COVID-19 Resource Center / COVID-19 Outpatient Therapeutics - Health Care Professionals
COVID-19 Outpatient Therapeutics - Health Care Professionals
Statement regarding Omicron Subvariants
11/21/22 Update: With the rapid increase in the circulation of certain SARS-CoV-2 Omicron subvariants in the United States, California, and our geographical region, the SHC COVID-19 Outpatient Therapeutics Team has decided to implement the following changes to our monoclonal antibody (mAb) therapies for the prophylaxis and treatment of COVID-19:
- Pre-exposure prophylaxis [Evusheld]
- The subvariants BA.4.6, BA.2.75.2, BA.5.2.6, BF.7, BQ.1, and BQ.1.1 are likely to be resistant to tixagevimab plus cilgavimab (Evusheld). Certain SARS-CoV-2 viral variants may not be neutralized by Evusheld and may not be effective at preventing COVID-19 caused by these variants.
- Effective 11/21/22, SHC will halt the scheduling of new outpatient Evusheld appointments and close the Evusheld provider referral RedCap form
- Effective 11/23/22, SHC will halt ALL administrations of Evusheld for inpatient and outpatient areas.
- Patients who are eligible to receive Evusheld as PrEP should be informed of the following recommendations as preventative measures:
- Receive a bivalent COVID-19 vaccine unless contraindicated due to a history of severe adverse reactions to a COVID-19 vaccine or any of its components.
- Continue to take precautions (e.g. masking in public indoor areas) to avoid exposure.
- Treatment [Bebtelovimab]
- The subvariants BQ.1 and BQ.1.1 are likely to be resistant to bebtelovimab. Certain SARS-CoV-2 viral variants may not be neutralized by bebtelovimab and may not be effective at treating COVID-19 caused by these variants.
- Effective 11/21/22, SHC will halt the administration of bebtelovimab.
- Based on the latest NIH COVID-19 Treatment Guidelines, the following therapeutics are expected to be active against these resistant subvariants and are available for the treatment of mild to moderate COVID-19 in non-hospitalized adults who are at high-risk of progressing to severe disease in order of preference:
- ritonavir-boosted nirmatrelvir (Paxlovid)
- remdesivir (Veklury) [IV infusion for 3 consecutive days]
- molnupiravir (Lagevrio)
- If your patient develops COVID-19, please fill out the SHC patient eligibility intake form below.
Thank you,
The SHC COVID-19 Outpatient Therapeutics Team
General Information for Health Care Professionals
Stanford Health Care is offering COVID-19 therapeutics for treatment or prevention in eligible patients, whether within or outside of the Stanford Health Care system, in accordance with national guidelines.
Due to the evolving variants and supply of medications, Stanford Health Care will select the specific therapeutic based individual patient factors.
For questions, please contact us at 650-391-8503.
Stanford Health Care reserves the right to select based on medication supply and clinical data available at the time of referral.
Are you a patient?
General Information for Health Care Professionals
Stanford Health Care is offering COVID-19 therapeutics for treatment or prevention in eligible patients, whether within or outside of the Stanford Health Care system, in accordance with national guidelines.
Due to the evolving variants and supply of medications, Stanford Health Care will select the specific therapeutic based individual patient factors.
Stanford Health Care reserves the right to select based on medication supply and clinical data available at the time of referral.
Are you a patient?
For questions, please contact us at 650-391-8503.
Post-exposure prophylaxis – Jan. 19, 2022
No monoclonals active against the omicron variant are available for post-exposure prophylaxis.
Confirming Patient Eligibility
- Positive direct SARS-CoV-2 viral testing
- Be symptomatic with onset within the previous 7 days
a. Symptoms include at least one of the following: fever, cough, sore throat, malaise, headache, muscle pain, gastrointestinal symptoms, or shortness of breath with exertion - Meet one or more high-risk criteria (see below)
High-risk criteria
- BMI >25 kg/m2
- Chronic kidney disease
- Diabetes mellitus
- Immunosuppressive disease/therapy — this does not include:
- HIV alone with CD4 >200 CD4+ T cells/mm3
- Prednisone or prednisone equivalent <20 mg daily for <3 weeks
- Pregnancy
- Age >= 50 years
- Cardiovascular disease including congenital heart disease, hypertension
- Chronic respiratory disease including chronic obstructive pulmonary disease
- Sickle cell disease
- Neurodevelopmental disorders
For the most current information on conditions that may increase risk for severe COVID, please refer to the CDC guidance
Referral Process Overview
Step 1: Familiarize Yourself
- Stanford Health Care reserves the right to select the medication therapy based on medication supply and clinical data available at the time of referral.
Step 2: Educate the Patient
- Inform the patient of the current therapies that are unapproved therapies but are authorized by the FDA for use under Emergency Use Authorization. Click here for information that may assist in explaining EUA to patients.
- Discuss the risks, benefits, and alternatives to therapies with patients.
- If the patient is interested in pursuing therapy:
- The referral will be screened to ensure that the patient is eligible for therapy.
- If approved, the patient will be contacted via phone to schedule an appointment and will receive detailed information about what to expect.
- If denied, the patient will be informed of the reason for denial.
Step 4: Follow-up & Reporting
- If the patient experienced an adverse reaction, the provider must report it to all of the following:
- FDA MedWatch
- Manufacturer
- Enter a SAFE Event (Stanford Health Care-privileged providers only) or email DL-SHC-Pharmacy-COVID@stanfordhealthcare.org.