Hamilton monoclonal antibody clinic sees 'incredible results' for high-risk COVID patients

A Hamilton-based clinic that provides a new therapy aimed at keeping high-risk COVID-19 patients out of hospital is seeing "incredible results," according to the doctor leading it.

St. Joseph's hospital launched Ontario's first COVID-19 monoclonal antibody therapy clinic for outpatients in October.

It's a treatment that early studies have shown reduced the risk of hospitalization and deaths by about 70 per cent, and Dr. Zain Chagla said patients with the virus report feeling better within a couple of days of receiving it.

"The whole point here is to reduce people ending up in hospital," said the doctor who is heading up the pilot program.

Despite the risk facing the patients they're working with, fewer than five people who have received the therapy have ended up in a hospital bed, he said.

"None of those people needed to be in the ICU on a ventilator. None of those people died and we've had a number of incredibly high-risk patients who have had very benign outcomes of their COVID-19."

Chagla celebrated the 99th dose doled out through the Hamilton program in a Dec. 27 post on Twitter.

"A huge thanks to the incredible nursing team, pharmacy team, clerical, informatics, and everyone else that made this a success," he wrote. "The vast majority of patients who were high risk made a full recovery."

The Hamilton clinic was the first of its kind in Ontario, though it has been used in other countries including the U.S., U.K. and Australia.

The treatment helps the immune system begin to fight back against COVID-19 sooner than it would on its own by providing laboratory-made antibodies to attack the virus, rather than waiting for the body to build them, Dr. Kashif Pirzada, an emergency physician at Toronto's Humber River Hospital, previously said to the CBC.

"These treatments give you those antibodies up front … COVID kills you by evading your immune system and making your system overreact. If it gets to the overreaction, it's already too late," he said at the time.

Therapy expensive, needs to happen quickly

Current monoclonal antibodies need to be provided soon after someone is diagnosed with the virus and are given by infusion, a process that takes about an hour and is followed by another hour of observation in case of allergic reaction.

They're also expensive, with Matthew Miller, an associate professor at the Institute for Infectious Disease Research at McMaster University in Hamilton, estimating they cost about 1,000 times more than a vaccine.

It's also not known how effective the therapies are, especially when it comes to different variants of COVID-19.

Ontario's Ministry of Health said Toronto's University Health Network (UHN) is managing the supply and distribution of casirivimab/imdevimab, and sotrovimab, the monoclonal antibody treatments currently approved in the province.

A spokesperson for UHN said there are currently six "depots" for casirivimab/imdevimab and eight for sotrovimab.

The province and hospitals have also worked out criteria for who can receive the therapy, including that patients must have tested positive for COVID-19 and have had symptoms in the past seven days.

St. Joe's webpage for the clinic stresses the treatment is not a replacement for vaccination, which it says offers "greater effects than monoclonal therapy can offer."

Chagla said he's heard about other clinics being considered in Ontario and has received some requests for more information.

But "of the clinics in Ontario and, I think across Canada, we've administered more doses here than anywhere else in the span of the last two-and-a-half months."

His site has served patients locally and welcomed some from as far away as London or east of the GTA when local case numbers were low.

Trying to limit the healthcare burden

The doctor highlighted the work of the nursing staff at the clinic who he said have created an environment where patients who were afraid to even get tested for the virus can get their questions answered and feel comfortable.

"Patients have been incredibly grateful," he said. "People are feeling better after getting this treatment."

With the Omicron variant surging in Ontario and across Canada, Chagla said the number of doses the clinic has given spiked to 55-60 in the mid-December, matching roughly the total number handed during the two previous months combined.

It's important to keep prioritizing monoclonal antibody therapy to help high-risk patients and keep them out of hospital, he said.

"The whole point of what we've been doing here with public health is trying to reduce the healthcare burden that gets generated."