In December, Chrisette Dharma, MD, founder and Medical Director of Southwest Family Medicine Associates (SFMA) in Dallas, nearly lost her brother to COVID-19. Shortly after his diagnosis, she moved into his home to care for him, giving him dexamethasone, steroids, plus a multitude of vitamins. She drove him to the emergency department each day for outpatient remdesevir. By day seven, he needed oxygen.
Dharma looked for a plasma match for him, but there were none at that critical point. On day 10, when he still was not improving, Dharma arranged for a monoclonal antibody infusion. "He turned around between 24 and 48 hours after the infusion," she said. "It was at the tail end of his window of opportunity. Another day or two or three, and the virus would likely have become entrenched in his cells and it would have been too late."
Through her brother's experience, Dharma saw that monoclonal antibody (mAb) therapy could be a game-changer, extending primary care physicians' reach in protecting unvaccinated patients.
From personal experience to professional opportunity
While COVID-19 vaccines offer hope for minimizing severe illness and death, monoclonal antibodies are another option that could save lives and decrease the spread of SARS CoV-2 — the virus that causes COVID-19.
After witnessing the success of her brother's treatment, Dharma became a champion for this therapy. When she was presented with the opportunity to join a late-stage clinical trial for mAbs, she was excited to take part.
The trial is testing a combination of two antibodies administered through injection. Dharma said this treatment is promising for preventing COVID-19 in people who may have been exposed to the virus and for treating early infection.
"Evidence is rapidly accumulating that mAb therapy has an efficacy and staying power not found in other treatments we have tried over the past year," she said. "In trials and in the field, it works for the majority of patients — if we use it in time.”
She added that this method is both efficacious and patient friendly. “If we make it easy for people to access prevention and cure, not only are we helping those particular patients, but it means less virus will ultimately be circulating in our communities, and therefore less worry over variants."
The right treatment at the right time
Currently, mAb infusions are reserved for the very sick, generally weeks into their illness. Dharma said logistical and cost barriers of ordering and administering these infusions have in part slowed delivery to patients. These delays increase the risk of the treatment being administered past the time when it has the most effect.
Dharma explained that when patients develop the antibodies on their own, which takes seven to 10 days, their bodies are in a race with the virus. Once the virus penetrates the cells, monoclonal antibodies are likely to be marginally helpful, if at all, and the race may be lost.
"Right now, all we are doing is making these last-ditch efforts," she said. "If we catch patients during the sweet spot of three to 10 days after symptoms start, we are arming them in time to prevent the virus's penetration of the cells, giving them a tremendous head start on the fight."
An alternative for unvaccinated people
About 30% of Americans do not plan to get the COVID-19 vaccine, according to a recent Pew Research Center study. Dharma noted that while this population of people may be at high risk for serious illness if they get COVID-19, alternatives such as monoclonal antibodies could mitigate the risk.
These injections may offer a workaround needed to help protect unvaccinated people. "Most of these same people who oppose the vaccination are OK with medications," she said.
Administering mAbs via a shot also saves valuable time and effort required by an infusion, Dharma said. "Figuring out that there are cost savings with preemptive infusions versus hospitalization for patients at medium to high risk is not higher math."
Disclaimer: This content is shared for informational purposes only; this clinical trial is not sponsored or endorsed by Southwestern Health Resources.
Southwest Family Medicine Associates is looking for patients who have recently tested positive for COVID-19 to participate in a multisite trial. Participants will receive the monoclonal antibody injection aimed to prevent severe symptoms.
The COVID-19 testing and treatment are free. Call 469-893-1242 or visit the website to learn more.