Treating COVID-19 Patients at Home with Monoclonal Antibody Therapy

Brian Stein, MD; Shivanjali Shankaran, MD; Matthew Kemper, PharmD; Kathleen Egan, LCSW, ACM; Erica Feddeler, DNP, RN, NP; LaShon Gurrola, BSN, RN

Monoclonal antibodies (MAB) are used in outpatient treatments for patients who contracted a mild COVID-19 infection, have had symptoms for seven days or less and are at high risk for developing severe disease. The goal of MAB therapy is to lower the rate of hospitalizations related to COVID-19 and decrease the severity of its symptoms. The U.S. Food and Drug Administration authorized the emergency use of REGEN-CoV (casirivimab/imdevimab) for treating COVID-19 in November 2020. In September 2021, in response to an increased need for MAB treatments, RUSH—alone among academic medical centers in Chicago — began subcutaneous injections of the medication in patients’ homes.

Senior RUSH leaders approached Case Management in August 2021 to start a MAB program for patients identified as at risk for severe symptoms. The program was implemented through a partnership between the antimicrobial stewardship team in the RUSH Infectious Disease Division, Home Infusion Solutions and RUSH’s preferred home health care providers. As a result of this collaboration, a workflow was created within just three weeks of the program, which went live during the first week of September 2021. The workflow allowed providers to place orders to RUSH Ambulatory Care Management, whose team populated a work queue monitored by Erica Feddeler, RN, NP; LaShon Gurrola, RN; and care managers. As a result, RUSH provided MAB therapy to nearly a hundred patients in their homes, usually within 24 hours of their referral.