that seven-day window is not effective. From the time symptoms appear, a patient must be tested, receive a positive test result, obtain a referral from a primary care physician to schedule an appointment at an infusion center, where they can then receive the infusion, making the window for administering monoclonal antibodies within the FDA’s guidelines extremely short. To maximize success within this time constraint, the Ohio State Wexner Medical Center converted two existing spaces into freestanding infusion centers to separate the intake of patients with active cases from non-COVID-19 patients. The medical center also leveraged its electronic health records to identify and fast track its high-risk patients.

“By anticipating the needs of these high-risk patients, we have facilitated same-day referrals and have been scheduling infusion appointments within 24 hours of referrals,” says Dr. Malvestutto. “Although we advise high-risk patients to contact their providers for referrals and schedule appointments at one of our two designated infusion centers, workflows are also in place to administer infusions for COVID-19 patients who arrive in our emergency departments within the allowed time period and meet the high-risk criteria.”

Monoclonal antibody therapy involves an infusion of synthetic antibodies that target the spike protein on the surface of the coronavirus. Monoclonal antibodies bind to the spike proteins of the coronavirus, preventing them from binding to healthy cells and causing damage to the lungs and other organs. By administering monoclonal antibodies to patients who have tested positive for COVID-19, the therapy shortens the duration of the illness and significantly reduces serious complications that might lead to hospitalization.

Candidates for monoclonal antibody therapy include those over the age of 65; patients over age 55 with comorbid conditions such as heart disease, hypertension, chronic obstructive pulmonary disease (COPD) or asthma; cancer patients undergoing chemotherapy; patients taking medications that suppress the immune system; and children ages 12 through 17 who have congenital conditions that place them at high risk. Patients who receive monoclonal antibody infusions must wait 90 days before receiving the COVID-19 vaccine, to ensure that the body’s response to the antibodies does not interfere with the immune response to the vaccine.

“Elderly patients, pregnant patients, and patients who are immunocompromised, including cancer patients and patients with advanced AIDS, have come to Ohio State after testing positive for COVID-19, expressing a great deal of fear, understandably,” says Dr. Malvestutto. “Without this therapeutic intervention, these patients could have experienced dire outcomes.”

By providing both the COVID-19 vaccine and monoclonal antibody infusions, the medical center continues to rapidly accelerate the inoculation of patients, while also significantly reducing the risk for patients who test positive for coronavirus. The medical center has also administered over 20,000 COVID-19 vaccines, with 99.5% of patients reporting mild to no adverse reactions.

“This is an exciting time, as Ohio State continues to lead the way to recovery for thousands of Ohioans impacted by the pandemic,” says Dr. Malvestutto.