Hospitals have resorted to creating their own lottery systems to allocate a scarce supply of COVID-19 antibody treatments for immunocompromised patients, NPR reported Jan. 25.
At Boston-based Massachusetts General Hospital, the initial deliveries of AstraZeneca's monoclonal antibody combination drug Evusheld covered less than 1 percent of its patients with suppressed immune systems. The hospital developed a three-tiered system to rank patients by medical need, and to give patients in the top tier an equal chance.
"We put everybody's name into a lottery," Camille Kotton, MD, told NPR. "If people literally get their name pulled in the lottery, we bring them in for an injection."
Dr. Kotton is the clinical director of transplant and immunocompromised-host infectious diseases at Massachusetts General.
Rochester, Minn.-based Mayo Clinic has devised a similar approach, making randomized selections from a five-tiered system.
"It's basically by luck," said Raymund Razonable, MD, who runs the system's monoclonal antibody treatment program. "They happen to be randomly picked by the computer system," he told the news outlet, adding that it will likely take months to get through the list of several thousand people in its tier with the most vulnerable patients.
The omicron variant has thrown a wrench in the effectiveness of the nation's monoclonal antibody therapy candidates, prompting the FDA to halt the use of Regeneron and Eli Lilly's treatments Jan. 24. Some systems, including NewYork-Presbyterian, NYU Langone and Mount Sinai, had already stopped administering the two treatments prior to the FDA's decision.
AstraZeneca's Evusheld is among the few candidates demonstrating some protection against omicron, though it remains in short supply, NPR reports. The National Institutes of Health now recommends sotrovimab, made by GlaxoSmithKline and Vir Biotechnology, as the primary monoclonal treatment, though its supply is extremely limited.