Some antibody treatments aren't effective against omicron, Cleveland hospital officials say

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Claudia from Kent asks, "I heard on NPR this morning... that monoclonal antibody infusion therapy is ineffective against the omicron variant. Is this true, and what is the basis for this assessment?"

Yes, this is true, according to Cleveland hospital officials.

University Hospitals and MetroHealth have stopped using some brands of monoclonal antibody treatments that aren't effective against the omicron variant of COVID-19, and the U.S. Food and Drug Administration on Monday revoked the emergency use authorization for Regeneron and Eli Lilly antibody drugs.  

Omicron looks so different than the original virus or any of the other variants that the antibody treatment no longer recognizes the virus, said MetroHealth infectious disease specialist Dr. Amy Ray. 

"The drugs that were specifically tailored to the alpha variant and the delta variant recognize those strains very well, but the antibodies just were not recognizing omicron," she said. 

Because the antibodies couldn't recognize the virus, it couldn't bind to it to neutralize it, or kill it, Ray said. 

The antibody treatment Sotrovimab still works, but supply is so low that Ohio hospitals have to prioritize those most at risk, she said. MetroHealth uses the National Institute of Health's risk priortization chart that helps health care systems allocate medicine, but that doesn't stop people from calling the hospital asking to be given monoclonal antibodies, Ray said. 

"People call and demand monoclonals," she said. "Just because you may think you need a monoclonal doesn't mean you're the right candidate, and when you have a limited supply, it's incumbent upon us as a health care system to take equity into account."

The treatment is typically given to high-risk patients early in their infection. It's an intravenous infusion, which makes logistics difficult, Ray said. MetroHealth set up an area of the hospital to give the treatment, where the COVID-positive patients could be kept separate from other patients to avoid spreading the virus. 

The treatment is only given to people who aren't in the hospital, said University Hospitals pediatric infectious disease specialist Dr. Amy Edwards. 

"You have to not be in the hospital to get monoclonal antibodies," Edwards said. "The emergency use authorization is for people who are outpatient in order to prevent them from being hospitalized from COVID-19."

There's no data that shows the treatment would be effective for people with more serious infectious, Edwards said. 

There is a group of people who aren't vaccinated who think they can be treated with monoclonal antibodies if they get sick, Edwards said. She doesn't understand why people who are skeptical of the vaccine are accepting of monoclonal antibody treatment. 

"There's less research on monoclonal antibodies than there are on the vaccine," she said. "People who are medically skeptical seem much more comfortable relying on the monoclonal antibodies than they do on the vaccine, which doesn't make a lot of sense to me."

Because a lot of the supply is ineffective against the omicron variant, Edwards said that option may not be available, but getting the vaccine is an easy way to prevent severe COVID-19 infection. 

If the Regeneron and Eli Lilly antibody drugs are effective against future variants, the FDA could reauthorize its use.