MUSC Health begins monoclonal antibody treatments

As MUSC Health begins a widescale, months-long vaccination program against the novel coronavirus, it has also gained a new tool to treat COVID-19.

The health system began treating eligible patients with a monoclonal antibody infusion in November. Similar to convalescent plasma, this treatment injects antibodies directly into the patient’s bloodstream. Whereas convalescent plasma comes from recovered patients, the monoclonal antibodies are created in a lab.

Leeann Bauch, director of nursing for perioperative and procedural services at MUSC Health, was the first patient infused here, on Thursday, Nov. 19. She said her recovery was remarkable, and in stark contrast to the weeks of dragging that a friend felt after contracting COVID.

“Thirty-six hours after the infusion, which was Saturday morning, I was cleaning my house. I still had some chills, but by Sunday, I felt like I had never had COVID,” she said.

By coincidence, Bauch had attended a presentation about the drug, called bamlanivimab, on the previous Monday, when she started having symptoms.

By the time she got home Monday, she decided her symptoms “checked off too many boxes,” so she did a virtual urgent care visit and scheduled a COVID test for Tuesday. Despite her symptoms, she still thought it was likely a gastrointestinal bug and was working on her phone as she sat in the car at the COVID drive-through testing site in West Ashley. Wednesday, though, her test results came back positive.

“I’ve been in health care for 33 years, so I have a good dose of skepticism, and I would say that it really works."

Leeann Bauch

She knew the team was looking for patients to receive the treatment and thought she qualified, and her doctors agreed.

Bauch qualified for the treatment because of her high-risk status. In February, she had been diagnosed with tracheomalacia, a weakness in the cartilage in her trachea that could cause blockage in her windpipe, putting her at high risk for intubation.

Bamlanivimab and a similar monoclonal antibody treatment crafted by Regeneron received emergency-use authorization (EUA) from the U.S. Food and Drug Administration to treat people with mild to moderate symptoms who are at high risk of severe illness. Those at high risk include people over the age 65, people over the age of 55 with certain preexisting conditions such as heart disease and lung disease, people with diabetes or chronic kidney disease and people with a body mass index over 35.

Vanessa Diaz, M.D., medical director for Care Coordination for the MUSC Health Primary Care Integrated Center of Clinical Excellence, said the treatment must be given within 10 days of symptom onset – and preferably sooner. The antibodies work by binding to the coronavirus and blocking it from replicating, so it will work better if the virus has had less chance to multiply. That’s why it’s important that people get tested as soon as they begin showing symptoms, she said.

“When somebody comes in with symptoms, don’t wait until they get sicker to get COVID testing, because we might miss that window of them being eligible for the infusion,” Diaz said.

The infusion itself takes about an hour. Patients must then be monitored for side effects for an hour afterwards. Because the drug is still in emergency-use status, patients are asked to report any issues that occur within a week.

"When somebody comes in with symptoms, don’t wait until they get sicker to get COVID testing, because we might miss that window of them being eligible for the infusion."

Vanessa Diaz, M.D.

Though the drug is considered investigational, Diaz said the trial results that led to the EUA were promising: While 10% of the placebo group ended up hospitalized or in the emergency room, only 3% of the group that received the treatment was hospitalized or treated in an emergency room.

“The thing that is scary about COVID is it is very hard for us to identify who is going to do well and who is going to be that person who ends up in the hospital getting intubated,” she said.

Bauch said she believes the treatment is effective.

“I’ve been in health care for 33 years, so I have a good dose of skepticism, and I would say that it really works,” she said.

Bauch, who earlier in her career worked in clinical trials, said she felt comfortable receiving an investigational treatment after looking at the results seen so far.

“It’s a risk-benefit. If I were a low-risk person, maybe I would not have done it under the emergency use. But as a high-risk person, I felt this was worth the risk,” she said.

MUSC Health has set up a trailer at the West Ashley testing site solely for these infusions. This separates the COVID-positive patients from other patients and allows for designated nurses to focus on the infusions.

The COVID-19 remote monitoring team, which has been checking on patients recovering at home nearly since the beginning of the pandemic, is helping out by going through patient records to find candidates for the treatment.

However, there is a limited supply of the drugs. MUSC Health has so far received 48 doses of bamlanivimab and 24 doses of the Regeneron combination, and has treated 51 patients as of Dec. 16. Currently, the trailer is set up to treat four patients per day. There are plans to expand, Diaz said, to treat up to 18 patients per day. Expansion plans also call for taking referrals from outside health care providers; the treatment is currently limited to people who have their COVID test performed at an MUSC site.

Bauch particularly praised the nurses who stayed with her for the entirety of the treatment.

“The infusion nurses were awesome. I was so proud of them and proud that I work beside them at MUSC,” Bauch said.