Gerald Smetana, MD: What PCPs Need to Know About Monoclonal Antibodies and Paxlovid

Primary care providers (PCPs) might not feel comfortable prescribing the necessary outpatient treatments, like monoclonal antibodies, for COVID-19 because these drugs are outside of their usual scope of practice, according to Gerald Smetana, MD, Professor of Medicine, Harvard Medical School, Clinician Educator, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center.

However, as a PCP himself, Smetana encouraged providers to become comfortable with the outpatient therapies available for treating the virus because it's the primary care providers who are currently positioned to be the prescribers in these scenarios.

"We're on the front lines, we're the ones who are getting these phone calls," Smetana said in an interview with HCPLive, "and we just simply don't have the time between when symptom onset occurs and patients have to be treated to get those types of subspecialty consultations."

Prescribing Resources for COVID-19 Treatments

While the responsibility of prescribing these treatments has fallen on PCPs, Smetana explained that there are resources to help. The first priority when prescribing monoclonal antibodies or an oral antiviral needs to be checking for drug interactions.

Pharmacists can serve as great resources for providers as well. Not only are pharmacists very familiar with these outpatient therapies, but some of the drugs Smetana mentioned when he gave a presentation on "New Drugs for the PCP: Outpatient Treatment of COVID-19" at Pri-Med West 2022, are packaged in a "very unusual format that most patients would have never seen before."

It's the pharmacists who will be teaching the patients how to use the medication, he pointed out. They can also be another line of defense when it comes to catching any drug interactions.

Outpatient COVID-19 Therapies

The treatment landscape of COVID-19 is continually evolving with new strains emerging. Smetana spoke about the various monoclonal antibodies, but as of right now, bebtelovimab is the only one that's retained an emergency use authorization (EUA) from the US Food and Drug Administration (FDA) for all variations of the virus.

In addition to monoclonals, the first oral antiviral treatment for COVID-19, Nirmatrelvir-ritonavir (Paxlovid), has the same indication as bebtelovimab--outpatients with the virus who are at risk of progression to severe disease.

Nirmatrelvir-ritonavir was approved in December and needs to be administered within 5 days of symptom onset. Recently, the antiviral has become available in commercial pharmacies and should be widely accessible now in most communities, according to Smetana.

"This is possible to get at local pharmacies, not just academic medical centers," he said. "It has to be given within 5 days of symptom onset, which is an important barrier. So, patients have to call us as soon as possible after testing positive. And because we do have that short window, this is why, you know, we're going to be the primary prescribers for that drug."