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No one in Israel’s healthcare system anticipated this scenario: Many COVID-risk patients who are candidates to receive the drug Regeneron have refused to take it since health-maintenance organizations began offering it on September 23. . It has only been administered to 256 patients so far, with 291 declining it.
The drug, which costs $ 1,500 per patient, is given intravenously and studies show significantly reduces the risk of serious illness if given within 72 hours of infection. The drug made headlines last year when it was handed over to former U.S. President Donald Trump, who was diagnosed with COVID-19. About a month later, it was approved by the FDA for emergency use.
Until recently, the drug was administered in Israel mainly to inpatients in hospitals and geriatric facilities. But since September 23, its use has spread across HMOs.
The health ministry has designated expensive drugs as a limited national asset and feared excessive demand from patients, especially those who do not meet the criteria. A letter from Ministry Director General Nachman Ash to HMOs called for clearly defined criteria to be established as to who is eligible for the drug, and for professional committees to be formed in each fund to review exceptional requests from unresponsive patients. to all clinical criteria. Criteria. Noting the shortage of the drug which he called a “national good”, Ash wrote that “all measures must be taken to avoid wasting and destroying doses or administering doses to those who do not meet the criteria. “.
As a result, HMOs established criteria based on the patient’s age, number of hospitalizations in the past three years, immunization status, and whether they had any chronic conditions such as kidney disease, diabetes, and coronary heart disease, among others, or were heavy smokers or suffered from immunosuppression. Each criterion is worth as many points, and if patients “score” seven points, they are eligible for the drug. Non-vaccination is worth five points and is the most weighted criterion. The HMOs have prepared for the rapid deployment of the drug. In addition, IDF medical teams were called in to help HMOs deliver the drugs to housebound patients, and on the same day the Health Ministry announced the expansion of the drug’s use, HMOs began to approach potential patients.
But it turns out that demand is very low and HMOs find themselves urging patients to take a drug meant to protect them from serious illness.
“So far, we have administered the drug to more than 140 patients, mainly in the homes of patients across the country, with the help of the Medical Corps,” says Dr. Doron Netzer, chief of medicine in the community division. by Clalit Health Services. Netzer tells Haaretz that the entire process at the patient’s home, including the infusion (which takes about 20 minutes) and observation afterwards, takes 90 minutes to two hours. Netzer teams contact COVID-19 patients who have risk factors for serious illness and explain the importance of taking the drug. But to his surprise, a substantial number refused. This includes many people who are not vaccinated and are therefore more at risk of serious illness and are also eligible for the expensive drug.
“Another group of ‘Regeneron deniers’ are the mild ones who feel good and don’t sense danger. It’s human and understandable, but they have a 20-25% risk of developing serious disease, and we can’t persuade them [to take the drug], “he says. Others express their will, make an appointment, then give up at the last moment – often due to consultations with friends and family.” It’s their right. It’s a new treatment. which is arguably the best available today, but there is still mistrust among some patients, ”says Netzer.
Criteria in the process of being relaxed
A senior official from another HMO told Haaretz: “We invest a lot in Regeneron, but we have four times as many rejections as takers. On the one hand, we were surprised. On the other hand, why would someone who refused vaccination take medication? If at first we thought we had to ration it, now we are relaxing the criteria and giving it to consenting patients even if they don’t fully meet the criteria.
The drug is manufactured by the American company Regeneron under the registered trademark REGEN-COV. He made the headlines last year, when he was handed over to former US President Donald Trump, who was diagnosed with COVID-19. About a month later, it was approved by the FDA for emergency use.
Since its approval, a study published in the New England Journal of Medicine has shown 81% effectiveness in preventing symptomatic disease and 66% in preventing contagion in people living with confirmed patients. In addition, the duration of symptoms in those infected was shorter than half of those who had not received the drug.
Regeneron contains two antibodies – Casirivimab and Imdevimab – which adhere to the viral envelope of the coronavirus and disrupt its ability to enter the cell and replicate.
Company studies have shown it to be 70 percent effective in preventing serious illness in unadmitted patients when given within 72 hours of infection – provided it is administered near from the onset of symptoms and not after the onset of deterioration. Studies have found virtually no side effects except for an allergic reaction or local bleeding and swelling from the injection itself.
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