Risk-Targeting COVID-19 Patients to Optimize Monoclonal Antibody Allocation

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), may result in severe disease associated with high rates of hospitalization and death. To date, several neutralizing monoclonal antibody (nMAb) therapeutics have been granted emergency use authorization by the U.S. Food and Drug Administration. The real-world benefit of nMAb therapy is likely influenced by the neutralizing specificity of an nMAb product to the infecting variant causing disease and the baseline risk of a poor outcome in the host. In this session, findings of nMAb treatment effectiveness from a consortium study of four diverse health systems will be presented, which utilized individual health records (>167,000 patients) and SARS-CoV-2 genome sequence information from a subset of patients (>13,000). Individual risk factors (e.g., vaccination status, immunocompromised status) were studied, as well as the use of a machine learning predictive model to stratify patients by a priori risk of severe COVID-19. Variant sequence data elucidated important differences in nMAb treatment effectiveness as the dominant variant circulating the U.S. changed. The session will conclude with health system recommendations on strategies to allocate COVID-19 therapeutics to optimize outcomes, as well as approaches for continued monitoring of COVID-19 therapeutic outcomes.