Antibody Resource Guide

COVID-19 Antibody Treatment Resource Guide

The National Infusion Center Association has developed the resources described below in our antibody treatment resource guide to support prescribers, infusion providers, and patients in the safe and efficient use of COVID-19 antibody treatments.  These resources can be found in the COVID-19 Antibody Treatment Resource Center.

Locating Sites of Care

NICA COVID-19 Locator 

Use NICA’s COVID-19 Therapy Locator Tool to identify sites of care administering COVID-19 antibody therapies.

Prescribers & Patients: 

  • Simply enter your city and state or your zip code and click “search” 
  • Click on a location to view site details including phone number, hours of operation, website,  amenities, and more.  
  • If results do not populate for the area searched, try widening the search radius. If there are still no  results to display, contact your local/regional health authorities as your state may not have opted into our antibody therapy locator program yet. 

Infusion Providers: 

  • Be sure patients can find your infusion site by “claiming” your location and adding pertinent details  to the profile like phone number, hours of operation, amenities, and more.  
  • Consider using the URL field to direct prescribers and patients to pertinent information on your  center’s website, such as patient arrival instructions, required forms, etc.  
  • If you need assistance claiming your center or building out your profile, email [email protected].

This national map is maintained by the Department of Health and Human Services and displays locations that have received shipments of COVID-19 antibody therapies.  

  • If results do not populate for the area searched, try widening the search radius. If there are still no  results to display, contact your local/regional health authorities as your state may not have opted to have their antibody therapy locations displayed. 
  • It is important to note that locations are displayed based on the address where medication was  shipped (e.g., centralized pharmacy, warehouse) and may not reflect the location/address where  patient care is provided. 

COVID-19 Antibody Treatment Indication Checklist

This checklist is intended to help prescribers determine if treatment with COVID-19 antibodies is  authorized for use in accordance with the Emergency Use Authorization (EUA) requirements.  • If COVID-19 antibody treatment is not indicated, the checklist can be included in the medical  record to document the clinical decision-making process.  

  • If COVID-19 antibody treatment is indicated, the checklist can accompany the medication order to  document eligibility criteria and support medical necessity. Individual infusion site documentation requirements may vary

COVID-19 Antibody Treatment Order Set

An order set is developed for each approved COVID-19 antibody therapy and serves as the prescription  for treatment. 

  • Facilitates proper prescribing by capturing the necessary elements of a valid, complete COVID-19 antibody treatment infusion order 
  • Captures criteria for authorized use mandatory reporting requirements per EUA.  • Guides infusion clinician in safe administration by prompting best practices and adherence to  administration requirements.
  • Supports continuity of care by prompting the infusion provider to send records of completed  treatment to the prescriber. 

Coding Guide

List of common diagnosis codes that may apply to eligible patients.‡ 

  • Provides prescriber with easy access to codes needed to complete order set and indications  checklist 
  • ICD-10 data helps public health officials understand which patient populations are receiving  COVID-19 therapeutics to support efforts aimed at equitable allocation and distribution of  COVID-19 therapeutics. 

Referral Checklist

Many HCPs prescribing COVID-19 antibody treatments may be unfamiliar with the infusion referral  process. As COVID-19 antibody treatments are thought to be most effective when given as early as  possible in the disease course, it is critical to streamline the referral process to reduce unnecessary delays  to expedite access to treatment and optimize outcomes. This checklist provides a template overview of  necessary steps to refer a patient for COVID-19 antibody treatment. 

  • Infusion sites of care are encouraged to download and modify this checklist to create a custom  checklist including any unique, site-specific requirements. 

Patient Education: Preparing for a COVID-19 Antibody Infusion

Prescribers can provide and review this handout with patients to help them understand and prepare for  their infusion to promote treatment acceptance and adherence.  

  • Includes a field for prescriber to indicate facility name and phone number where referral/order  was sent, with instruction for patients to call if they have not received an appointment promptly.  This is intended to reduce treatment delays or patients “timing out” of treatment eligibility due to  communication challenges. 

Casirivimab + Imdevimab Flowsheet / Bamlanivimab Flowsheet

The flowsheet, sometimes called a treatment note, is used to document all care associated with  administration of COVID-19 antibody therapies.  

  • Guides the clinician to follow industry standards and best practices as well as adhere to  administration and documentation requirements under the EUA. This is not an all-inclusive list of diagnoses meeting EUA criteria for high risk for progressing to severe  COVID-19 and/or hospitalization.
  • Provides a detailed record to fax to the referring prescriber for inclusion in the patient’s medical  record.
  • Especially helpful for temporary sites of care or other infusion providers using paper  documentation. 

Drip Rate Tables

In sites of care administering infusions by gravity (as opposed to with an infusion pump or other rate control device), HCPs will be required to calculate the appropriate drip rate using the volume to be infused  and drop factor of the administration set used (infusion tubing). As many HCPs may be unfamiliar with the  calculations required, these tables provide the appropriate drip rates for administration of both products  using administration sets with any drop factor.

Casirivimab + Imdevimab Medication Safety Alert

Casirivimab and Imdevimab are supplied in multiple packaging configurations and have unique preparation  requirements that may increase risk for medication errors. 

  • Provides considerations and strategies to reinforce use of proper quantities/combinations of  product to prepare a single dose. 

Patient Education: COVID-19 Antibody Treatment Discharge Instructions

This patient handout explains signs and symptoms to watch for and report following a COVID-19 antibody  infusion.  

  • Provides home care instructions for discomfort at the IV site 
  • Reinforces the need to continue isolation to prevent disease transmission
  • Lists emergency warning signs that necessitate seeking medical attention

NICA Standards for In-Office Infusion

View NICA’s minimum standards for the administration of intravenous and injectable medication in an  outpatient setting. 

Eli Lilly Bamlanivimab Playbook

NICA collaborated with Eli Lilly to develop this playbook with in-depth information about preparation and  administration of bamlanivimab as well as other considerations for operationalizing an infusion site. 

Regeneron Casirivimab + Imdevimab Emergency Use Authorization (EUA) Guidebook

NICA collaborated with Regeneron to develop this playbook with in-depth information about preparation  and administration of casirivimab + imdevimab as well as other considerations for operationalizing an  infusion site. 

Report an Adverse Event to MedWatch

Healthcare providers must submit a report on all medication errors and all serious adverse events  potentially related to COVID-19 antibody therapy. 

Multilingual COVID-19 Resources

The CDC has developed the COVID-19 Communication Toolkit: For Migrants, Refugees, and Other  Limited-English-Proficient Populations in various languages. Resources are available in Spanish, Simplified  Chinese, Korean, Tagalog, Hmoob (Hmong), Af Soomaali (Somali), and Vietnamese.

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Clinical Toolkit

The COVID-19 Clinical Toolkit is an online tool that aims to provide clinicians with up-to-date information on the presentation, prognosis, pathophysiology, and treatment strategies for COVID-19. Click on one of the options below to learn more.

This activity is provided by Med Learning Group. This activity is co-provided by Ultimate Medical Academy/CCM.
This activity is supported by educational grants from AbbVie, Astellas, Genentech, Lilly, Merck & Co., Inc., Pfizer and Regeneron Pharmaceuticals, Inc.

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Updates in the Treatment and Prevention of COVID-19​

Subcutaneous Administration of Casirivimab and Imdevimab Reduced the Risk of Symptomatic COVID-19 by 81% Among Household Contacts

Top-line results from a phase 3 trial showed that the combination of casirivimab and imdevimab reduced the risk of symptomatic infections by 81% among household contacts of SARS-CoV-2 infected individuals. The trial enrolled 1,505 individuals who did not have COVID-19 symptoms or anti-SARS-CoV-2 antibodies, but who lived in the same household as an individual who tested positive for SARS-CoV-2 within the prior 4 days. A single subcutaneous injection of casirivimab and imdevimab provided rapid protection to those with exposure to SARS-CoV-2 at home, with protection against symptomatic infections ranging from 72% in the first week to 93% in subsequent weeks. Individuals who developed symptomatic infections despite casirivimab and imdevimab therapy had a shorter duration of symptoms compared with those who received placebo (1 week vs 3 weeks, respectively). Infected individuals who received therapy also cleared the virus faster. Adverse events (AEs) occurred in 20% of patients receiving casirivimab and imdevimab and 29% of patients receiving placebo. Injection site reactions, all of which were grades 1-2, occurred in 4% of patients in the treatment group and 2% of placebo participants.

Casirivimab and Imdevimab Significantly Reduced Progression to Symptomatic COVID-19 in Recently Infected Asymptomatic Patients

In a phase 3 trial of 204 recently infected asymptomatic COVID-19 patients, subcutaneous administration of casirivimab and imdevimab reduced the overall risk of progressing to symptomatic COVID-19 by 31%, and by 76% after the third day. In addition to reducing the risk of symptomatic infections, the top-line results report that the combination of casirivimab and imdevimab shortened the total number of weeks patients experienced symptoms by 45% and reduced the viral burden by more than 90%. No patients withdrew from the trial due to AEs in either group. Casirivimab and imdevimab are investigational drugs with emergency use authorization for the treatment of individuals with mild-to-moderate COVID-19 who are at high-risk of progressing to severe COVID-19 or hospitalization. Casirivimab and imdevimab (REGEN-COV™) continues to be evaluated in clinical trials in multiple settings for COVID-19, including the open-label RECOVERY trial of hospitalized patients in the UK.

Johnson & Johnson COVID-19 Vaccine Administration Paused

The Centers for Disease Control and Prevention (CDC) and the Federal Drug Administration (FDA) are recommending a pause in the use of the Ad26.COV2.S vaccine developed by Johnson & Johnson (Janssen) as they review data involving 6 reported cases of a rare and severe type of blood clot in individuals after vaccination. The vaccine has been administered to more than 6.8 million individuals in the US. In all 6 reported cases, a type of blood clot called cerebral venous sinus thrombosis (CVST) occurred in combination with low platelet levels (thrombocytopenia). Treatment of CVST differs from other blood clots and administration of heparin may be dangerous in these patients. All 6 cases occurred among women aged 18 to 48 years and symptoms usually occurred 6 to 13 days after vaccination. People who develop severe headache, abdominal pain, leg pain, or shortness of breath within 3 weeks after vaccination should contact their healthcare provider.

References:

Regeneron Press Release. Phase 3 Prevention Trial Showed 81% Reduced Risk of Symptomatic SARS-CoV-2 Infections with Subcutaneous Administration of REGEN-COV™ (Casirivimab and Imdevimab). April 12, 2021. Available at: https://investor.regeneron.com/news-releases/news-release-details/phase-3-prevention-trial-showed-81-reduced-risk-symptomatic-sars

Regeneron Press Release. Phase 3 Treatment Trial in Recently Infected Asymptomatic Patients Showed REGEN-COV™ (Casirivimab and Imdevimab) Significantly Reduced Progression to Symptomatic COVID-19. April 12, 2021. Available at: https://investor.regeneron.com/news-releases/news-release-details/phase-3-treatment-trial-recently-infected-asymptomatic-patients

FDA Statement. Joint CDC and FDA Statement on Johnson & Johnson COVID-19 Vaccine. April 13, 2021. Available at: https://www.fda.gov/news-events/press-announcements/joint-cdc-and-fda-statement-johnson-johnson-covid-19-vaccine