St. Joseph’s Healthcare Hamilton Monoclonal Antibody Clinic (also known as COVID Care Clinic)
COVID Therapeutics are available in high risk patients in order to reduce the risk of severe COVID-19, when started early. There are two therapeutics currently approved in Canada. Nirmatrelvir/Ritonavir (Paxlovid), is an oral antiviral, that is available through physicians and commercial pharmacies across Ontario. Remdesivir, is an intravenous antiviral, that is available through the HHNB Home and Community Care Support Services.
FAQs
Patients who are considered higher risk are eligible for treatment. These include the elderly, those with immunocompromising conditions, those with multiple risk factors, and individuals who are under vaccinated or unvaccinated.
No, staying up to date on vaccination is still very important, and has greater effects than therapy can offer.
- Paxlovid can be prescribed by community providers such as physicians and nurse practitioners, as well as by pharmacists. The most common issue with paxlovid is drug interactions, and resources such as the Liverpool covid drug checker (https://www.covid19-druginteractions.org/checker), the Ontario Science table guidance (https://covid19-sciencetable.ca/sciencebrief/nirmatrelvir-ritonavir-paxlovid-what-prescribers-and-pharmacists-need-to-know-3-0/)
- Patients who are on DOAC’s such as apixaban, rivaroxaban, dabigratran, and edoxaban can use the Ontario Science table guidance for patients on a DOAC and Paxlovid (https://covid19-sciencetable.ca/sciencebrief/paxlovid-for-a-patient-on-a-doac-2-0/)
- Paxlovid is given as 300mg / 100mg PO BID for patients with a GFR > 60, and 150mg/100mg PO BID for those with a GFR between 30-60. While there is no on-label recommendations for those with a GFR < 30, there is recommendations on a dose in this population (https://www.ontariohealth.ca/sites/ontariohealth/files/2022-04/PaxlovidClinicalGuide.pdf)
Given the health human resources needed to administer remdesivir, it should be considered for high risk patients who have a contraindication to Paxlovid, such as certain medications where drug-drug interactions cannot be mitigated. Both therapies are equally efficacious, and there is no advantage to either, or giving both.
Remdesivir is available through the HHNB Home and Community Care Support Services.
A sample referral can be seen here and here (fill out both forms). Of note – please see the HHNB website for the most up to date forms (https://healthcareathome.ca/)
As of March 31, 2023 – St. Joseph’s Healthcare will no longer be offering monoclonal antibodies, paxlovid, or remdesivir to outpatients as part of an organized clinic. For information on Paxlovid or Remdesivir, please see the resources listed above.