This complimentary article from Hospital Pharmacist’s Letter is being provided to readers of Prescriber’s Letter, who may find its content relevant to their practice.
Bebtelovimab will expand monoclonal antibody (MAb) options for high-risk patients with mild to moderate COVID-19.
The Omicron variant limits OUTpatient MAb treatment options to sotrovimab. Now bebtelovimab is another choice for COVID-19 patients who are at high risk of severe illness (diabetes, etc).
Similar to sotrovimab, bebtelovimab is for adults...or kids age 12 and up who weigh 40 kg or more...and is provided at no cost.
Bebtelovimab is a single IV dose given over 30 SECONDS...compared to 15 to 30 minutes for IV sotrovimab.
And bebtelovimab is also active against the Omicron subvariant BA.2...while sotrovimab’s activity is reduced. But so far, a low percentage of US cases are BA.2.
The concern is that bebtelovimab’s evidence is very limited.
It hasn’t been directly compared to placebo in high-risk patients. Instead, data on reducing hospitalization are extrapolated from comparisons to placebo in PRIOR trials with OTHER COVID-19 MAbs.
Be ready to explain bebtelovimab’s place in therapy.
For now, stick with sotrovimab if nirmatrelvir/ritonavir (Paxlovid) isn’t an option for high-risk OUTpatients. But stay alert for local Omicron BA.2 rates...to ensure sotrovimab eligibility.
Think of remdesivir next...IF patients can complete its 3-day course AND their insurance covers it. Also use it in kids under age 12...it’s the only available outpatient treatment for them.
When remdesivir isn’t practical, weigh pros and cons of using bebtelovimab or oral molnupiravir.
Molnupiravir doesn’t seem to work as well as other options. But it’s too soon to say how it stacks up to bebtelovimab...since bebtelovimab’s limited data should be applied cautiously.
Consider patient-specific criteria.
For example, lean toward bebtelovimab if there are reproductive concerns with molnupiravir...or if patients are unlikely to fill a prescription or complete its 5-day course.
If you give bebtelovimab, start within 7 days of symptom onset. Be aware, sotrovimab’s EUA now also advises a 7-day window.
- https://www.fda.gov/media/156152/download (3-2-22)
- https://www.fda.gov/media/156154/download (3-2-22)
- https://www.fda.gov/media/149534/download (3-2-22)
- https://www.covid19treatmentguidelines.nih.gov/management/clinical-management/nonhospitalized-adults--therapeutic-management/ (3-2-22)