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Monoclonal Antibody Therapy to Treat COVID-19

Please consider the oral antiviral, Paxlovid, as a first choice for treatment for COVID-19 positive outpatients who are within 5 days of symptom onset and meet the criteria. You can find details on this and all other COVID treatments at www.bjc.org/for-physicians/covid.

BJC is administering monoclonal antibody therapy (mAb) for COVID-19 which has been granted emergency use authorization (EUA) by the FDA. The monoclonal antibody therapy is administered in an outpatient setting and is authorized for early treatment of high-risk patients who have mild to moderate COVID-19.

Monoclonal antibodies are investigational and are not FDA-approved for COVID-19.


QUICK LINKS: Inclusion Criteria | Exclusion Criteria | Ordering Treatment | EUA Fact Sheets


Who is eligible?

At BJC, and under the EUA mandatory requirements, monoclonal antibodies are only authorized for the treatment of mild to moderate COVID-19 in adults and pediatric patients with positive results of direct SARS-CoV-2 viral testing and who are at high risk for progressing to severe COVID-19 and/or hospitalization. These agents are not FDA-approved for these uses.

Patients who with at least one high-risk condition:

  • Older age
  • Obese or overweight
  • Pregnancy
  • Chronic kidney disease
  • Diabetes
  • Immunosuppressive disease or treatment
  • Cardiovascular disease or hypertension
  • Chronic lung disease
  • Sickle cell disease
  • Neurodevelopmental disorder or other condition that confers medical complexity
  • Medical-related technological dependence
  • Part of a group at increased risk of getting sick and dying from COVID-19 due to long-standing systemic health and social inequities, including racial and ethnic minorities and people with disabilities
  • Other medical condition and/or factor associated with increased risk for progression to severe COVID

And early COVID-19 infection

  • COVID-19 positive (rapid antigen or PCR test)
  • Able to receive treatment within 7 days of symptom onset
  • One or more symptoms consistent with COVID-19 (fever, cough, shortness of breath, fatigue, myalgia, headache, new loss of taste or smell, sore throat, congestion, runny nose, nausea or vomiting, diarrhea)

mAb Exclusion Criteria (if meets any one criterion)

  • Hospitalized with COVID-19
  • Requiring oxygen therapy due to COVID-19
  • Requiring increase in baseline oxygen due to COVID-19 in those on chronic oxygen therapy

COVID-19 treatment

The efficacy of the mAb therapy is dependent on the patient receiving treatment in a timely manner; important factors include duration of symptoms and the inclusion and exclusion criteria. The following algorithms and Tip Sheets will guide you through the process of ordering mAb treatment.

Order the Treatment

For qualifying adult patients who receive positive test results, treatment must be ordered in Epic. For pediatric patients, there is an option to enter into Epic or fill out a paper form.

We are now offering mAb therapy in the following existing infusion clinics as part of our normal operations. Please note that under standard operations, some facilities may have limitations on who can order or who can receive treatment based on state regulations or the hospital by-laws.

  • Memorial Hospital Belleville Multiservice Center - for patients who receive care in Illinois or are Illinois residents
  • Barnes-Jewish Hospital Cancer Care Clinic – available for Missouri residents and to be ordered only by providers with privileges at BJH in accordance with the hospital by-laws
  • Parkland Health Center Infusion Center – available for Missouri residents
  • St. Louis Children’s Hospital Infusion Centers – available for pediatric patients and patients followed by SLCH specialists

Please be aware that with the emergence of variants, ever changing guidelines on monoclonal antibody therapy, and supply constraints, we may need to change the drug administered in our infusion clinics in order to provide the best therapy for our patients. These changes, made based on input from the BJC/WashU Treatment Guidance Group, will need to be dynamic and will be made automatically.

Epic workflow for adult and pediatric patients:

Adult Epic HIP TIP for Ordering Treatment Pediatric Epic HIP TIP for Ordering Treatment

Paper form for pediatric patients only:

Please fill out the forms in their entirety and sign the bottom of the order form. Failure to do so could result in your patient being unable to receive treatment.

Pediatric Order Form (updated 4/11/2022)

For pediatric patients, providers may order monoclonal antibodies directly for any patients who meet EUA criteria. If you have questions or would like to discuss a case, please call St. Louis Children’s Hospital Children’s Direct 800.678.HELP (4357) and ask for the immunocompromised ID provider on call.


Emergency Room Administration:

If you are not able to utilize one of the options above, you can direct your patients to one of the following EDs for evaluation. If the ED provider deems it appropriate, the patient will be provided treatment options which may include Paxlovid, mAb therapy, or other available therapies. The following EDs have the ability to provide mAb treatment: Alton Memorial Hospital, Barnes-Jewish Hospital, Barnes-Jewish St. Peters Hospital, Christian Hospital, Missouri Baptist Medical Center, and Progress West Hospital. The list of EDs with the ability to offer this drug is subject to change at any time.


Treatment delivery

Monoclonal antibody treatment must be administered as a single intravenous (IV) injection over at least 30 seconds, with at least one hour of observation after the infusion is complete. Immediate access to medications to treat severe infusion reactions and the ability to activate the emergency medical system are required.


EUA Fact Sheets (bebtelovimab)

Download the Fact Sheet for Patients, Parents and Caregivers

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