Increased Availability of Therapeutics for COVID-19 in Orange County; Revised Evusheld Dosing
February 28, 2022
Cases of COVID-19 continue to decline across Orange County, although they are still at levels seen near the peak of the Delta Variant wave last summer. The current Orange County surveillance data can be found here.
While availability of both monoclonal antibodies and antiviral agents to treat COVID-19 were in very limited supply in January supplies are becoming more plentiful throughout the County.
Clinical Updates
Several therapeutic options are available for the outpatient treatment of patients with mild to moderate COVID-19 who are at high risk of disease progression:
Paxlovid is given orally for 5 days. It can cause significantdrug-drug interactions, which must be considered when it is used.
Sotrovimab and bebtelovimab are monoclonal antibodies that are given once via intravenous infusion.
Remdesivir for outpatient use is given intravenously daily for 3 days.
Molnupiravir is given orally for 5 days. It has been found to be less effective than other options and poses a theoretical risk for mutagenicity. Its use should be considered if the therapeutic options above are not available or are contraindicated.
For pediatric patients, Paxlovid, sotrovimab, and bebtelovimab are all approved for use under FDA Emergency Use Authorization (EUA) for those ≥ 12 years and weighing ≥ 40 kg. Remdesivir is FDA-approved for use in patients ≥ 12 years and weighing ≥ 40 kg and is also approved under FDA EUA for use in nonhospitalized and hospitalized pediatric patients weighing 3.5 kg to <40 kg or aged <12 years and weighing ≥3.5 kg.
To identify sites in your area where COVID-19 therapeutics may be available check the COVID-19 Therapeutics Locator.
The list of underlying conditions that are associated with higher risk for severe COVID-19 disease is extensive and is available here. Included in this list are conditions quite prevalent in the general population including obesity (BMI > 30), smoking current and former, and diabetes.
In addition,EVUSHELD (tixagevimab co-packaged with cilgavimab) is available under EUA for use in those 12 years and older weighing at least 40 kg, who are not currently infected with or known to be recently exposed to SARS-CoV-2 who have moderate to severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments and may not mount an adequate immune response to COVID-19 vaccination.
On February 24, the FDA revised the EUA for Evusheld, increasing the dose to 300 mg of tixagevimab and 300 mg of cilgavimab, due to concerns about lower efficacy against certain Omicron subvariants. Health care professionals should contact patients who received the previous Evusheld dose of 150 mg of tixagevimab and 150 mg of cilgavimab to return for an additional 150 mg tixagevimab and 150 mg cilgavimab dose as soon as possible. An FAQ of the updated EUA can be found here.
For questions or concerns, providers can contact the OCHCA Communicable Disease Control Division at 714-834-8180.
