Monoclonal antibody–based therapies targeting SARS-CoV-2 were given less often to Asian, Black, Hispanic, and other minority-race outpatients with COVID-19 compared with similar White patients, according to a new analysis led by researchers at the Centers for Disease Control and Prevention (CDC).
Such disparities amplify the increased risk among these groups for severe COVID-19–associated outcomes, including death, as a consequence of their higher prevalence of preexisting conditions, the researchers note.
Anti–SARS-CoV-2 monoclonal antibody therapies are typically administered to nonhospitalized patients with mild to moderate laboratory-confirmed SARS-CoV-2 infection who are at high risk for progressing to severe disease and hospitalization. They are also given to certain individuals who are at high risk of becoming infected and progressing to serious illness after they have been exposed to the virus.
The treatment, generally given in outpatient settings, must be administered by intravenous infusion or subcutaneous injection by a health care professional soon after the patient receives a positive test result and within 10 days of the appearance of symptoms.
According to the CDC, certain racial and ethnic groups—including Black, Hispanic or Latino, and American Indian or Alaska Native individuals—are at higher risk of requiring hospitalization for or dying from COVID-19 compared with White individuals. The agency notes that race and ethnicity are markers for risk because of other underlying conditions that affect health and because of factors such as socioeconomic status, access to health care, and risk of occupation-related exposure that individuals such as frontline, essential, and critical infrastructure workers experience.
The researchers used data from 41 US health care sites that participate in the National Patient-Centered Clinical Research Network, focusing on electronic health records of patients with COVID-19 to assess the administration of medications for COVID-19 by race (Asian, Black, White, and an “Other Race” category that including American Indian, Alaska Native, Native Hawaiian, and others) and by ethnicity (Hispanic or non-Hispanic). During March 2020 to August 2021, 805 276 (13.6%) of the nearly 6 million patients in the network’s health care system who were tested for COVID-19 were infected with SARS-CoV-2.
These patients represented approximately 3.0% of all positive results reported to the CDC during the period covered by the study and were similar demographically to those included in CDC case data by age, sex, race, and ethnicity.
Only a small proportion of the patients with COVID-19 received monoclonal antibodies, with an average monthly use of 2.2% to 4.0%, depending on the group. A higher proportion of patients with conditions that put them at high risk (including age 65 years or older, obesity, pregnancy, chronic kidney disease, diabetes, immunosuppression, cardiovascular disease, and lung disease) received monoclonal antibody treatment.
The relative differences in use of monoclonal antibody therapy between ethnic and racial groups were significant. The new analysis found that Hispanic patients received the treatment 58% less often than non-Hispanic patients, and patients who were Asian, Black, or in the Other race category received the therapy 48%, 22%, and 47% less often, respectively, than White patients.
The researchers note that because the data they analyzed are from “a convenience sample” of health care facilities, their findings have limited generalizability to the US population. However, finding racial and ethnic disparities in monoclonal antibody treatment is consistent with results from previous studies, they said.
The CDC-led study also examined the use of 2 medications used to treat hospitalized patients with COVID-19: the commonly used corticosteroid dexamethasone and the antiviral medication remdesivir.
“Among inpatients, disparities were different and of lesser magnitude: Hispanic inpatients received dexamethasone 6% less often than did non-Hispanic inpatients, and Black inpatients received remdesivir 9% more often than did White inpatients,” the report says, noting that the smaller relative differences in treatment with dexamethasone and remdesivir “might be attributed to ease of medication access.”
The study did not identify the underlying causes for the disparities in monoclonal antibody treatments, the researchers said, which suggests that the disparities might reflect systemic factors, such as limited access to testing and care resulting from constraints on availability, inadequate insurance coverage, transportation difficulties, or the lack of a primary care clinician to recommend treatment. The researchers cite other potential factors contributing to the disparity, including variations in the supply and distribution of the medication, potential biases in prescribing practices, and “limited penetration of messaging” in some communities about the availability and effectiveness of monoclonal antibody therapy to prevent disease progression.
Hesitancy about receiving treatment might also contribute to disparities. Another study found that patients who were non-Hispanic White and English-speaking accepted monoclonal antibody therapy more often compared with non-White and Hispanic patients.
“This finding highlights disparities as a priority for intervention and can guide strategies aimed at more equitable COVID-19 outcomes,” the researchers said. They note that “policies, resources, and programs addressing the specific needs of served populations, institutions, and places can accelerate progress towards health equity.”
Reducing racial and ethnic disparities in treatment for COVID-19 requires patient and clinician awareness of the problem and its potential solutions, as well as resources and action by government, private entities, and community- and faith-based organizations, the researchers said, adding that studies have demonstrated that using a mobile infusion unit or other strategies to bring health care to populations that face obstacles to accessing monoclonal antibody therapy increases use of the therapy, decreases severe outcomes from infection, and reduces costs.
“Efforts to reduce racial and ethnic disparities with equitable outpatient COVID-19 treatment access, practices, and supportive systems are urgently needed,” the researchers said. They also point to vaccines and preventive measures as the best defense against infection, noting that use of COVID-19 medications such as monoclonal antibodies, remdesivir, and dexamethasone can reduce illness and death and ease strain on hospitals, “but are not a substitute for COVID-19 vaccination.”
Published: January 25, 2022. doi:10.1001/jamahealthforum.2022.0115
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Stephenson J. JAMA Health Forum.
Corresponding Author: Joan Stephenson, PhD, Consulting Editor, JAMA Health Forum (Joan.Stephenson@jamanetwork.org).
Conflict of Interest Disclosures: None reported.