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Revised Prioritization Strategy for Bamlanivimab Utilization

The Eli Lilly monoclonal antibody for COVID-19 infection (bamlanivimab) has now been given an Emergency Use Authorization by the FDA. The drug is not indicated for the following groups: 

  1. Hospitalized patients 
  2. Patients receiving supplemental oxygen 
  3. Patients on home oxygen who are requiring increased amounts 

Patients with moderate illness will be prioritized over those with mild illness and this is reflected in the risk scores below. Patients must have a symptom duration and a positive COVID-19 test no more than seven days prior to treatment. 

Mild illness: Fever with mild respiratory symptoms including cough, sore throat, and malaise. 

Moderate illness: Fever with cough, chills, shortness of breath, and findings of lower respiratory tract infection on imaging or examination and an O2 saturation of > 94%. 

The following risk score can be calculated based on risk factors 

  1. Moderate illness 3 points 
  2. Age > 653 points 
  3. BMI > 353 points 
  4. Immunosuppressed* 3 points 
  5. Chronic kidney disease* 2 points 
  6. Diabetes mellitus* 2 points 
  7. Age > 55 with COPD* 2 points 
  8. Age > 55 with HTN or CAD/CHF 1 point 
  9. Mild illness 1 point 

*Immunosuppressed: Patients on immunosuppressive medications or who have immunosuppressive disease (e.g. CLL) 

* CKD: Stage 3 or above 

* Diabetes on oral agents or insulin 

*COPD: Requiring home O2 (but at baseline flow rate) 

Patients whose score is >5 will be eligible for treatment. 

December 7, 2020