High-risk COVID outpatients least likely to receive monoclonal antibodies
Nonhospitalized COVID-19 patients at highest risk for severe outcomes are often the least likely to receive monoclonal antibodies (mAbs), finds a study of more than 1.9 million Medicare beneficiaries published late last week in JAMA.
A team led by a Harvard Medical School researcher examined a sample of outpatient, emergency department, and laboratory insurance claims for fee-for-service Medicare beneficiaries who received a new diagnosis of COVID-19 or had a confirmed exposure from November 2020 to August 2021. mAbs were first available for use in COVID-19 patients in November 2020.
Among the 1,902,914 participants, 7.2% received mAbs. Patients with fewer underlying illnesses were more likely than those with more conditions to receive the treatment (23.2% with 0 chronic conditions vs 6.3%, 6.0%, and 4.7% with 1 to 3, 4 or 5, and 6 or more chronic conditions, respectively; adjusted odds ratio [aOR], 7.43 for 0 vs 6 or more).
Black patients were less likely than their White peers to be given mAb (6.2% vs 7.4%; aOR, 0.77), as were those who were also enrolled in Medicaid (4.6% vs 8.1%; aOR, 0.74). Participants 85 years and older were 42% more likely to receiving mAbs than those 65 to 74.
Administration of mAb also varied widely by US region, with Rhode Island (24.9%) and Louisiana (21.2%) administering the most, while Alaska (1.1%) and Washington (0.7%) had the lowest rates. Southern states had the highest rates of mAb use (10.6%), with the lowest rates in the West (2.9%).
The study authors said that patients at highest risk may have had problems navigating the multiple steps required to access mAb, including a timely COVID-19 diagnosis and referral and booking an appointment for an infusion within 10 days. "In addition, mAb supply may have been low or less used by clinicians in some regions of the country," they wrote.
In a Harvard press release, lead author Michael Barnett, MD, said that geographic mAb differences may have been influenced by supply levels in different parts of the country. "We need new approaches to prevent these inequities from happening again with newer treatments on the horizon," he said.
Feb 4 JAMA research letter
Feb 4 Harvard press release
COVID-19 patients at increased risk for cardiovascular complications
A new study suggests patients with COVID-19 are at an increased risk for a variety of cardiovascular complications between 30 days and 1 year after infection. The study, published today in Nature Medicine, is based on data from the US Department of Veterans Affairs.
In total, 153,760 veterans with COVID-19 were compared to two cohorts of controls. Risk for cardiovascular complications occurred for all patients, including those not hospitalized, but non-hospitalized veterans were at less risk than hospitalized patients, and hospitalized patients were at less risk than those admitted to intensive care units.
Strokes, dysrhythmias, inflammation of the heart muscle, and ischemic heart disease were all more frequent in COVID-19 patients.
People who survived the first 30 days of COVID-19 exhibited increased risk of stroke (hazard ratio [HR],1.52; 95% confidence interval [CI], 1.43 to 1.62), for a burden of 4.03 (95% CI, 3.32 to 4.79) per 1,000 persons at 12 months. The risks and burdens of ischemic heart disease outcomes, including myocardial infarctions, were 1.66 (95% CI, 1.52, 1.80) and 7.28 (95% CI, 5.80 to 8.88), respectively. The HR for myocarditis was 5.38 (95% CI, 3.80 to 7.59).
"Our study shows that the risk of incident cardiovascular disease extends well beyond the acute phase of COVID-19," the authors concluded. "Because of the chronic nature of these conditions, they will likely have long-lasting consequences for patients and health systems and also have broad implications on economic productivity and life expectancy."
Feb 7 Nat Med study
Omicron strain much less likely to cause severe outcomes, study finds
The first peer-reviewed US study of COVID-19 outcomes in patients infected with the Omicron (B.1.1.529) variant shows that, relative to patients infected with previous variants Delta (B1617.2) and Alpha (B117), Omicron patients were younger, had significantly higher vaccine breakthrough rates, and were significantly less likely to be hospitalized.
The study, published late last week in the American Journal of Pathology, also found that, when hospitalized, Omicron patients needed less intense respiratory support and had shorter stays, consistent with early reports of the generally milder nature of cases caused by the highly transmissible strain.
Houston Methodist Hospital researchers led the study, which mined the electronic health records of 4,468 COVID-19 patients infected with Omicron from late November to early January 2022. Omicron took only 3 weeks to make up 90% of COVID-19 cases after it emerged in Texas in November, accounting for 98% of new infections by January, the authors said.
Median Omicron patient age was 44.3 years, compared with 50.0 for Alpha and 48.3 for Delta. Length of hospital stay was 3.2 days for Omicron, versus 5.1 days for Alpha and 5.4 days for Delta; and Omicron resulted in 55.4% of breakthrough cases in vaccinated patients, compared with 3.2% and 24.3% of those infected with Alpha and Delta, respectively.
Of all Omicron cases during the study period, 55.9% met the Centers for Disease Control and Prevention criteria for a vaccine breakthrough infection. There was no clear-cut relationship between time since receipt of the final primary vaccine dose and breakthrough infection.
Two asymptomatic COVID-19 patients were found to be infected with the Omicron subvariant BA.2, commonly called the Omicron "stealth" variant because it can evade detection by some commonly used COVID-19 tests.
"The present study highlights the importance of analyzing SARS-CoV-2 genome data integrated with patient metadata and stresses the need to continue to do this in near-real time as the Omicron surge continues, the virus evolves, and new variants with potentially altered fitness and biomedically relevant phenotypes are generated," the researchers wrote.
Feb 3 Am J Pathol study