As one of the most accessible healthcare providers, pharmacist-led monoclonal antibody clinic makes sense

Pharmacists are arguably one of the most accessible healthcare providers to the public, especially during pandemic times, and often go unrecognized for their effort and sacrifices to help curb this devastating virus. One shining example of a pharmacist who readily contributes to the frontline battle is Dr. Gavin Howington (PharmD 2014). Howington, an Emergency Medicine Clinical Pharmacy Specialist at UK HealthCare and Clinical Assistant Professor at the UK College of Pharmacy, is making a daily impact on the lives of high-risk patients who contract COVID-19. Through the use of monoclonal antibody therapy, Howington helps the healthcare field gain control over a virus that continually evolves over time.

What is Monoclonal Antibody Therapy?

In simple terms, monoclonal antibody therapy is a mixture of two separate antibodies designed to help decrease disease symptoms, hospitalization and death among high-risk SARS-CoV-2 patients. High-risk patients include those who are 65 and up or struggle with obesity, chronic obstructive pulmonary disease, diabetes, asthma and other medical conditions. In the United States, this therapy can be given to qualified patients either through intravenous infusion or a series of shots. For UK, a cocktail developed by Regeneron Pharmaceuticals is given through four shots administered at different spots on the patient’s body.

As for what monoclonal antibody therapy does, when injections or infusions are given, the antibodies bind to and neutralize the virus, preventing the damage caused by SAR-CoV-2. The reason a cocktail of antibodies is used is to decrease the chance that a SARS-CoV-2 viral mutation will make monoclonal antibody therapy less effective or all together ineffective. Through the use of this groundbreaking therapy, data has determined that the chance of high-risk patients becoming hospitalized or decompensating and dying decreases by 70%.

How Pharmacists are Utilizing the Therapy

Howington expressed excitement about how the therapy is decreasing overall hospitalization and death rates in already over-run medical centers. However, he warned that monoclonal antibody therapy is not a full substitute for a COVID-19 vaccination. “There are plenty of patients that come in and are vaccinated, but there are also a lot that are unvaccinated. I try to take this as a moment to say ‘You have COVID. Maybe now this is the time where we should really think about you getting vaccinated once you are over this current infection. Is there anything I can present you with that helps make you feel more comfortable with doing that?’” said Howington. “The reality is that monoclonal antibody therapy is amazing. It’s phenomenal and you should absolutely get it if you qualify. But it’s important to remember that it only lasts for approximately 90 days at the maximum. It’s not a permanent fix or substitute for vaccination. It’s an additional tool in our tool kit for fighting COVID.”

Howington also reflected on how rewarding it has been working in the clinic, especially through the way he impacts others. Recently, he was able to change a patient’s mind about receiving the COVID vaccine by discussing the vaccine’s possible risks and benefits. Howington specifically addressed the patient’s concerns about the development of myocarditis or pericarditis after receiving the vaccine. He also discussed how developing myocarditis or pericarditis after receiving a COVID vaccine is rare. Even when cases do occur, they are often mild, requiring only a brief period of observation, and respond well to medication therapy when needed. “That made my day,” said Howington. “If you decide after 90 days [post-monoclonal antibody therapy] to get vaccinated, I have accomplished something. Because not only have I gotten to provide you with a therapy that prevents you from decompensating by 70%, but I have also helped you better understand the COVID vaccine.”

It is clear to Howington that COVID-19 is here to say, so vaccination is key to gaining control over the pandemic. “The virus isn’t going away. Our goal has to be risking mitigation. Let's get people vaccinated and give them the best chance possible at only developing minimal symptoms so they don’t need hospitalization or ICU admission and so they don’t die,” said Howington. “As an advocate for vaccines, I truly believe that our way out of this is vaccination. I think that as many people as possible that are eligible need to get vaccinated. People that are eligible to get boosters need to get their boosters. Also, from the standpoint of global health, we need to play our role and contribute vaccines to the rest of the world. It’s not just about us and the United States. Until we can essentially stop the virus from replicating, we are going to continue to see variants and surges. We’ve got to do whatever it takes from a messaging standpoint to help people understand that the vaccine is safe and the best choice It’s the only way we’re going to gain control. The goal is not to eradicate SARS-CoV-2; instead, the goal is to make this like the common cold. And pharmacists are an essential part of this process.”

The Expanding Role of the Pharmacist

Howington also discussed how he actively works to positively change how people see pharmacists in healthcare. “I really try hard to fight the good fight and help people understand what pharmacists offer. When you say pharmacist, the first thing someone thinks of is pills or community pharmacy, such as Walgreens, Kroger or CVS. However, many pharmacists across the nation, including those in retail pharmacies, do so much more than check prescriptions and count pills. Your retail or independent pharmacists are ensuring that your medication is correct. In my general job, I am as hands on as you can get,” said Howington. “Pharmacists spend the most time in school focusing on medication, therapeutics and vaccines. More than any other healthcare professional! We can obtain your vitals, blood pressure, heart rate and oxygen saturation, and that’s not something that patients commonly think of when they picture what a pharmacist can do. A pharmacist can literally be the person who takes care of you the entire course of your stay at the monoclonal antibody therapy clinic. I’m doing that every day I work. I love more than anything to show up, demonstrate to everyone what pharmacists can do and take care of COVID patients.”

Whether a physician, physician assistant, nurse practitioner, respiratory therapist, nurse or pharmacist, everyone at UK HealthCare is working toward keeping Kentuckians healthy. “We try whenever possible to make each other smile and help each other get through the day," said Howington. “To know you aren’t on an island by yourself, that it’s not just you and that there are a lot of other people just like you that are toughing it out every day doing a lot of good work, helps. Whenever patients thank me for the work I do, or I walk a vaccine hesitant patient through their concerns and they get the vaccine, I know we’re making a difference.”