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Non-oral COVID-19 Treatment Options in the Outpatient Setting
The proliferation of treatment options for SARS-CoV-2 can be seen as one of the success stories of the global COVID-19 pandemic.
Individuals who have been diagnosed with COVID-19 and are at high risk of hospitalization may be eligible for treatment with non-oral medications which have received FDA approval or emergency use authorization (EUA). These medications are administered intravenously (IV), typically in an infusion center. They can be divided into two categories: 1) monoclonal antibodies and 2) antiviral drugs.
Antibody Therapy:
Monoclonal antibodies are synthetic versions of antibodies made by the immune system against SARS-CoV-2. The body’s immune system typically takes a couple of weeks to build up antibodies against SARS-CoV-2 after an exposure (either via infection with the virus or via vaccination), therefore the administration of synthetic antibodies can effectively fast-track this targeted immune defense. Antibody treatments work by binding to certain key parts of the virus, blocking the virus from binding to and entering cells.
Antibody treatments with EUA for outpatient use include sotrovimab and bebtelovimab.
Antiviral Therapy:
Remdesivir is an antiviral drug that was previously authorized for use in hospital patients, but just recently (end of January 2022) received FDA authorization for outpatient use. Remdesivir works by incorporating into the viral RNA (ribonucleic acid), inhibiting the ability of SARS-CoV-2 to replicate.
What Are the Treatment Criteria?:
All three of the above medications are approved for use in adult or pediatric (age 12 yo and older, weighing ≥ 40 kg) patients who have mild-to-moderate symptomatic COVID-19 and who are at high risk of progression to hospitalization. In order to be efficacious, they should be started as soon as possible, no later than 7 days after symptoms began.
How Well Do The Treatments Work?
Studies have demonstrated > 80% efficacy of both remdesivir and sotrovimab for preventing hospitalization or death due to COVID-19 (if started with 7 days of symptom onset). Data are still emerging for bebtelovimab; preliminary studies have also shown a reduction in hospitalization or death in high-risk patients.
What Are the Common Side Effects?:
Monoclonal antibody treatments for COVID-19 are generally well tolerated. The most commonly reported side effects are injection site reactions and infusion-related reactions (1% of patients who received sotrovimab experienced infusion-related reactions).
The most common side effects following administration of Remdesivir were nausea, headaches, and rash. Elevated liver enzymes (a laboratory finding) are common in patients who receive Remdesivir, and caution is advised in those individuals with liver or kidney disease.
