How are Charlotte doctors using COVID antiviral pills and antibody treatments?

Charlotte Journalism Collaborative

3 years ago

MELISSA MELVIN-RODRIGUEZ, Charlotte Observer. See PHOTO GALLERY: 2 years of COVID took a toll on health care workers and the community at www.charlotteobserver.com

By Kallie Cox, The Charlotte Observer

There’s growing interest in treatment options for COVID-19 in Charlotte but supply remains fairly limited and local health care providers say they’re prioritizing making the drugs available for high-risk patients.

While vaccines offer the best protection against severe illness, according to doctors and experts, treatments for COVID-19 including the Pfizer pill are becoming more widely available.

The Charlotte Observer spoke recently with local physicians about “test to treat” programs and options, such as antiviral pills and antibody treatments. Hospital systems Novant and Atrium Health have offered antibody treatments in North Carolina since December 2020. Other providers including Tryon Medical Partners and the Charlotte Community Health Clinic offer treatment, as well.

StarMed — one of the area’s busiest providers of COVID tests — says it’s looking to expand treatment access and that treatment drugs are currently in low supply. Earlier this month, President Joe Biden announced in his State of the Union Address that antiviral pills — specifically Pfizer’s Paxlovid pill — would become more readily available to Americans and that he would be implementing a nationwide test to treat program.

StarMed Chief Medical Officer Dr. Arin Piramzadian says treatment steps similar to “test to treat” are already underway in Charlotte. Generally the process includes an assessment of health risk factors of anyone who tests positive for coronavirus and a quick prescription or telemedicine consult to begin antiviral treatment for eligible patients.

ANTIVIRAL PILLS

There are two types of antiviral pills that are prescribed to patients who test positive for COVID-19, these are Paxlovid from Pfizer and molnupiravir from Merck.

Paxlovid “is up to 90% effective in decreasing chance of death and hospitalization,” while molnupiravir has a “30% reduction and chance of death,” Piramzadian said.

Dr. Jennifer Womack from Tryon Medical Partners, said the pills directly attack the virus that causes COVID-19.

Womack said both the pills and antibody treatments have proven effective against the omicron variant. Whether to prescribe one over the other is based on tolerability and availability.

The oral antiviral pills have a lot of medication interactions, Womack said, so if a patient is taking a medication that could have an interaction, they’ll recommend the antibody treatment instead.

The FDA first granted emergency use authorization of Paxlovid Dec. 22, 2021 for those 12 and older. It granted emergency use authorization for molnupiravir Dec. 23 for those 18 and over.

Charlotte Community Health Clinic’s Chief Medical Officer Dr. Anne Steptoe said the pill has been very safe in testing and has relatively few side effects.

ANTIBODY TREATMENTS FOR COVID

Monoclonal antibody treatment is given through an IV and works to block the virus that causes COVID-19 from entering cells in the body, according to the N.C. Department of Health and Human Services.

Steptoe said treatments were typically reserved for high-risk individuals but during the recent omicron variant surge, some treatments were offered to low-risk patients, as well.

Some “risk factors” for the virus may surprise people, she said.

“For example, smoking cigarettes is a risk factor that would qualify someone without severe disease,” Steptoe said. “But individuals often think that those treatments are reserved for the elderly, or very sick individuals.”

Piramzadian said some of the risk factors for COVID-19 include age, obesity, depression, high cholesterol, high blood pressure, coronary artery disease, breathing issues such as COPD or asthma and one he says people don’t always think about: vitamin D deficiency.

“Having vitamin D deficiency is actually one of the most significant risk factors that people don’t really look into,” Piramzadian said. “Studies have shown that a majority of the patients who end up in the ICU or dying have vitamin D deficiencies.”

There are two types of monoclonal infusions used to treat patients, Piramzadian said. Those can decrease the severity of symptoms by 70%, death by 70%, hospitalization by up to 87%, and also shorten how long symptoms last.

The most common risk factors associated with the multiple infusions are that people can feel a little dizzy, lightheaded, fevers, or chills less than 3% of the time and less than 1% can have severe allergic reactions, Piramzadian said. Patients are monitored for an hour after receiving the treatment.

Before registering for monoclonal antibody therapy on StarMed’s website, patients are asked to fill out a questionnaire that indicates whether they are at “high-risk” for poor outcomes due to COVID-19. The form asks patients if they are over 65, overweight, a smoker, if they are deficient in vitamin D and if they are pregnant, among other risk factors.

Piramzadian said there are fewer restrictions when it comes to prescribing the antiviral pills, but supply is still limited.

WHEN TO SEEK TREATMENT AND HOW TO FIND IT

The antiviral pills are only effective if they are taken within the first five days of symptom onset, Womack said. Antibody treatment is only effective within the first seven days.

At StarMed, according to Piramzadian, anyone with high-risk factors who tests positive at StarMed’s Tuckaseegee location is immediately informed about the pill. That clinic has treatment options on site and can see patients from other StarMed testing locations. In some cases, a patient will need a telemedicine visit to obtain a prescription.

Even if someone is not a regular patient of StarMed they can schedule an appointment to seek treatment for COVID-19 for free by visiting starmed.care/covid-therapy or calling 704-941-6000.