Hamilton clinic to use monoclonal antibody treatment for high-risk COVID-19 patients

St. Joseph's hospital launched Ontario's first COVID-19 monoclonal antibody therapy clinic for outpatients on Monday, a treatment shown in early studies to reduce hospitalization by 71 per cent, and death by 70 per cent in high-risk COVID-positive patients.

Treatment at the clinic, which administers the therapy intravenously, is by referral only, and open to people who are over the age of 18 and at high-risk of hospitalization, such as people who are unvaccinated or immune-compromised.

"The big thing we're trying to emphasize, if you have symptoms and are unvaccinated or vaccinated, is go get tested early and quickly," he said, noting access to testing will be another key factor in the success of the treatment. "It's only going to work if people get tested appropriately. Get a test if you're feeling symptomatic, even if it's minor symptoms."

Dr. Kashif Pirzada, an emergency physician at Toronto's Humber River Hospital who teaches at McMaster University, says the treatment helps the immune system begin to fight back against COVID-19 sooner than it would on its own.

"If you get infected with COVID, it takes two to three days for your body to build antibodies to attack the virus," said Pirzada, who will have access to monoclonal antibody therapy in his own hospital starting on Monday.

"These treatments give you those antibodies up front COVID kills you by evading your immune system and making your system overreact. If it gets to the overreaction, it's already too late."

Monoclonal antibody treatments wereused to treat rheumatoid arthritis and Crohn's disease, including those with injections given at home using an auto-injector-type device.

Monoclonal therapy has been used inU.S., U.K and Australia

Anna Miller, senior communications adviser with Ontario's Ministry of Health, says Toronto's University Health Network is managing the supply and distribution of casirivimab/imdevimab, and sotrovimab, the monoclonal antibody treatments currently approved in Ontario. She says hospitals already have access to the drugs for inpatients, while the St. Joe's clinic in Hamilton is the first outpatient setting where they will be available.

Dr. Chagla says his clinic's pilot is expected to run for at least six months, "to get us through the wintertime," but that he hopes it lasts and becomes a launching point for several other novel COVID-19 treatments that could be arriving soon. He also notes that even though monoclonal antibody therapy treatment is new in Ontario, it's been used for some time in other jurisdictions, such as the United States, the United Kingdom and Australia.

"We're a little bit behind in Canada rolling it out."

Dr. Pirzada says that's a trend he's noticed throughout the pandemic.

"We're gripped by this analysis paralysis, where we wait to act and it's too late," he said, describing the despair of seeing patients die in the third wave while knowing these treatments were available elsewhere.

"There were many patients of mine I would have loved giving it to, who unfortunately didn't make it."

Monoclonal antibody treatments have been used by doctors in the United States on people including now-former president Donald Trump, who fought COVID-19 in October 2020.

Matthew Miller, an associate professor at the Institute for Infectious Disease Research at McMaster University in Hamilton, said logistical and economic issues are hindering the use of monoclonal antibodies to treat COVID-19.

Before the treatments can be given, people need to be diagnosed with COVID-19 quickly, Miller said. And he estimated monoclonal antibodies are about 1,000 times more expensive than a vaccine.

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