MICROBIOLOGY SECTION.

15 MICROBIOLOGY/RESISTANCE INFORMATION. Antiviral ActivityThe cell culture neutralization activity of bamlanivimab and of etesevimab against SARS-CoV-2 was measured in dose-response model quantifying plaque reduction using cultured Vero E6 cells. Bamlanivimab, etesevimab and 1:1 (weight/weight) ratio of bamlanivimab and etesevimab together neutralized the USA/WA/1/2020 isolate of SARS-CoV-2 with estimated EC50 values 0.14 nM (0.02 ug/mL), 0.97 nM (0.14 ug/mL) and 0.14 nM (0.02 ug/mL), respectively.Bamlanivimab demonstrated antibody-dependent cell-mediated cytotoxicity on reporter Jurkat cells expressing FcRIIIa following engagement with target cells expressing spike protein. Bamlanivimab did not elicit complement-dependent cytotoxicity activity in cell-based assays.Etesevimab did not demonstrate detectable antibody-dependent cell-mediated cytotoxicity on Jurkat reporter cells expressing FcRIIIa. Etesevimab did not elicit complement-dependent cytotoxicity activity in cell-based assays.. Antibody Dependent Enhancement (ADE) of InfectionThe risk that bamlanivimab and etesevimab could mediate viral uptake and replication by immune cells was studied in THP-1 and Raji cell lines and primary human macrophages. In general, experiments with bamlanivimab, with etesevimab, and with bamlanivimab and etesevimab together did not demonstrate productive viral infection in immune cells exposed to SARS-CoV-2 at concentrations of mAb(s) down to at least 100-fold below the respective EC50 value(s).. Antiviral ResistanceThere is potential risk of treatment failure due to the development of viral variants that are resistant to bamlanivimab and/or etesevimab (Table 5). There are other authorized treatments available and healthcare providers should choose an authorized therapeutic option with activity against circulating variants in their state, territory, or US jurisdiction. Variant frequency data for states, territories, and US jurisdictions can be accessed on the following CDC website: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/variant-proportions.html.Resistant variants were identified using directed evolution of the spike protein and serial passage in cell culture of SARS-CoV-2 in the presence of bamlanivimab or etesevimab individually. Resistant variants were not identified when bamlanivimab and etesevimab were tested together using the same methodology. Viral variants identified in these studies that had reduced susceptibility to bamlanivimab included spike protein amino acid substitutions E484D/K/Q, F490S, Q493R, and S494P, and variants that had reduced susceptibility to etesevimab included substitutions K417N, D420N, and N460K/S/T/Y. Neutralization assays using SARS-CoV-2 and vesicular stomatitis virus (VSV) virus-like particles (VLP) pseudotyped with variant SARS-CoV-2 spike protein confirmed reductions in susceptibility to the selecting antibody. Retention of susceptibility to the other antibody alone was observed, with the exception of the E484D and Q493R substitution. All variants maintained susceptibility to bamlanivimab and etesevimab together, with the exception of those with E484D, E484K, E484Q, and Q493R substitutions, which had reduced susceptibility of 145-fold, 24-fold, 17-fold, and 1,054-fold, respectively in pseudotyped VLP assay.Evaluation of susceptibility of variants identified through global surveillance in subjects treated with bamlanivimab and etesevimab is ongoing. Pseudotyped VLP evaluation of amino acid substitutions identified in global surveillance showed that the V483A substitution reduced susceptibility to bamlanivimab 48-fold, but activity was maintained with etesevimab, and with bamlanivimab and etesevimab together. N501Y and N501T substitutions reduced susceptibility to etesevimab approximately 5-fold and 20-fold, respectively. Activity against variants with N501Y or N501T substitutions was maintained with bamlanivimab alone, and with bamlanivimab and etesevimab together.Bamlanivimab and etesevimab together retained activity against SARS-CoV-2 B.1.1.7 lineage (Alpha; UK origin) virus and related pseudotyped VLPs expressing the spike protein found in the B.1.1.7 variant (Tables and 6). SARS-CoV-2 B.1.351 lineage (Beta; South Africa origin) virus and related pseudotyped VLPs expressing spike proteins from B.1.351 lineage or substitutions K417N E484K N501Y found in this lineage had reduced susceptibility to bamlanivimab and etesevimab together of >324, 431-fold or >45-fold, respectively. Pseudotyped VLPs expressing spike protein from the P.1 lineage (Gamma; Brazil origin) or K417T E484K N501Y found in the P.1 lineage had reduced susceptibility to bamlanivimab and etesevimab together of 252-fold or >3,351-fold, respectively.Bamlanivimab and etesevimab together and etesevimab alone retained activity against SARS-CoV-2 B.1.617.2 lineage (Delta; India origin) virus and related pseudotyped VLPs, but bamlanivimab alone had reduced activity (>1,136 and >1,868-fold, respectively). Bamlanivimab and etesevimab are expected to retain activity against B.1.617.2 sublineage AY.3 (India origin). B.1.617.2 sublineages AY.1/AY.2 (India origin) have an additional K417N substitution; pseudotyped VLPs expressing AY.1/AY.2 related spike sequence had reduced susceptibility to bamlanivimab and etesevimab together of 1,235-fold. SARS-CoV-2 recombinant virus containing the L452R substitution present in B.1.427/B.1.429 lineages (Epsilon; USA [California] origin) and pseudotyped VLPs expressing the full-length spike protein or the L452R substitution found in this lineage showed reduced susceptibility to bamlanivimab and etesevimab together of 11-fold, 9-fold or 5-fold, respectively. Pseudotyped VLPs expressing spike protein from the B.1.617.1 lineage (Kappa; India origin) showed reduced susceptibility to bamlanivimab and etesevimab together of 6-fold; for this variant, susceptibility to etesevimab alone was maintained, but not to bamlanivimab alone (>1,030-fold reduction). Bamlanivimab and etesevimab together and etesevimab alone retained activity against pseudotyped VLPs expressing the full-length spike protein from the C.37 lineage (Lambda; Peru origin), but bamlanivimab alone had reduced activity (>2,112-fold reduction). Pseudotyped VLPs expressing spike protein from the B.1.621 lineage (Mu; Colombia origin) show reduced susceptibility to bamlanivimab and etesevimab together of 116-fold, due to susceptibility reductions to bamlanivimab (>1,863-fold) and etesevimab (17-fold) alone. Pseudotyped VLPs expressing the spike protein from the B.1.1.529/BA.1 lineage (Omicron; South Africa origin) show reduced susceptibility to bamlanivimab alone (>1,465-fold), etesevimab alone (>616-fold), and bamlanivimab and etesevimab together (>2,938-fold).Table 5: Pseudotyped Virus-Like Particle Neutralization Data for SARS-CoV-2 Variant Substitutions with Bamlanivimab and Etesevimab Together (1:2 Molar Ratio)a Key substitutions occurring in the receptor binding domain of spike protein are listed. Pseudoviruses containing the full-length spike protein reflective of the consensus sequence for each of the variant lineages were tested.b No change: <5-fold reduction in susceptibility.c Bamlanivimab and etesevimab together are unlikely to be active against variants from this lineage.d Etesevimab retains activity against this variant.e Isolates of the B.1.526 lineage harbor several spike protein amino acid substitutions, and not all isolates contain the E484K substitution (as of February 2021).Lineage with Spike Protein SubstitutionCountry First IdentifiedWHO NomenclatureKey Substitutions TestedaFold Reduction in SusceptibilityB.1.1.7UKAlphaN501Yno changeb B.1.351South AfricaBetaK417N E484K N501Y431c P.1BrazilGammaK417T E484K N501Y252c B.1.617.2/AY.3IndiaDeltaL452R T478Kno changeb AY.1/AY.2(B.1.617.2 sublineages)IndiaDelta [+K417N]L452R T478K K417N1,235c B.1.427/B.1.429USA (California)EpsilonL452R9d B.1.526e USA (New York)IotaE484K30B.1.617.1IndiaKappaL452R E484Q6d C.37PeruLambdaL452Q F490Sno changeb B.1.621ColombiaMuR346K E484K N501Y116c B.1.1.529/BA.1South AfricaOmicronG339D S371L S373P S375F K417N N440K G446S S477N T478K E484A Q493R G493S Q498R N501Y Y505H>2,938c Table 6: Authentica SARS-CoV-2 Neutralization Data for Bamlanivimab and Etesevimab Together (1:2 Molar Ratio)a The B.1.1.7 variant was assessed using cell culture-expanded virus isolates and tested using an immunofluorescence based microneutralization assay and by plaque reduction assay; B.1.351 and B.1.617.2 variants were assessed using cell culture-expanded virus isolates and tested using plaque reduction assay; the B.1.526/E484K and B.1.427/B.1.429/L452R substitutions were assessed using recombinant SARS-CoV-2 (USA/WA/1/2020 isolate with E484K or L452R) and tested using plaque reduction assay.b Key substitutions occurring in receptor binding domain of spike protein which are associated with each lineage.c No change: <5-fold reduction in susceptibility.d Isolates of the B.1.526 lineage harbor several spike protein amino acid substitutions, and not all isolates contain the E484K substitution (as of February 2021). This assay was conducted using recombinant SARS-CoV-2 with the E484K substitution only.Lineage with Spike Protein SubstitutionCountry First IdentifiedWHO NomenclatureKey Substitutions TestedbFold Reduction in SusceptibilityB.1.1.7UKAlphaN501Yno changec B.1.351South AfricaBetaK417N, E484K, N501Y>324B.1.617.2/AY.3IndiaDeltaL452R, T478Kno changec B.1.427/B.1.429USA (California)EpsilonL452R11B.1.526d USA (New York)IotaE484K11Due to the large reduction of pseudotyped VLP neutralization activity of both bamlanivimab and etesevimab against the substitutions in B.1.351 (Beta; South Africa origin), P.1 (Gamma; Brazil origin), AY.1/AY.2 (Delta [+K417N]; India origin), B.1.621 (Mu; Colombia origin), and B.1.1.529/BA.1 (Omicron; South Africa origin), it is unlikely that bamlanivimab and etesevimab together will be active against these variants.It is unclear how small reductions in susceptibility to bamlanivimab and etesevimab seen in authentic or recombinant SARS-CoV-2 or pseudotyped VLP assays correlate with clinical outcomes.In authentic SARS-CoV-2 assays, bamlanivimab and etesevimab together retained activity against variants of B.1.1.7 (Alpha) and B.1.617.2/AY.3 (Delta) lineages (Table 6), although bamlanivimab alone had reduced activity to B.1.617.2/AY.3 (Delta) in this assay (>1,136-fold). SARS-CoV-2 (USA/WA/1/2020 isolate) engineered to express the E484K substitution present in the B.1.526 lineage (Iota; USA [New York] origin) or the L452R substitution present in the B.1.427/B.1.429 lineage (Epsilon; USA [California] origin) showed reduced susceptibility to bamlanivimab and etesevimab together of 11-fold. Susceptibility to etesevimab alone was maintained for both isolates, but not to bamlanivimab alone (>833-fold and >1,460-fold reduction for E484K and L452R viruses, respectively). Available nonclinical and clinical PK data indicate that etesevimab at the authorized dose may retain activity against the B.1.526 variant clinically, although only very limited data are currently available from patients infected with this variant in clinical trials. Preliminary clinical evidence indicates that the administration of bamlanivimab and etesevimab together result in similar viral load reductions in participants infected with the L452R variant (Epsilon; USA [California] origin) as observed in those who were infected with bamlanivimab-sensitive strains. Of the 134 participants infected with the L452R variant at baseline in the Phase portion of BLAZE-1, of the 50 individuals treated with placebo (6%) and of the 84 participants treated with bamlanivimab 700 mg and etesevimab 1,400 mg (1%) were hospitalized (p=0.15).Genotypic and phenotypic testing are ongoing to monitor for potential bamlanivimab- and etesevimab-resistance associated spike variations in clinical trials. Analysis of baseline samples show that 8.4% (188/2246) of clinical trial patients were infected with viral variants containing single amino acid substitutions at positions associated with reduced susceptibility to either bamlanivimab or etesevimab as predicted by pseudotyped VLP or authentic SARS-CoV-2 neutralization assays. No patients were infected with variant that was predicted to have reduced susceptibility to both bamlanivimab and etesevimab by these assessments.Patient samples were also analyzed for treatment-emergent viral variants, defined as variants with single amino acid substitutions at positions that had reduced susceptibility to either bamlanivimab or etesevimab present at an allele fraction of >=15%.In the Phase portion of BLAZE-1, treatment-emergent variants were observed in 9.0% (42/467) of patients treated with bamlanivimab 2,800 mg and etesevimab 2,800 mg together, in 5.3% (21/394) of patients treated with bamlanivimab 700 mg and etesevimab 1,400 mg together, and in 4.0% (27/674) of patients treated with placebo. The majority of these were only detected at one time point in the sequential series with 0.9% (4/467), 1.0% (4/394), and 0.3% (2/674) of patients having multiple instances of detection in the bamlanivimab 2,800 mg and etesevimab 2,800 mg together, bamlanivimab 700 mg and etesevimab 1,400 mg together, and placebo groups, respectively.In patients treated with bamlanivimab and etesevimab together, substitutions detected in one or more patients included ones with reduced susceptibility (>=5-fold) to bamlanivimab only: L452R/W, E484K, G485V, F490L, and S494P; and ones with reduced susceptibility to etesevimab only: D405G/Y, K417N, D420N/Y, N460H/I/T, A475S/V, Y489H, and N501I/Y. While these variants had reduced susceptibility to either bamlanivimab OR etesevimab compared to wild-type in pseudotyped VSV VLP or authentic virus assay they still retained susceptibility to the other antibody in the combination.There were also observations of variants with reduced susceptibility (>=5-fold) to both bamlanivimab and etesevimab and to bamlanivimab etesevimab tested together: E484D (n=1; 145-fold reduction to bamlanivimab etesevimab tested together at molar ratio of 1:2), Q493K/R (n=9; 584-fold and 1,054-fold reduction to bamlanivimab etesevimab tested together at molar ratio of 1:2 for Q493K and Q493R, respectively) out of total of 861 patients treated with bamlanivimab and etesevimab together.In subgroup of participants infected with virus harboring L452R substitution found in the B.1.427/B.1.429 (Epsilon) lineage, S459P treatment-emergent substitution was identified in one subject. Concurrent L452R+S459P substitutions conferred 1,656-fold reduction in susceptibility to bamlanivimab etesevimab together (1:2 molar ratio).Additional treatment-emergent substitutions in patients treated with bamlanivimab and etesevimab together, with no phenotypic data, include D405del, D420G, C480R, G485D, S494L, and P499L. The impact of these substitutions on susceptibility is not currently known.In subgroup of 53 pediatric subjects who were infected with B.1.617.2 (Delta)-related variant, which has reduced susceptibility to bamlanivimab (>1,136-fold), the following treatment-emergent substitutions with reduced susceptibility to etesevimab were detected: D420A (n=2), N460T (n=1), N460Y (n=1). Three of these four subjects had high viral load (>5.27 log10) on Day 7.Additional treatment-emergent substitutions with no phenotypic data detected in other pediatric subjects who were infected with B.1.617.2 (Delta)-related variant at an allele fraction of >=50% included: F347C, V401L, G431S and I434V.It is possible that bamlanivimab and etesevimab resistance-associated variants could have cross-resistance to other mAbs targeting the receptor binding domain of SARS-CoV-2. The clinical impact is not known.. In the Phase portion of BLAZE-1, treatment-emergent variants were observed in 9.0% (42/467) of patients treated with bamlanivimab 2,800 mg and etesevimab 2,800 mg together, in 5.3% (21/394) of patients treated with bamlanivimab 700 mg and etesevimab 1,400 mg together, and in 4.0% (27/674) of patients treated with placebo. The majority of these were only detected at one time point in the sequential series with 0.9% (4/467), 1.0% (4/394), and 0.3% (2/674) of patients having multiple instances of detection in the bamlanivimab 2,800 mg and etesevimab 2,800 mg together, bamlanivimab 700 mg and etesevimab 1,400 mg together, and placebo groups, respectively.. In patients treated with bamlanivimab and etesevimab together, substitutions detected in one or more patients included ones with reduced susceptibility (>=5-fold) to bamlanivimab only: L452R/W, E484K, G485V, F490L, and S494P; and ones with reduced susceptibility to etesevimab only: D405G/Y, K417N, D420N/Y, N460H/I/T, A475S/V, Y489H, and N501I/Y. While these variants had reduced susceptibility to either bamlanivimab OR etesevimab compared to wild-type in pseudotyped VSV VLP or authentic virus assay they still retained susceptibility to the other antibody in the combination.. There were also observations of variants with reduced susceptibility (>=5-fold) to both bamlanivimab and etesevimab and to bamlanivimab etesevimab tested together: E484D (n=1; 145-fold reduction to bamlanivimab etesevimab tested together at molar ratio of 1:2), Q493K/R (n=9; 584-fold and 1,054-fold reduction to bamlanivimab etesevimab tested together at molar ratio of 1:2 for Q493K and Q493R, respectively) out of total of 861 patients treated with bamlanivimab and etesevimab together.. In subgroup of participants infected with virus harboring L452R substitution found in the B.1.427/B.1.429 (Epsilon) lineage, S459P treatment-emergent substitution was identified in one subject. Concurrent L452R+S459P substitutions conferred 1,656-fold reduction in susceptibility to bamlanivimab etesevimab together (1:2 molar ratio).. Additional treatment-emergent substitutions in patients treated with bamlanivimab and etesevimab together, with no phenotypic data, include D405del, D420G, C480R, G485D, S494L, and P499L. The impact of these substitutions on susceptibility is not currently known.. In subgroup of 53 pediatric subjects who were infected with B.1.617.2 (Delta)-related variant, which has reduced susceptibility to bamlanivimab (>1,136-fold), the following treatment-emergent substitutions with reduced susceptibility to etesevimab were detected: D420A (n=2), N460T (n=1), N460Y (n=1). Three of these four subjects had high viral load (>5.27 log10) on Day 7.. Additional treatment-emergent substitutions with no phenotypic data detected in other pediatric subjects who were infected with B.1.617.2 (Delta)-related variant at an allele fraction of >=50% included: F347C, V401L, G431S and I434V.. Immune Response AttenuationThere is theoretical risk that antibody administration may attenuate the endogenous immune response to SARS-CoV-2 and make patients more susceptible to re-infection.

ADVERSE REACTIONS SECTION.

8 ADVERSE REACTIONS AND MEDICATION ERRORS REPORTING REQUIREMENTS AND INSTRUCTIONS. Clinical trials evaluating the safety of bamlanivimab and etesevimab are ongoing [see Overall Safety Summary (6)].Completion of FDA MedWatch Form to report all medication errors and serious adverse events occurring during bamlanivimab and etesevimab use and considered to be potentially related to bamlanivimab and etesevimab is mandatory and must be done by the prescribing healthcare provider and/or the providers designee. These adverse events must be reported within calendar days from the onset of the event:Serious adverse events are defined as:death;a life-threatening adverse event;inpatient hospitalization or prolongation of existing hospitalization;a persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions;a congenital anomaly/birth defect;a medical or surgical intervention to prevent death, life-threatening event, hospitalization, disability, or congenital anomaly.If serious and unexpected adverse event occurs and appears to be associated with the use of bamlanivimab and etesevimab under this EUA, the prescribing healthcare provider and/or the providers designee should complete and submit MedWatch form to FDA using one of the following methods:Complete and submit the report online: www.fda.gov/medwatch/report.htm, orComplete and submit postage-paid FDA Form 3500 (https://www.fda.gov/media/76299/download) and return by:Mail to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787, orFax (1-800-FDA- 0178), or Call 1-800-FDA-1088 to request reporting formIMPORTANT: When reporting adverse events or medication errors to MedWatch, please complete the entire form with detailed information. It is important that the information reported to FDA be as detailed and complete as possible. Information to include:Patient demographics (e.g., patient initials, date of birth)Pertinent medical historyPertinent details regarding adverse events and course of illnessConcomitant medicationsTiming of adverse event(s) in relationship to administration of bamlanivimab and etesevimabPertinent laboratory and virology informationOutcome of the event and any additional follow-up information if it is available at the time of the MedWatch report. Subsequent reporting of follow-up information should be completed if additional details become available.The following steps are highlighted to provide the necessary information for safety tracking:In section A, box 1, provide the patients initials in the Patient IdentifierIn section A, box 2, provide the patients date of birthIn section B, box 5, description of the event:Write bamlanivimab and etesevimab use for COVID-19 under Emergency Use Authorization (EUA) as the first lineProvide detailed report of medication error and/or adverse event. It is important to provide detailed information regarding the patient and adverse event/medication error for ongoing safety evaluation of this unapproved drug. Please see information to include listed above. In section G, box 1, name and address:Provide the name and contact information of the prescribing healthcare provider or institutional designee who is responsible for the report.Provide the address of the treating institution (NOT the healthcare providers office address). death;. life-threatening adverse event;. inpatient hospitalization or prolongation of existing hospitalization;. persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions;. congenital anomaly/birth defect;. medical or surgical intervention to prevent death, life-threatening event, hospitalization, disability, or congenital anomaly.. Complete and submit the report online: www.fda.gov/medwatch/report.htm, or. Complete and submit postage-paid FDA Form 3500 (https://www.fda.gov/media/76299/download) and return by:Mail to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787, orFax (1-800-FDA- 0178), or Mail to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787, or. Fax (1-800-FDA- 0178), or. Call 1-800-FDA-1088 to request reporting form. Patient demographics (e.g., patient initials, date of birth). Pertinent medical history. Pertinent details regarding adverse events and course of illness. Concomitant medications. Timing of adverse event(s) in relationship to administration of bamlanivimab and etesevimab. Pertinent laboratory and virology information. Outcome of the event and any additional follow-up information if it is available at the time of the MedWatch report. Subsequent reporting of follow-up information should be completed if additional details become available.. In section A, box 1, provide the patients initials in the Patient Identifier. In section A, box 2, provide the patients date of birth. In section B, box 5, description of the event:Write bamlanivimab and etesevimab use for COVID-19 under Emergency Use Authorization (EUA) as the first lineProvide detailed report of medication error and/or adverse event. It is important to provide detailed information regarding the patient and adverse event/medication error for ongoing safety evaluation of this unapproved drug. Please see information to include listed above. Write bamlanivimab and etesevimab use for COVID-19 under Emergency Use Authorization (EUA) as the first line. Provide detailed report of medication error and/or adverse event. It is important to provide detailed information regarding the patient and adverse event/medication error for ongoing safety evaluation of this unapproved drug. Please see information to include listed above.. In section G, box 1, name and address:Provide the name and contact information of the prescribing healthcare provider or institutional designee who is responsible for the report.Provide the address of the treating institution (NOT the healthcare providers office address). Provide the name and contact information of the prescribing healthcare provider or institutional designee who is responsible for the report.. Provide the address of the treating institution (NOT the healthcare providers office address).

BOXED WARNING SECTION.

TreatmentThis EUA is for the use of the unapproved products bamlanivimab and etesevimab administered together for the treatment of mild to moderate COVID-19 in adults and pediatric patients, including neonates, with positive results of direct SARS-CoV-2 viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death [see Limitations of Authorized Use (1.1)].For treatment of COVID-19, bamlanivimab and etesevimab should be administered together as soon as possible after positive results of direct SARS-CoV-2 viral testing and within 10 days of symptom onset.Post-Exposure ProphylaxisThis EUA is for the use of the unapproved products bamlanivimab and etesevimab administered together in adults and pediatric individuals, including neonates, for post-exposure prophylaxis of COVID-19 in individuals who are at high risk for progression to severe COVID-19, including hospitalization or death, and are:not fully vaccinated or who are not expected to mount an adequate immune response to complete SARS-CoV-2 vaccination (for example, individuals with immunocompromising conditions including those taking immunosuppressive medications) and have been exposed to an individual infected with SARS-CoV-2 consistent with close contact criteria per Centers for Disease Control and Prevention (CDC) or who are at high risk of exposure to an individual infected with SARS-CoV-2 because of occurrence of SARS-CoV-2 infection in other individuals in the same institutional setting (for example, nursing homes, prisons) [see Limitations of Authorized Use (1.2)].For post-exposure prophylaxis, bamlanivimab and etesevimab should be administered together as soon as possible following exposure to SARS-CoV-2.Criteria for Identifying High Risk IndividualsThe following medical conditions or other factors may place adults and pediatric patients, including neonates, at higher risk for progression to severe COVID-19:Older age (for example age >=65 years of age)<1 year oldObesity or being overweightPregnancyChronic kidney diseaseDiabetesImmunosuppressive disease or immunosuppressive treatmentCardiovascular disease (including congenital heart disease) or hypertensionChronic lung diseases (for example, chronic obstructive pulmonary disease, asthma [moderate-to-severe], interstitial lung disease, cystic fibrosis and pulmonary hypertension)Sickle cell diseaseNeurodevelopmental disorders (for example, cerebral palsy) or other conditions that confer medical complexity (for example, genetic or metabolic syndromes and severe congenital anomalies)Having medical-related technological dependence (for example, tracheostomy, gastrostomy, or positive pressure ventilation (not related to COVID-19))Other medical conditions or factors (for example, race or ethnicity) may also place individual patients at high risk for progression to severe COVID-19 and authorization of bamlanivimab and etesevimab under the EUA is not limited to the medical conditions or factors listed above. For additional information on medical conditions and factors associated with increased risk for progression to severe COVID-19, see the CDC website: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Healthcare providers should consider the benefit-risk for an individual patient.SARS-CoV-2 Viral VariantsCirculating SARS-CoV-2 viral variants may be associated with resistance to monoclonal antibodies. Health care providers should review the Antiviral Resistance information in Section 15 of this Fact Sheet for details regarding specific variants and resistance.There are other authorized treatments available and healthcare providers should choose an authorized therapeutic option with activity against the circulating variants in their state, territory, or US jurisdiction. Current variant frequency data are available at: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/variant-proportions.htmlFor additional information on all products authorized for treatment or prevention of COVID-19, please see https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization.Under this EUA, bamlanivimab and etesevimab must be administered together by intravenous (IV) infusion only.Treatment DosageThe authorized dosage for adults (18 years and older) and pediatric patients (<18 years and weighing at least 40 kg) is 700 mg bamlanivimab and 1,400 mg of etesevimab administered together as single intravenous (IV) infusion [see Dosage and Administration (2.2, 2.4) and Clinical Trial Results and Supporting Data for EUA (18.1)]. The authorized dosage for pediatric patients weighing less than 40 kg will vary depending on weight [see Dosage and Administration (2.2, 2.4)]. Given the similar course of COVID-19, the safety and efficacy of bamlanivimab and etesevimab in younger pediatric patients, including neonates, is supported by safety and efficacy data in adolescents and adults, together with additional pharmacokinetic and safety data from the clinical trial in pediatric patients. The recommended dosing regimen for pediatric patients <=12 kg is based on pharmacokinetic modeling and simulation [see Clinical Pharmacology (14.3)]. The youngest participant in the pediatric clinical trial was 10 months of age and weighed 8.6 kg [see Clinical Trials and Supporting Data for EUA (18.1)].Post-Exposure Prophylaxis DosageThe authorized dosage for adults (18 years and older) and pediatric individuals (<18 years and weighing at least 40 kg) is 700 mg bamlanivimab and 1,400 mg of etesevimab administered together as single intravenous (IV) infusion [see Dosage and Administration (2.2, 2.4)]. The authorized dosage for pediatric individuals weighing less than 40 kg will vary depending on weight [see Dosage and Administration (2.2, 2.4)].The authorized dosage is based on the totality of the scientific evidence including clinical pharmacology data and clinical trial data [see Clinical Pharmacology (14.2) and Clinical Trial Results and Supporting Data for EUA (18.2)]. The recommended dosing regimen for pediatric patients <=12 kg is predicted based on pharmacokinetic modeling and simulation [see Clinical Pharmacology (14.3)].The clinical data for post-exposure prophylaxis is based on data generated in the Phase study BLAZE-2. While this study only evaluated dosing with bamlanivimab alone, it is reasonable to expect that bamlanivimab and etesevimab together may be safe and effective for post-exposure prophylaxis based on:Phase data from BLAZE-1 demonstrated treatment of COVID-19 with bamlanivimab and etesevimab together showed statistically significant reduction in progression of severe COVID-19, including hospitalization or death [see Clinical Trial Results and Supporting Data for EUA (18.1)].Nonclinical and clinical data support that bamlanivimab and etesevimab together will provide an advantage over bamlanivimab alone against certain SARS-CoV-2 viral variants [see Microbiology/Resistance Information (15)]. Use of bamlanivimab and etesevimab together for post-exposure prophylaxis in subjects who meet high-risk criteria is based on subgroup analysis of high-risk individuals enrolled in BLAZE-2 [see Clinical Trial Results and Supporting Data for EUA (18.2)].Given the similar course of COVID-19, the safety and efficacy of bamlanivimab and etesevimab in younger pediatric patients, including neonates, is supported by safety and efficacy data in adolescents and adults, together with additional pharmacokinetic and safety data from the clinical trial in pediatric patients studying bamlanivimab and etesevimab for the treatment of mild to moderate COVID-19. Children were not enrolled in the post-exposure prophylaxis trial, BLAZE-2.Intravenous Infusion:Bamlanivimab and etesevimab are both available as solutions in separate vials and must be combined prior to administration.Administer bamlanivimab and etesevimab together as single intravenous (IV) infusion via pump or gravity [see Table and Table and Dosage and Administration (2.4)].Clinically monitor patients during administration and observe patients for at least hour after infusion is complete.Repeat dosing of bamlanivimab and etesevimab has not been evaluated.Bamlanivimab and etesevimab may only be administered in settings in which health care providers have immediate access to medications to treat severe infusion reaction, such as anaphylaxis, and the ability to activate the emergency medical system (EMS), as necessary.Health care providers must submit report on all medication errors and ALL SERIOUS ADVERSE EVENTS potentially related to bamlanivimab and etesevimab. See Sections and of the Full EUA Prescribing Information for reporting instructions below.Patients treated with bamlanivimab and etesevimab together should continue to self-isolate and use infection control measures (e.g., wear mask, isolate, social distance, avoid sharing personal texts, clean and disinfect high touch surfaces, and frequent handwashing) according to CDC guidelines.The authorized dosage may be updated as additional data from clinical trials becomes available.For information on clinical trials that are testing the use of bamlanivimab and etesevimab in COVID-19, please see www.clinicaltrials.gov.. not fully vaccinated or who are not expected to mount an adequate immune response to complete SARS-CoV-2 vaccination (for example, individuals with immunocompromising conditions including those taking immunosuppressive medications) and have been exposed to an individual infected with SARS-CoV-2 consistent with close contact criteria per Centers for Disease Control and Prevention (CDC) or. who are at high risk of exposure to an individual infected with SARS-CoV-2 because of occurrence of SARS-CoV-2 infection in other individuals in the same institutional setting (for example, nursing homes, prisons) [see Limitations of Authorized Use (1.2)].. Older age (for example age >=65 years of age). <1 year old. Obesity or being overweight. Pregnancy. Chronic kidney disease. Diabetes. Immunosuppressive disease or immunosuppressive treatment. Cardiovascular disease (including congenital heart disease) or hypertension. Chronic lung diseases (for example, chronic obstructive pulmonary disease, asthma [moderate-to-severe], interstitial lung disease, cystic fibrosis and pulmonary hypertension). Sickle cell disease. Neurodevelopmental disorders (for example, cerebral palsy) or other conditions that confer medical complexity (for example, genetic or metabolic syndromes and severe congenital anomalies). Having medical-related technological dependence (for example, tracheostomy, gastrostomy, or positive pressure ventilation (not related to COVID-19)). Circulating SARS-CoV-2 viral variants may be associated with resistance to monoclonal antibodies. Health care providers should review the Antiviral Resistance information in Section 15 of this Fact Sheet for details regarding specific variants and resistance.. There are other authorized treatments available and healthcare providers should choose an authorized therapeutic option with activity against the circulating variants in their state, territory, or US jurisdiction. Current variant frequency data are available at: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/variant-proportions.html. For additional information on all products authorized for treatment or prevention of COVID-19, please see https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization.. The authorized dosage for adults (18 years and older) and pediatric patients (<18 years and weighing at least 40 kg) is 700 mg bamlanivimab and 1,400 mg of etesevimab administered together as single intravenous (IV) infusion [see Dosage and Administration (2.2, 2.4) and Clinical Trial Results and Supporting Data for EUA (18.1)]. The authorized dosage for pediatric patients weighing less than 40 kg will vary depending on weight [see Dosage and Administration (2.2, 2.4)]. Given the similar course of COVID-19, the safety and efficacy of bamlanivimab and etesevimab in younger pediatric patients, including neonates, is supported by safety and efficacy data in adolescents and adults, together with additional pharmacokinetic and safety data from the clinical trial in pediatric patients. The recommended dosing regimen for pediatric patients <=12 kg is based on pharmacokinetic modeling and simulation [see Clinical Pharmacology (14.3)]. The youngest participant in the pediatric clinical trial was 10 months of age and weighed 8.6 kg [see Clinical Trials and Supporting Data for EUA (18.1)].. The authorized dosage for adults (18 years and older) and pediatric individuals (<18 years and weighing at least 40 kg) is 700 mg bamlanivimab and 1,400 mg of etesevimab administered together as single intravenous (IV) infusion [see Dosage and Administration (2.2, 2.4)]. The authorized dosage for pediatric individuals weighing less than 40 kg will vary depending on weight [see Dosage and Administration (2.2, 2.4)].. The authorized dosage is based on the totality of the scientific evidence including clinical pharmacology data and clinical trial data [see Clinical Pharmacology (14.2) and Clinical Trial Results and Supporting Data for EUA (18.2)]. The recommended dosing regimen for pediatric patients <=12 kg is predicted based on pharmacokinetic modeling and simulation [see Clinical Pharmacology (14.3)].. The clinical data for post-exposure prophylaxis is based on data generated in the Phase study BLAZE-2. While this study only evaluated dosing with bamlanivimab alone, it is reasonable to expect that bamlanivimab and etesevimab together may be safe and effective for post-exposure prophylaxis based on:Phase data from BLAZE-1 demonstrated treatment of COVID-19 with bamlanivimab and etesevimab together showed statistically significant reduction in progression of severe COVID-19, including hospitalization or death [see Clinical Trial Results and Supporting Data for EUA (18.1)].Nonclinical and clinical data support that bamlanivimab and etesevimab together will provide an advantage over bamlanivimab alone against certain SARS-CoV-2 viral variants [see Microbiology/Resistance Information (15)]. Phase data from BLAZE-1 demonstrated treatment of COVID-19 with bamlanivimab and etesevimab together showed statistically significant reduction in progression of severe COVID-19, including hospitalization or death [see Clinical Trial Results and Supporting Data for EUA (18.1)].. Nonclinical and clinical data support that bamlanivimab and etesevimab together will provide an advantage over bamlanivimab alone against certain SARS-CoV-2 viral variants [see Microbiology/Resistance Information (15)].. Use of bamlanivimab and etesevimab together for post-exposure prophylaxis in subjects who meet high-risk criteria is based on subgroup analysis of high-risk individuals enrolled in BLAZE-2 [see Clinical Trial Results and Supporting Data for EUA (18.2)].. Given the similar course of COVID-19, the safety and efficacy of bamlanivimab and etesevimab in younger pediatric patients, including neonates, is supported by safety and efficacy data in adolescents and adults, together with additional pharmacokinetic and safety data from the clinical trial in pediatric patients studying bamlanivimab and etesevimab for the treatment of mild to moderate COVID-19. Children were not enrolled in the post-exposure prophylaxis trial, BLAZE-2.. Bamlanivimab and etesevimab are both available as solutions in separate vials and must be combined prior to administration.. Administer bamlanivimab and etesevimab together as single intravenous (IV) infusion via pump or gravity [see Table and Table and Dosage and Administration (2.4)].. Clinically monitor patients during administration and observe patients for at least hour after infusion is complete.. Repeat dosing of bamlanivimab and etesevimab has not been evaluated.

CLINICAL PHARMACOLOGY SECTION.

14 CLINICAL PHARMACOLOGY. 14.1 Mechanism of Action. Bamlanivimab is recombinant neutralizing human IgG1 monoclonal antibody (mAb) to the spike protein of SARS-CoV-2 and is unmodified in the Fc region. Bamlanivimab binds the spike protein with dissociation constant KD 0.071 nM and blocks spike protein attachment to the human ACE2 receptor with an IC50 value of 0.17 nM (0.025 ug/mL).Etesevimab is recombinant neutralizing human IgG1 mAb to the spike protein of SARS-CoV-2, with amino acid substitutions in the Fc region (L234A, L235A) to reduce effector function. Etesevimab binds the spike protein with dissociation constant KD 6.45 nM and blocks spike protein attachment to the human ACE2 receptor with an IC50 value of 0.32 nM (0.046 ug/mL).Bamlanivimab and etesevimab bind to different but overlapping epitopes in the receptor binding domain (RBD) of the S-protein. Using both antibodies together is expected to reduce the risk of viral resistance.. 14.2 Pharmacodynamics. flat exposure-response relationship for efficacy was identified for bamlanivimab and etesevimab administered together within the dose range of 700 mg bamlanivimab and 1,400 mg etesevimab to 2,800 mg bamlanivimab and 2,800 mg etesevimab (4 and times the authorized dose, respectively), based on clinical data and pharmacokinetic/pharmacodynamic modeling.For post-exposure prophylaxis of COVID-19, dose of 700 mg bamlanivimab and 1,400 mg etesevimab was supported based on clinical data and pharmacokinetic/pharmacodynamic modeling.. 14.3 Pharmacokinetics. summary of PK parameters of bamlanivimab and etesevimab following administration of single dose of 700 mg bamlanivimab and 1,400 mg etesevimab is provided in Table 3. There is no change in PK of bamlanivimab or etesevimab administered alone or together suggesting there is no interaction between the two antibodies. There were no differences in PK of etesevimab between mild/moderate ambulatory participants and healthy participants.Table 3: Pharmacokinetic Parameters of Bamlanivimab (BAM) and Etesevimab (ETE) Administered IV in AdultsAbbreviations: CV coefficient of variation; Cmax maximum concentration; AUCinf area under the concentration versus time curve from zero to infinity; Vss steady-state volume of distribution.a = number of subjects simulated using the PK model.b The number of subjects for Vss, half-life, and clearance are based on population PK model that included bamlanivimab doses up to 7,000 mg and etesevimab doses up to 2,800 mg.NBAM(700 mg)ETE(1400 mg)Systemic Exposure Geometric Mean (%CV) Cmax, mcg/mL270187 (41.7)422 (41.2) Geometric Mean (%CV) Cday 29, mcg/mL311 BAM; 320 ETE25.7 (42.9)116 (38.1) Median (5th,95th percentile) Cweek 8, mcg/mL1000a 10.1 (3.59, 22.9)58.3 (26.8, 117) Geometric Mean (%CV) AUCinf, mcg day/mL4992500 (28.0)10600 (29.9)Distribution Geometric Mean (%CV) Vss (L)1899 BAM; 1498 ETEb 6.59 (24.9)5.78 (24.7)Elimination Geometric Mean (%CV) Elimination Half-Life (day)1899 BAM; 1498 ETEb 20.9 (17.3)32.6 (21.7) Geometric Mean (%CV) Clearance (L/day)1899 BAM; 1498 ETEb 0.274 (31.5)0.134 (32.5)Bamlanivimab and etesevimab are expected to be degraded into small peptides and component amino acids via catabolic pathways in the same manner as endogenous IgG antibodies.. Special Populations:The PK profiles of bamlanivimab and etesevimab were not affected by age, sex, race, or disease severity based on population PK analysis. Body weight had no clinically relevant effect on the PK of bamlanivimab or etesevimab in adults with COVID-19 over the body weight range of 41 kg to 173 kg [see Use in Specific Populations (11.4, 11.7)].. Pediatric populationThe PK of bamlanivimab and etesevimab has been evaluated in 88 pediatric patients <18 years who received weight-based dosing [see Dosage and Administration (2.2)]. The data show that weight-based dosing in pediatric patients provides comparable plasma exposures to those observed in adults who received bamlanivimab 700 mg and etesevimab 1,400 mg. No dosage adjustment is recommended in pediatric patients <18 years who weigh at least 40 kg. Pediatric patients weighing less than 40 kg should be dosed on the basis of body weight [see Dosage and Administration (2.2, 2.4)]. The recommended dosing regimen for pediatric patients <=12 kg is predicted to result in similar exposures when compared to exposures achieved in adults receiving bamlanivimab 700 mg and etesevimab 1,400 mg based on pharmacokinetic modeling and simulation. The youngest participant in the pediatric treatment trial was 10 months of age and weighed 8.6 kg [see Clinical Trials and Supporting Data for EUA (18.1)].Table 4: Pharmacokinetic Parameters of Bamlanivimab (BAM) and Etesevimab (ETE) Administered IV in Pediatric PatientsAbbreviations: CV coefficient of variation; Cmax maximum concentration; AUCinf area under the concentration versus time curve from zero to infinity.Body Weight>=40 kg>20 to <40 kg>12 to <=20 kg<=12 kgBAM ETE Dose700 mg 1400 mg350 mg 700 mg175 mg 350 mg15 mg/kg 30 mg/kgBAM: Geometric Mean (%CV) [n] Cmax, mcg/mL235 (51.0) [52]239 (39.1) [16]243 (66.0) [7]371 (9.8) [2] Cday 29, mcg/mL26.8 (50.2) [34]26.1 (32.5) [8]23.0 (53.0) [3][0] AUCinf, mcg day/mL2760 (30.7) [66]2780 (25.7) [20]2430 (28.4) [9]3000 (19.1) [3]ETE: Geometric Mean (%CV) [n] Cmax, mcg/mL508 (50.6) [50]444 (26.6) [14]444 (64.9) [7]831 (16.8) [2] Cday 29, mcg/mL133 (46.8) [34]138 (29.5) [8]125 (51.5) [3][0] AUCinf, mcg day/mL12900 (32.4) [66]12400 (23.2) [20]11300 (29.6) [9]13500 (13.0) [3]. Patients with renal impairmentBamlanivimab and etesevimab are not eliminated intact in the urine. Renal impairment is not expected to impact the PK of bamlanivimab and etesevimab, since mAbs with molecular weight >69 kDa are known not to undergo renal elimination. Similarly, dialysis is not expected to impact the PK of bamlanivimab and etesevimab [see Use in Specific Populations (11.5)].. Patients with hepatic impairmentBased on population PK analysis, there is no significant difference in PK of bamlanivimab or etesevimab in patients with mild hepatic impairment compared to patients with normal hepatic function. Bamlanivimab and etesevimab have not been studied in patients with moderate or severe hepatic impairment [see Use in Specific Populations (11.6)].. Drug interactions:Bamlanivimab and etesevimab are not renally excreted or metabolized by cytochrome P450 enzymes; therefore, interactions with concomitant medications that are renally excreted or that are substrates, inducers, or inhibitors of cytochrome P450 enzymes are unlikely.

DOSAGE & ADMINISTRATION SECTION.

2 DOSAGE AND ADMINISTRATION. 2.1 Patient Selection. The following medical conditions or other factors may place adults and pediatric patients, including neonates, at higher risk for progression to severe COVID-19:Older age (for example age >=65 years of age)<1 year oldObesity or being overweightPregnancyChronic kidney diseaseDiabetesImmunosuppressive disease or immunosuppressive treatmentCardiovascular disease (including congenital heart disease) or hypertensionChronic lung diseases (for example, chronic obstructive pulmonary disease, asthma [moderate-to-severe], interstitial lung disease, cystic fibrosis and pulmonary hypertension)Sickle cell diseaseNeurodevelopmental disorders (for example, cerebral palsy) or other conditions that confer medical complexity (for example, genetic or metabolic syndromes and severe congenital anomalies)Having medical-related technological dependence (for example, tracheostomy, gastrostomy, or positive pressure ventilation (not related to COVID-19))Other medical conditions or factors (for example, race or ethnicity) may also place individual patients at high risk for progression to severe COVID-19 and authorization of bamlanivimab and etesevimab under the EUA is not limited to the medical conditions or factors listed above. For additional information on medical conditions and factors associated with increased risk for progression to severe COVID-19, see the CDC website: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Healthcare providers should consider the benefit-risk for an individual patient.. Older age (for example age >=65 years of age). <1 year old. Obesity or being overweight. Pregnancy. Chronic kidney disease. Diabetes. Immunosuppressive disease or immunosuppressive treatment. Cardiovascular disease (including congenital heart disease) or hypertension. Chronic lung diseases (for example, chronic obstructive pulmonary disease, asthma [moderate-to-severe], interstitial lung disease, cystic fibrosis and pulmonary hypertension). Sickle cell disease. Neurodevelopmental disorders (for example, cerebral palsy) or other conditions that confer medical complexity (for example, genetic or metabolic syndromes and severe congenital anomalies). Having medical-related technological dependence (for example, tracheostomy, gastrostomy, or positive pressure ventilation (not related to COVID-19)). 2.2 Dosage. Treatment:The dosage in adults (18 years and older) and pediatric patients (<18 years and weighing at least 40 kg) is bamlanivimab 700 mg and etesevimab 1,400 mg. The dosage for pediatric patients weighing less than 40 kg will vary depending on body weight:>20 kg to <40 kg: 350 mg bamlanivimab and 700 mg etesevimab>12 kg to 20 kg: 175 mg bamlanivimab and 350 mg etesevimab1 kg to 12 kg: 12 mg/kg bamlanivimab and 24 mg/kg etesevimabThe recommended dosing regimen for pediatric patients <=12 kg is predicted based on pharmacokinetic modeling and simulation [see Clinical Pharmacology (14.3)]. The youngest participant in the pediatric clinical trial for treatment was 10 months of age and weighed 8.6 kg [see Use in Specific Populations (11.3) and Clinical Trials and Supporting Data for EUA (18.1)].For treatment of COVID-19, bamlanivimab and etesevimab should be administered together as soon as possible after positive results of direct SARS-CoV-2 viral testing and within 10 days of symptom onset.Post-Exposure Prophylaxis:The dosage in adults (18 years and older) and pediatric individuals (<18 years and weighing at least 40 kg) is 700 mg bamlanivimab and 1,400 mg etesevimab administered together as single intravenous infusion. The dosage for pediatric individuals weighing less than 40 kg will vary depending on body weight:>20 kg to <40 kg: 350 mg bamlanivimab and 700 mg etesevimab>12 kg to 20 kg: 175 mg bamlanivimab and 350 mg etesevimab1 kg to 12 kg: 12 mg/kg bamlanivimab and 24 mg/kg etesevimabThe recommended dosing regimen for pediatric patients <=12 kg is predicted based on pharmacokinetic modeling and simulation [see Clinical Pharmacology (14.3)]. The youngest participant in the pediatric clinical trial for treatment was 10 months of age and weighed 8.6 kg [see Use in Specific Populations (11.3) and Clinical Trials and Supporting Data for EUA (18.1)]. Children were not enrolled in the post-exposure prophylaxis trial, BLAZE-2 [see Clinical Trials and Supporting Data for EUA (18.2)].For post-exposure prophylaxis, bamlanivimab and etesevimab should be given together as soon as possible following exposure to SARS-CoV-2.Under this EUA, bamlanivimab and etesevimab must be administered together as single intravenous infusion.. >20 kg to <40 kg: 350 mg bamlanivimab and 700 mg etesevimab. >12 kg to 20 kg: 175 mg bamlanivimab and 350 mg etesevimab. kg to 12 kg: 12 mg/kg bamlanivimab and 24 mg/kg etesevimab. >20 kg to <40 kg: 350 mg bamlanivimab and 700 mg etesevimab. >12 kg to 20 kg: 175 mg bamlanivimab and 350 mg etesevimab. kg to 12 kg: 12 mg/kg bamlanivimab and 24 mg/kg etesevimab. 2.3 Dosage Adjustment in Specific Populations. Pregnancy or LactationNo dosage adjustment is recommended in pregnant or lactating women [see Use in Specific Populations (11.1, 11.2)].Pediatric UseNo dosage adjustment is recommended in pediatric patients <18 years who weigh at least 40 kg. For pediatric patients weighing less than 40 kg, dosage adjustment on the basis of body weight is required [see Dosage and Administration (2.4)]. The recommended dosing regimen for pediatric patients <=12 kg is predicted based on pharmacokinetic modeling and simulation [see Clinical Pharmacology (14.3)]. The youngest participant in the pediatric clinical trial for treatment was 10 months of age and weighed 8.6 kg [see Use in Specific Populations (11.3) and Clinical Trials and Supporting Data for EUA (18.1)]. Children were not enrolled in the post-exposure prophylaxis trial, BLAZE-2 [see Clinical Trials and Supporting Data for EUA (18.2)].Geriatric UseNo dosage adjustment is recommended in geriatric patients [see Use in Specific Populations (11.4)].Renal ImpairmentNo dosage adjustment is recommended in patients with renal impairment [see Use in Specific Populations (11.5)].Hepatic ImpairmentNo dosage adjustment is recommended in patients with mild hepatic impairment. Bamlanivimab and etesevimab has not been studied in patients with moderate or severe hepatic impairment [see Use in Specific Populations (11.6)].. 2.4 Dose Preparation and Administration. General InformationBamlanivimab and etesevimab solution for infusion should be prepared by qualified healthcare professional using aseptic technique.Bamlanivimab and etesevimab are supplied in individual vials but are administered together.Inspect bamlanivimab and etesevimab vials visually for particulate matter and discoloration. Bamlanivimab and etesevimab are clear to opalescent and colorless to slightly yellow to slightly brown solutions.The prepared infusion solution should not be administered simultaneously with any other medication. The compatibility of bamlanivimab and etesevimab injection with IV solutions and medications other than 0.9% Sodium Chloride Injection is not known.If the infusion must be discontinued due to an infusion reaction, discard any unused product.The use of closed system transfer devices (CSTDs), elastomeric pumps, and pneumatic transport with bamlanivimab and etesevimab has not been studied.Clinically monitor patients during administration and observe patients for at least hour after infusion is complete.IV Infusion inAdults (>=18 years regardless of weight)andPediatric Patients (<18 years and weighing at least 40 kg)Materials Needed1 bamlanivimab vial (700 mg/20 mL)2 etesevimab vials (700 mg/20 mL)1 polyvinyl chloride (PVC) or polyethylene (PE)-line PVC, sterile prefilled infusion bag containing 0.9% Sodium Chloride Injection (sizes 50 mL to 250 mL)1 PVC or PE-lined PVC infusion set1 in-line or add-on 0.2/0.22 micron polyethersulfone (PES) filter0.9% Sodium Chloride for flushing tubingPreparationRemove bamlanivimab vial and etesevimab vials from refrigerated storage and allow to equilibrate to room temperature for approximately 20 minutes before preparation. Do not expose to direct heat. Do not shake the vials. Inspect vials. Withdraw 20 mL from one bamlanivimab vial and 40 mL from two etesevimab vials and inject all 60 mL into prefilled infusion bag containing 0.9% Sodium Chloride (see Table 1).Discard any product remaining in the vials.Gently invert the bag by hand approximately 10 times to mix. Do not shake. Table 1: Recommended Dilution and Administration Instructions for Bamlanivimab and Etesevimab for IV Infusiona in Adults (>=18 years regardless of weight) and Pediatric Patients (<18 years and weighing at least 40 kg)a 700 mg of bamlanivimab and 1,400 mg of etesevimab are added to the same infusion bag and administered together as single intravenous infusion.b The minimum infusion time for patients weighing at least 40 kg and less than 50 kg who are administered bamlanivimab and etesevimab diluted in 250-mL prefilled 0.9% Sodium Chloride infusion bag must be extended to at least 70 minutes to reduce endotoxin load.Druga: Add 20 mL of bamlanivimab (1 vial) and 40 mL of etesevimab (2 vials) for total of 60 mL to prefilled infusion bag and administer as instructed belowSize of Prefilled 0.9% Sodium Chloride Infusion BagMaximum Infusion RateMinimum Infusion Time50 mL310 mL/hr21 minutes100 mL310 mL/hr31 minutes150 mL310 mL/hr41 minutes250 mLFor patients weighing at least 50 kg310 mL/hr60 minutes250 mLb For patients weighing >=40 kg and <50 kg266 mL/hr70 minutesAdministrationThese products are preservative-free and therefore, the diluted infusion solution should be administered immediately.If immediate administration is not possible, store the diluted infusion solution for up to 24 hours at refrigerated temperature (2C to 8C [36F to 46F]) and up to hours at room temperature (20C to 25C [68F to 77F]) including infusion time. If refrigerated, allow the infusion solution to equilibrate to room temperature for approximately 20 minutes prior to administration. Attach the infusion set to the IV bag. Use of in-line or add-on 0.2/0.22 micron polyethersulfone (PES) filter is strongly recommended.Prime the infusion set.Administer the entire infusion solution in the bag via pump or gravity according to the size of infusion bag used (see Table 1). Due to potential overfill of prefilled saline bags, the entire infusion solution in the bag should be administered to avoid underdosage.Once infusion is complete, flush the tubing with 0.9% Sodium Chloride to ensure delivery of the required dose.IV Infusion inPediatric Patients (<18 years and weighing <40 kg)Materials NeededIV bagSyringe Pump1 bamlanivimab vial (700 mg/20 mL)1 bamlanivimab vial (700 mg/20 mL)1 etesevimab vial (700 mg/20 mL)1 etesevimab vial (700 mg/20 mL)1 sterile, empty 50-mL PVC or PE-lined PVC infusion bag1 disposable syringe1 PVC or PE-lined PVC Infusion set1 syringe extension set1 in-line or add-on 0.2/0.22 micron PES filter1 syringe pump0.9% Sodium Chloride for flushing0.9% Sodium Chloride for flushingUnder this EUA, single-dose vials may be used to prepare more than one pediatric dose; in addition, pediatric doses do not need to be diluted for patients <18 years and weighing <40 kg.PreparationRemove bamlanivimab and etesevimab vials from refrigerated storage and allow to equilibrate to room temperature for approximately 20 minutes before preparation. Do not expose to direct heat. Do not shake vials. Inspect vials. Withdraw appropriate amounts of bamlanivimab and etesevimab from vials based on body weight and inject into the empty infusion bag or draw into disposable syringe (see Table 2).Multiple doses of bamlanivimab and etesevimab may be prepared from each product vial (see the storage conditions specified below). Prepare all infusion bags or syringes at the same time. Appropriately label any prepared doses including the patient weight and dose, and time of preparation to minimize risk of medication errors, particularly in cases where multiple doses are prepared simultaneously.Discard any product remaining in the vials after all doses have been prepared. Gently invert the infusion bag or syringe to mix the contents. Do not shake or vigorously agitate. Table 2: Recommended Dosing, Preparation and Administration Instructions for Undiluted Bamlanivimab (BAM) and Etesevimab (ETE) for IV Infusion in Pediatric Patients (<18 years and weighing less than 40 kg)a Amount of BAM (as mL) and amount of ETE (as mL) for patients weighing up to 12 kg are calculated and rounded to one decimal place.Body WeightBAM/ETE dose(mg)Amount of BAM(as mL)aAmount of ETE(as mL)aMaximum Infusion Rate>20 kg to <40 kg350 mg 700 mg10 mL20 mL1.88 mL/min>12 kg to 20 kg175 mg 350 mg5 mL10 mL0.94 mL/min>11 kg to 12 kg138 mg 276 mg3.9 mL7.9 mL0.74 mL/min>10 kg to 11 kg126 mg 252 mg3.6 mL7.2 mL0.68 mL/min>9 kg to 10 kg114 mg 228 mg3.3 mL6.5 mL0.61 mL/min>8 kg to kg102 mg 204 mg2.9 mL5.8 mL0.54 mL/min>7 kg to kg90 mg 180 mg2.6 mL5.1 mL0.48 mL/min>6 kg to kg78 mg 156 mg2.2 mL4.5 mL0.42 mL/min>5 kg to kg66 mg 132 mg1.9 mL3.8 mL0.36 mL/min>4 kg to kg54 mg 108 mg1.5 mL3.1 mL0.29 mL/min>3 kg to kg42 mg 84 mg1.2 mL2.4 mL0.23 mL/min>2 kg to kg30 mg 60 mg0.9 mL1.7 mL0.16 mL/min>1.5 kg to kg21 mg 42 mg0.6 mL1.2 mL0.11 mL/min1 kg to 1.5 kg15 mg 30 mg0.4 mL0.9 mL0.08 mL/min. Bamlanivimab and etesevimab solution for infusion should be prepared by qualified healthcare professional using aseptic technique.. Bamlanivimab and etesevimab are supplied in individual vials but are administered together.. Inspect bamlanivimab and etesevimab vials visually for particulate matter and discoloration. Bamlanivimab and etesevimab are clear to opalescent and colorless to slightly yellow to slightly brown solutions.. The prepared infusion solution should not be administered simultaneously with any other medication. The compatibility of bamlanivimab and etesevimab injection with IV solutions and medications other than 0.9% Sodium Chloride Injection is not known.. If the infusion must be discontinued due to an infusion reaction, discard any unused product.. The use of closed system transfer devices (CSTDs), elastomeric pumps, and pneumatic transport with bamlanivimab and etesevimab has not been studied.. Clinically monitor patients during administration and observe patients for at least hour after infusion is complete.. bamlanivimab vial (700 mg/20 mL). etesevimab vials (700 mg/20 mL). polyvinyl chloride (PVC) or polyethylene (PE)-line PVC, sterile prefilled infusion bag containing 0.9% Sodium Chloride Injection (sizes 50 mL to 250 mL). PVC or PE-lined PVC infusion set. in-line or add-on 0.2/0.22 micron polyethersulfone (PES) filter. 0.9% Sodium Chloride for flushing tubing. Remove bamlanivimab vial and etesevimab vials from refrigerated storage and allow to equilibrate to room temperature for approximately 20 minutes before preparation. Do not expose to direct heat. Do not shake the vials. Inspect vials. Withdraw 20 mL from one bamlanivimab vial and 40 mL from two etesevimab vials and inject all 60 mL into prefilled infusion bag containing 0.9% Sodium Chloride (see Table 1).. Discard any product remaining in the vials.. Gently invert the bag by hand approximately 10 times to mix. Do not shake. These products are preservative-free and therefore, the diluted infusion solution should be administered immediately.If immediate administration is not possible, store the diluted infusion solution for up to 24 hours at refrigerated temperature (2C to 8C [36F to 46F]) and up to hours at room temperature (20C to 25C [68F to 77F]) including infusion time. If refrigerated, allow the infusion solution to equilibrate to room temperature for approximately 20 minutes prior to administration. If immediate administration is not possible, store the diluted infusion solution for up to 24 hours at refrigerated temperature (2C to 8C [36F to 46F]) and up to hours at room temperature (20C to 25C [68F to 77F]) including infusion time. If refrigerated, allow the infusion solution to equilibrate to room temperature for approximately 20 minutes prior to administration.. Attach the infusion set to the IV bag. Use of in-line or add-on 0.2/0.22 micron polyethersulfone (PES) filter is strongly recommended.. Prime the infusion set.. Administer the entire infusion solution in the bag via pump or gravity according to the size of infusion bag used (see Table 1). Due to potential overfill of prefilled saline bags, the entire infusion solution in the bag should be administered to avoid underdosage.. Once infusion is complete, flush the tubing with 0.9% Sodium Chloride to ensure delivery of the required dose.. Remove bamlanivimab and etesevimab vials from refrigerated storage and allow to equilibrate to room temperature for approximately 20 minutes before preparation. Do not expose to direct heat. Do not shake vials. Inspect vials. Withdraw appropriate amounts of bamlanivimab and etesevimab from vials based on body weight and inject into the empty infusion bag or draw into disposable syringe (see Table 2).Multiple doses of bamlanivimab and etesevimab may be prepared from each product vial (see the storage conditions specified below). Prepare all infusion bags or syringes at the same time. Appropriately label any prepared doses including the patient weight and dose, and time of preparation to minimize risk of medication errors, particularly in cases where multiple doses are prepared simultaneously.Discard any product remaining in the vials after all doses have been prepared. Multiple doses of bamlanivimab and etesevimab may be prepared from each product vial (see the storage conditions specified below). Prepare all infusion bags or syringes at the same time. Appropriately label any prepared doses including the patient weight and dose, and time of preparation to minimize risk of medication errors, particularly in cases where multiple doses are prepared simultaneously.. Discard any product remaining in the vials after all doses have been prepared.. Gently invert the infusion bag or syringe to mix the contents. Do not shake or vigorously agitate. AdministrationThese products are preservative-free and therefore, the infusion solution should be administered immediately.If immediate administration is not possible, store the infusion solution for up to 24 hours at refrigerated temperature (2C to 8C [36F to 46F]) and up to hours at room temperature (20C to 25C [68F to 77F]) including infusion time. If refrigerated, allow the infusion solution to equilibrate to room temperature for approximately 20 minutes prior to administration. IV bag:Attach the infusion set to the IV bag. Use of in-line or add-on 0.2/0.22 micron polyethersulfone (PES) filter is strongly recommended.Prime the infusion set.Administer the entire infusion solution in the bag via pump or gravity over at least 16 minutes (see Table 2).Once infusion is complete, flush the tubing with 0.9% Sodium Chloride to ensure delivery of the required dose. Syringe Pump:Administer the entire contents of the syringe via syringe pump over at least 16 minutes (see Table 2).After the entire contents of the syringe have been administered, flush the extension set with 0.9% Sodium Chloride to ensure delivery of the required dose. These products are preservative-free and therefore, the infusion solution should be administered immediately.If immediate administration is not possible, store the infusion solution for up to 24 hours at refrigerated temperature (2C to 8C [36F to 46F]) and up to hours at room temperature (20C to 25C [68F to 77F]) including infusion time. If refrigerated, allow the infusion solution to equilibrate to room temperature for approximately 20 minutes prior to administration. If immediate administration is not possible, store the infusion solution for up to 24 hours at refrigerated temperature (2C to 8C [36F to 46F]) and up to hours at room temperature (20C to 25C [68F to 77F]) including infusion time. If refrigerated, allow the infusion solution to equilibrate to room temperature for approximately 20 minutes prior to administration.. IV bag:Attach the infusion set to the IV bag. Use of in-line or add-on 0.2/0.22 micron polyethersulfone (PES) filter is strongly recommended.Prime the infusion set.Administer the entire infusion solution in the bag via pump or gravity over at least 16 minutes (see Table 2).Once infusion is complete, flush the tubing with 0.9% Sodium Chloride to ensure delivery of the required dose. Attach the infusion set to the IV bag. Use of in-line or add-on 0.2/0.22 micron polyethersulfone (PES) filter is strongly recommended.. Prime the infusion set.. Administer the entire infusion solution in the bag via pump or gravity over at least 16 minutes (see Table 2).. Once infusion is complete, flush the tubing with 0.9% Sodium Chloride to ensure delivery of the required dose.. Syringe Pump:Administer the entire contents of the syringe via syringe pump over at least 16 minutes (see Table 2).After the entire contents of the syringe have been administered, flush the extension set with 0.9% Sodium Chloride to ensure delivery of the required dose. Administer the entire contents of the syringe via syringe pump over at least 16 minutes (see Table 2).. After the entire contents of the syringe have been administered, flush the extension set with 0.9% Sodium Chloride to ensure delivery of the required dose.

PHARMACOKINETICS SECTION.

14.3 Pharmacokinetics. summary of PK parameters of bamlanivimab and etesevimab following administration of single dose of 700 mg bamlanivimab and 1,400 mg etesevimab is provided in Table 3. There is no change in PK of bamlanivimab or etesevimab administered alone or together suggesting there is no interaction between the two antibodies. There were no differences in PK of etesevimab between mild/moderate ambulatory participants and healthy participants.Table 3: Pharmacokinetic Parameters of Bamlanivimab (BAM) and Etesevimab (ETE) Administered IV in AdultsAbbreviations: CV coefficient of variation; Cmax maximum concentration; AUCinf area under the concentration versus time curve from zero to infinity; Vss steady-state volume of distribution.a = number of subjects simulated using the PK model.b The number of subjects for Vss, half-life, and clearance are based on population PK model that included bamlanivimab doses up to 7,000 mg and etesevimab doses up to 2,800 mg.NBAM(700 mg)ETE(1400 mg)Systemic Exposure Geometric Mean (%CV) Cmax, mcg/mL270187 (41.7)422 (41.2) Geometric Mean (%CV) Cday 29, mcg/mL311 BAM; 320 ETE25.7 (42.9)116 (38.1) Median (5th,95th percentile) Cweek 8, mcg/mL1000a 10.1 (3.59, 22.9)58.3 (26.8, 117) Geometric Mean (%CV) AUCinf, mcg day/mL4992500 (28.0)10600 (29.9)Distribution Geometric Mean (%CV) Vss (L)1899 BAM; 1498 ETEb 6.59 (24.9)5.78 (24.7)Elimination Geometric Mean (%CV) Elimination Half-Life (day)1899 BAM; 1498 ETEb 20.9 (17.3)32.6 (21.7) Geometric Mean (%CV) Clearance (L/day)1899 BAM; 1498 ETEb 0.274 (31.5)0.134 (32.5)Bamlanivimab and etesevimab are expected to be degraded into small peptides and component amino acids via catabolic pathways in the same manner as endogenous IgG antibodies.. Special Populations:The PK profiles of bamlanivimab and etesevimab were not affected by age, sex, race, or disease severity based on population PK analysis. Body weight had no clinically relevant effect on the PK of bamlanivimab or etesevimab in adults with COVID-19 over the body weight range of 41 kg to 173 kg [see Use in Specific Populations (11.4, 11.7)].. Pediatric populationThe PK of bamlanivimab and etesevimab has been evaluated in 88 pediatric patients <18 years who received weight-based dosing [see Dosage and Administration (2.2)]. The data show that weight-based dosing in pediatric patients provides comparable plasma exposures to those observed in adults who received bamlanivimab 700 mg and etesevimab 1,400 mg. No dosage adjustment is recommended in pediatric patients <18 years who weigh at least 40 kg. Pediatric patients weighing less than 40 kg should be dosed on the basis of body weight [see Dosage and Administration (2.2, 2.4)]. The recommended dosing regimen for pediatric patients <=12 kg is predicted to result in similar exposures when compared to exposures achieved in adults receiving bamlanivimab 700 mg and etesevimab 1,400 mg based on pharmacokinetic modeling and simulation. The youngest participant in the pediatric treatment trial was 10 months of age and weighed 8.6 kg [see Clinical Trials and Supporting Data for EUA (18.1)].Table 4: Pharmacokinetic Parameters of Bamlanivimab (BAM) and Etesevimab (ETE) Administered IV in Pediatric PatientsAbbreviations: CV coefficient of variation; Cmax maximum concentration; AUCinf area under the concentration versus time curve from zero to infinity.Body Weight>=40 kg>20 to <40 kg>12 to <=20 kg<=12 kgBAM ETE Dose700 mg 1400 mg350 mg 700 mg175 mg 350 mg15 mg/kg 30 mg/kgBAM: Geometric Mean (%CV) [n] Cmax, mcg/mL235 (51.0) [52]239 (39.1) [16]243 (66.0) [7]371 (9.8) [2] Cday 29, mcg/mL26.8 (50.2) [34]26.1 (32.5) [8]23.0 (53.0) [3][0] AUCinf, mcg day/mL2760 (30.7) [66]2780 (25.7) [20]2430 (28.4) [9]3000 (19.1) [3]ETE: Geometric Mean (%CV) [n] Cmax, mcg/mL508 (50.6) [50]444 (26.6) [14]444 (64.9) [7]831 (16.8) [2] Cday 29, mcg/mL133 (46.8) [34]138 (29.5) [8]125 (51.5) [3][0] AUCinf, mcg day/mL12900 (32.4) [66]12400 (23.2) [20]11300 (29.6) [9]13500 (13.0) [3]. Patients with renal impairmentBamlanivimab and etesevimab are not eliminated intact in the urine. Renal impairment is not expected to impact the PK of bamlanivimab and etesevimab, since mAbs with molecular weight >69 kDa are known not to undergo renal elimination. Similarly, dialysis is not expected to impact the PK of bamlanivimab and etesevimab [see Use in Specific Populations (11.5)].. Patients with hepatic impairmentBased on population PK analysis, there is no significant difference in PK of bamlanivimab or etesevimab in patients with mild hepatic impairment compared to patients with normal hepatic function. Bamlanivimab and etesevimab have not been studied in patients with moderate or severe hepatic impairment [see Use in Specific Populations (11.6)].. Drug interactions:Bamlanivimab and etesevimab are not renally excreted or metabolized by cytochrome P450 enzymes; therefore, interactions with concomitant medications that are renally excreted or that are substrates, inducers, or inhibitors of cytochrome P450 enzymes are unlikely.

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Fact Sheet for Patients, Parents and CaregiversEmergency Use Authorization (EUA) of Bamlanivimab and Etesevimab for Coronavirus Disease 2019 (COVID-19)You or your child are being given two medicines together called bamlanivimab and etesevimab for the treatment or post-exposure prophylaxis for prevention of coronavirus disease 2019 (COVID-19). SARS-CoV-2 is the virus that causes COVID-19. This Fact Sheet contains information to help you understand the potential risks and potential benefits of taking bamlanivimab and etesevimab.Receiving bamlanivimab and etesevimab may help to treat COVID-19 in certain people, or help to prevent COVID-19 in certain people who have been exposed to someone infected with SARS-CoV-2 or who are at high risk of an exposure because of being in the same setting, such as nursing homes or prisons.Read this Fact Sheet for information about bamlanivimab and etesevimab. Talk to your or your childs healthcare provider if you have questions. It is your choice if you or your child receive bamlanivimab and etesevimab or you may stop them at any time.What is COVID-19COVID-19 is caused by virus called coronavirus, SARS-CoV-2. People can get COVID-19 through contact with another person who has the virus.COVID-19 illnesses have ranged from very mild (including some with no reported symptoms) to severe, including illness resulting in death. While information so far suggests that most COVID-19 illness is mild, serious illness can happen and may cause some of your or your childs other medical conditions to become worse. People of all ages with severe, long-lasting (chronic) medical conditions like heart disease, lung disease, and diabetes, for example, and other conditions including obesity, seem to be at higher risk of being hospitalized for COVID-19. Older age, with or without other conditions, also places people at higher risk of being hospitalized for COVID-19.What are the symptoms of COVID-19The symptoms of COVID-19 include fever, cough, and shortness of breath, which may appear to 14 days after exposure. Serious illness including breathing problems can occur and may cause other medical conditions to become worse.What are bamlanivimab and etesevimabBamlanivimab and etesevimab are investigational medicines used together in adults and children who are at high risk for developing severe COVID-19, including hospitalization or death for:treatment of mild to moderate symptoms of COVID-19, ORpost-exposure prophylaxis for prevention of COVID-19 in persons who are:not fully vaccinated against COVID-19 (Individuals are considered to be fully vaccinated weeks after their second dose in 2-dose series [such as the Pfizer or Moderna vaccines], or weeks after single-dose dose vaccine [such as Johnson Johnsons Janssen vaccine]), or are not expected to build up enough of an immune response to the complete COVID-19 vaccination (for example, someone with immunocompromising conditions, including someone who is taking immunosuppressive medications), and have been exposed to someone who is infected with SARS-CoV-2. Close contact with someone who is infected with SARS-CoV-2 is defined as being within feet for total of 15 minutes or more, providing care at home to someone who is sick, having direct physical contact with the person (hugging or kissing, for example), sharing eating or drinking utensils, or being exposed to respiratory droplets from an infected person (sneezing or coughing, for example). For additional details, go to https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html, or someone who is at high risk of being exposed to someone who is infected with SARS-CoV-2 because of occurrence of SARS-CoV-2 infection in other individuals in the same institutional setting (for example, nursing homes, prisons). Bamlanivimab and etesevimab are investigational because they are still being studied. There is limited information known about the safety or effectiveness of using bamlanivimab and etesevimab to treatment or prevention of COVID-19. Bamlanivimab and etesevimab are not authorized for pre-exposure prophylaxis for prevention of COVID-19.The FDA has authorized the emergency use of bamlanivimab and etesevimab together for the treatment of COVID-19 and the post-exposure prophylaxis for prevention of COVID-19 under an Emergency Use Authorization (EUA). For more information on EUA, see the section What is an Emergency Use Authorization (EUA) at the end of this Fact Sheet.What should tell the healthcare provider before or my child receive bamlanivimab and etesevimabTell the healthcare provider about all of your or your childs medical conditions, including:Having any allergiesHaving received COVID-19 vaccineHaving any serious illnessesAre pregnant or plan to become pregnantAre breastfeeding or plan to breastfeedAre taking any medications (prescription, over-the-counter, vitamins, and herbal products)How are bamlanivimab and etesevimab givenBamlanivimab and etesevimab are given at the same time through vein (intravenous or IV).One dose of bamlanivimab and etesevimab will be given by IV infusion. The infusion will take 16 60 minutes or longer. Your or your childs healthcare provider will determine the duration of the infusion.What are the important possible side effects of bamlanivimab and etesevimabPossible side effects of bamlanivimab and etesevimab are:Allergic reactions. Allergic reactions can happen during and after infusion with bamlanivimab and etesevimab. Tell your or your childs healthcare provider right away if any of the following signs and symptoms of allergic reactions occur: fever, chills, nausea, headache, shortness of breath, low or high blood pressure, rapid or slow heart rate, chest discomfort or pain, weakness, confusion, feeling tired, wheezing, swelling of the lips, face, or throat, rash including hives, itching, muscle aches, feeling faint, dizziness, and sweating. These reactions may be severe or life threatening.Worsening of COVID-19 symptoms after bamlanivimab and etesevimab therapy for active infection: You or your child may experience new or worsening symptoms after infusion for mild to moderate COVID-19, including fever, difficulty breathing, rapid or slow heart rate, tiredness, weakness or confusion. If these occur, contact your or your childs healthcare provider or seek immediate medical attention as some of these events have required hospitalization. It is unknown if these events are related to treatment or are due to the progression of COVID-19.The side effects of getting any medicine by vein may include brief pain, bleeding, bruising of the skin, soreness, swelling, and possible infection at the infusion site.These are not all the possible side effects of bamlanivimab and etesevimab. Not lot of people have been given bamlanivimab and etesevimab. Serious and unexpected side effects may happen. Bamlanivimab and etesevimab are still being studied so it is possible that all of the risks are not known at this time.It is possible that bamlanivimab and etesevimab could interfere with your or your childs bodys own ability to fight off future infection of SARS-CoV-2. Similarly, bamlanivimab and etesevimab may reduce the bodys immune response to vaccine for SARS-CoV-2. Specific studies have not been conducted to address these possible risks. Talk to your or your childs healthcare provider if you have any questions.What other treatment choices are thereLike bamlanivimab and etesevimab, FDA may allow for the emergency use of other medicines to treat people with COVID-19. Go to https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization for information on the emergency use of other medicines that are not approved by FDA to treat people with COVID-19. Your or your childs healthcare provider may talk with you about clinical trials you or your child may be eligible for.It is your choice whether you or your child should be treated or not to be treated with bamlanivimab and etesevimab. Should you decide that you or your child should not receive bamlanivimab and etesevimab or stop it at any time, it will not change your or your childs standard medical care.What other prevention choices are thereVaccines to prevent COVID-19 are approved or available under Emergency Use Authorization. Use of bamlanivimab and etesevimab does not replace vaccination against COVID-19.Like bamlanivimab and etesevimab, FDA may allow for the emergency use of other medicines for post-exposure prophylaxis for prevention of COVID-19. Go to https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization for information on the emergency use of other medicines that are not approved by FDA for post-exposure prophylaxis for prevention of COVID-19. The healthcare provider may talk with you about clinical trials you or your child may be eligible for.Bamlanivimab and etesevimab are not authorized for pre-exposure prophylaxis for prevention of COVID-19.What if am pregnant or breastfeedingThere is limited experience treating pregnant women or breastfeeding mothers with bamlanivimab and etesevimab. For mother and unborn baby, the benefit of receiving bamlanivimab and etesevimab may be greater than the risk from the treatment. If pregnant or breastfeeding, discuss your options and specific situation with your healthcare provider.How do report side effects with bamlanivimab and etesevimabTell the healthcare provider right away if you or your child have any side effect that bothers you or your child, or does not go away.Report side effects to FDA MedWatch at www.fda.gov/medwatch, call 1-800-FDA-1088, or contact Eli Lilly and Company at 1-855-LillyC19 (1-855-545-5921).How can learn moreAsk your or your childs healthcare providerVisit www.LillyAntibody.com Visit https://www.covid19treatmentguidelines.nih.gov/ Contact your local or state public health departmentWhat is an Emergency Use Authorization (EUA)The United States FDA has made bamlanivimab and etesevimab available under an emergency access mechanism called an EUA. The EUA is supported by Secretary of Health and Human Service (HHS) declaration that circumstances exist to justify the emergency use of drugs and biological products during the COVID-19 pandemic.Bamlanivimab and etesevimab have not undergone the same type of review as an FDA-approved product. In issuing an EUA under the COVID-19 public health emergency, the FDA must determine, among other things, that based on the totality of scientific evidence available, it is reasonable to believe that the product may be effective for diagnosing, treating, or preventing COVID-19, or serious or life-threatening disease or condition caused by COVID-19; that the known and potential benefits of the product, when used to diagnose, treat, or prevent such disease or condition, outweigh the known and potential risks of such product; and that there are no adequate, approved and available alternatives. All of these criteria must be met to allow for the medicine to be used in the treatment of COVID-19 or prevention of COVID-19 during the COVID-19 pandemic.The EUA for bamlanivimab and etesevimab together is in effect for the duration of the COVID-19 declaration justifying emergency use of these products, unless terminated or revoked (after which the products may no longer be used).Literature revised December 3, 2021Eli Lilly and Company, Indianapolis, IN 46285, USACopyright (C) 2021, Eli Lilly and Company. All rights reserved.ETE-0005-EUA PAT-20211203. treatment of mild to moderate symptoms of COVID-19, OR. post-exposure prophylaxis for prevention of COVID-19 in persons who are:not fully vaccinated against COVID-19 (Individuals are considered to be fully vaccinated weeks after their second dose in 2-dose series [such as the Pfizer or Moderna vaccines], or weeks after single-dose dose vaccine [such as Johnson Johnsons Janssen vaccine]), or are not expected to build up enough of an immune response to the complete COVID-19 vaccination (for example, someone with immunocompromising conditions, including someone who is taking immunosuppressive medications), and have been exposed to someone who is infected with SARS-CoV-2. Close contact with someone who is infected with SARS-CoV-2 is defined as being within feet for total of 15 minutes or more, providing care at home to someone who is sick, having direct physical contact with the person (hugging or kissing, for example), sharing eating or drinking utensils, or being exposed to respiratory droplets from an infected person (sneezing or coughing, for example). For additional details, go to https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html, or someone who is at high risk of being exposed to someone who is infected with SARS-CoV-2 because of occurrence of SARS-CoV-2 infection in other individuals in the same institutional setting (for example, nursing homes, prisons). not fully vaccinated against COVID-19 (Individuals are considered to be fully vaccinated weeks after their second dose in 2-dose series [such as the Pfizer or Moderna vaccines], or weeks after single-dose dose vaccine [such as Johnson Johnsons Janssen vaccine]), or are not expected to build up enough of an immune response to the complete COVID-19 vaccination (for example, someone with immunocompromising conditions, including someone who is taking immunosuppressive medications), and have been exposed to someone who is infected with SARS-CoV-2. Close contact with someone who is infected with SARS-CoV-2 is defined as being within feet for total of 15 minutes or more, providing care at home to someone who is sick, having direct physical contact with the person (hugging or kissing, for example), sharing eating or drinking utensils, or being exposed to respiratory droplets from an infected person (sneezing or coughing, for example). For additional details, go to https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html, or someone who is at high risk of being exposed to someone who is infected with SARS-CoV-2 because of occurrence of SARS-CoV-2 infection in other individuals in the same institutional setting (for example, nursing homes, prisons). have been exposed to someone who is infected with SARS-CoV-2. Close contact with someone who is infected with SARS-CoV-2 is defined as being within feet for total of 15 minutes or more, providing care at home to someone who is sick, having direct physical contact with the person (hugging or kissing, for example), sharing eating or drinking utensils, or being exposed to respiratory droplets from an infected person (sneezing or coughing, for example). For additional details, go to https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html, or someone who is at high risk of being exposed to someone who is infected with SARS-CoV-2 because of occurrence of SARS-CoV-2 infection in other individuals in the same institutional setting (for example, nursing homes, prisons).. Having any allergies. Having received COVID-19 vaccine. Having any serious illnesses. Are pregnant or plan to become pregnant. Are breastfeeding or plan to breastfeed. Are taking any medications (prescription, over-the-counter, vitamins, and herbal products). Bamlanivimab and etesevimab are given at the same time through vein (intravenous or IV).. One dose of bamlanivimab and etesevimab will be given by IV infusion. The infusion will take 16 60 minutes or longer. Your or your childs healthcare provider will determine the duration of the infusion.. Allergic reactions. Allergic reactions can happen during and after infusion with bamlanivimab and etesevimab. Tell your or your childs healthcare provider right away if any of the following signs and symptoms of allergic reactions occur: fever, chills, nausea, headache, shortness of breath, low or high blood pressure, rapid or slow heart rate, chest discomfort or pain, weakness, confusion, feeling tired, wheezing, swelling of the lips, face, or throat, rash including hives, itching, muscle aches, feeling faint, dizziness, and sweating. These reactions may be severe or life threatening.. Worsening of COVID-19 symptoms after bamlanivimab and etesevimab therapy for active infection: You or your child may experience new or worsening symptoms after infusion for mild to moderate COVID-19, including fever, difficulty breathing, rapid or slow heart rate, tiredness, weakness or confusion. If these occur, contact your or your childs healthcare provider or seek immediate medical attention as some of these events have required hospitalization. It is unknown if these events are related to treatment or are due to the progression of COVID-19.. Ask your or your childs healthcare provider. Visit www.LillyAntibody.com Visit https://www.covid19treatmentguidelines.nih.gov/ Contact your local or state public health department.

SPL UNCLASSIFIED SECTION.

AUTHORIZED USE. TREATMENTThe U.S. Food and Drug Administration (FDA) has issued an Emergency Use Authorization (EUA) to permit the emergency use of the unapproved products bamlanivimab and etesevimab administered together for the treatment of mild to moderate coronavirus disease 2019 (COVID-19) in adults and pediatric patients, including neonates, with positive results of direct SARS-CoV-2 viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death.Limitations of Authorized UseUse in Patients Who Are Hospitalized or Who Require Oxygen Due to COVID-19Bamlanivimab and etesevimab are not authorized for use in patients years and older who are hospitalized due to COVID-19The reasons for hospital admission may be different and the threshold for hospital admission may be lower for neonates, young infants and toddlers with COVID-19 compared to older children and adults. The authorization allows for young children (i.e., birth to years of age) who are hospitalized with mild to moderate COVID-19 at the time of treatment to receive bamlanivimab and etesevimab.,Bamlanivimab and etesevimab are not authorized for use in patients, regardless of age, who:require oxygen therapy and/or respiratory support due to COVID-19, ORrequire an increase in baseline oxygen flow rate and/or respiratory support due to COVID-19 and are on chronic oxygen therapy and/or respiratory support due to underlying non-COVID-19 related comorbidity. Treatment with bamlanivimab and etesevimab has not been studied in patients hospitalized due to COVID-19. Monoclonal antibodies, such as bamlanivimab and etesevimab, may be associated with worse clinical outcomes when administered to hospitalized patients with COVID-19 requiring high flow oxygen or mechanical ventilation.POST-EXPOSURE PROPHYLAXISThe U.S. Food and Drug Administration (FDA) has issued an Emergency Use Authorization (EUA) to permit the emergency use of the unapproved products bamlanivimab and etesevimab administered together in adults and pediatric individuals, including neonates, for post-exposure prophylaxis of COVID-19 in individuals who are at high risk of progression to severe COVID-19, including hospitalization or death, and are:not fully vaccinated Individuals are considered to be fully vaccinated weeks after their second vaccine dose in 2-dose series (such as the Pfizer or Moderna vaccines), or weeks after single-dose vaccine (such as Johnson Johnsons Janssen vaccine). See this website for more details: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.htmlvaccinated. or who are not expected to mount an adequate immune response to complete SARS-CoV-2 vaccination (for example, individuals with immunocompromising conditions including those taking immunosuppressive medicationsSee this website for more details: https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html.) and have been exposed to an individual infected with SARS-CoV-2 consistent with close contact criteria per Centers for Disease Control and Prevention (CDC) Close contact with an infected individual is defined as: being within feet for total of 15 minutes or more, providing care at home to someone who is sick, having direct physical contact with the person (hugging or kissing, for example), sharing eating or drinking utensils, or being exposed to respiratory droplets from an infected person (sneezing or coughing, for example). See this website for additional details: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html. or who are at high risk of exposure to an individual infected with SARS-CoV-2 because of occurrence of SARS-CoV-2 infection in other individuals in the same institutional setting (for example, nursing homes, prisons) [see Limitations of Authorized Use (1.2)]. Limitations of Authorized UsePost-exposure prophylaxis with bamlanivimab and etesevimab is not substitute for vaccination against COVID-19.Bamlanivimab and etesevimab are not authorized for pre-exposure prophylaxis for prevention of COVID-19.. Bamlanivimab and etesevimab are not authorized for use in patients years and older who are hospitalized due to COVID-19The reasons for hospital admission may be different and the threshold for hospital admission may be lower for neonates, young infants and toddlers with COVID-19 compared to older children and adults. The authorization allows for young children (i.e., birth to years of age) who are hospitalized with mild to moderate COVID-19 at the time of treatment to receive bamlanivimab and etesevimab.,. Bamlanivimab and etesevimab are not authorized for use in patients, regardless of age, who:require oxygen therapy and/or respiratory support due to COVID-19, ORrequire an increase in baseline oxygen flow rate and/or respiratory support due to COVID-19 and are on chronic oxygen therapy and/or respiratory support due to underlying non-COVID-19 related comorbidity. require oxygen therapy and/or respiratory support due to COVID-19, OR. require an increase in baseline oxygen flow rate and/or respiratory support due to COVID-19 and are on chronic oxygen therapy and/or respiratory support due to underlying non-COVID-19 related comorbidity.. not fully vaccinated Individuals are considered to be fully vaccinated weeks after their second vaccine dose in 2-dose series (such as the Pfizer or Moderna vaccines), or weeks after single-dose vaccine (such as Johnson Johnsons Janssen vaccine). See this website for more details: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.htmlvaccinated. or who are not expected to mount an adequate immune response to complete SARS-CoV-2 vaccination (for example, individuals with immunocompromising conditions including those taking immunosuppressive medicationsSee this website for more details: https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html.) and have been exposed to an individual infected with SARS-CoV-2 consistent with close contact criteria per Centers for Disease Control and Prevention (CDC) Close contact with an infected individual is defined as: being within feet for total of 15 minutes or more, providing care at home to someone who is sick, having direct physical contact with the person (hugging or kissing, for example), sharing eating or drinking utensils, or being exposed to respiratory droplets from an infected person (sneezing or coughing, for example). See this website for additional details: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html. or who are at high risk of exposure to an individual infected with SARS-CoV-2 because of occurrence of SARS-CoV-2 infection in other individuals in the same institutional setting (for example, nursing homes, prisons) [see Limitations of Authorized Use (1.2)]. have been exposed to an individual infected with SARS-CoV-2 consistent with close contact criteria per Centers for Disease Control and Prevention (CDC) Close contact with an infected individual is defined as: being within feet for total of 15 minutes or more, providing care at home to someone who is sick, having direct physical contact with the person (hugging or kissing, for example), sharing eating or drinking utensils, or being exposed to respiratory droplets from an infected person (sneezing or coughing, for example). See this website for additional details: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html. or who are at high risk of exposure to an individual infected with SARS-CoV-2 because of occurrence of SARS-CoV-2 infection in other individuals in the same institutional setting (for example, nursing homes, prisons) [see Limitations of Authorized Use (1.2)].. Post-exposure prophylaxis with bamlanivimab and etesevimab is not substitute for vaccination against COVID-19.. Bamlanivimab and etesevimab are not authorized for pre-exposure prophylaxis for prevention of COVID-19.

USE IN SPECIFIC POPULATIONS SECTION.

11 USE IN SPECIFIC POPULATIONS. 11.1 Pregnancy. Risk SummaryThere are insufficient data to evaluate drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. Bamlanivimab and etesevimab should only be used during pregnancy if the potential benefit outweighs the potential risk for the mother and the fetus. There are maternal and fetal risks associated with untreated COVID-19 in pregnancy (see Clinical Considerations).Nonclinical reproductive toxicity studies have not been performed with bamlanivimab or etesevimab. In tissue cross reactivity studies using human fetal tissues, no binding of clinical concern was detected for etesevimab or bamlanivimab. Human immunoglobulin G1 (IgG1) antibodies are known to cross the placental barrier; therefore, bamlanivimab and etesevimab have the potential to be transferred from the mother to the developing fetus. It is unknown whether the potential transfer of bamlanivimab or etesevimab provides any treatment benefit or risk to the developing fetus.The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is to 4% and 15 to 20%, respectively.Clinical ConsiderationsDisease-associated maternal and/or embryo-fetal riskCOVID-19 in pregnancy is associated with adverse maternal and fetal outcomes, including preeclampsia, eclampsia, preterm birth, premature rupture of membranes, venous thromboembolic disease, and fetal death.. 11.2 Lactation. Risk SummaryThere are no available data on the presence of bamlanivimab or etesevimab in human or animal milk, the effects on the breastfed infant, or the effects on milk production. Maternal IgG is known to be present in human milk. The developmental and health benefits of breastfeeding should be considered along with the mothers clinical need for bamlanivimab and etesevimab and any potential adverse effects on the breastfed child from bamlanivimab and etesevimab or from the underlying maternal condition. Breastfeeding individuals with COVID-19 should follow practices according to clinical guidelines to avoid exposing the infant to COVID-19.. 11.3 Pediatric Use. Bamlanivimab and etesevimab administered together are authorized for the treatment of mild to moderate COVID-19 and post-exposure prophylaxis for prevention of COVID-19 in pediatric patients, including neonates [see Authorized Use (1)]. Given the similar course of COVID-19, the authorization of bamlanivimab and etesevimab for treatment and post-exposure prophylaxis in younger pediatric patients, including neonates, is supported by safety and efficacy data in adolescents and adults, together with additional pharmacokinetic and safety data from the clinical trial in pediatric patients studying bamlanivimab and etesevimab for the treatment of mild to moderate COVID-19.Use of bamlanivimab and etesevimab in pediatric patients is based on analyses of data from BLAZE-1 in subjects aged 10 months to 18 years of age [see Clinical Pharmacology (14.3) and Clinical Trials and Supporting Data for EUA (18.1)]. No dosage adjustment is recommended in pediatric patients 12-18 years of age who weigh at least 40 kg. Pediatric patients weighing less than 40 kg should be dosed on the basis of body weight [see Dosage and Administration (2.2, 2.4)]. The recommended dosing regimen for pediatric patients <=12 kg is predicted based on pharmacokinetic modeling and simulation [see Clinical Pharmacology (14.3)]. The youngest participant in the pediatric clinical trial for treatment was 10 months of age and weighed 8.6 kg [see Clinical Trials and Supporting Data for EUA (18.1)]. Safety in pediatric patients was similar to what was observed in adults [see Clinical Trial Experience (6.1)]. Children were not enrolled in the post-exposure prophylaxis trial, BLAZE-2 [see Clinical Trials and Supporting Data for EUA (18.2)].. 11.4 Geriatric Use. Of the 1141 patients receiving bamlanivimab and etesevimab in BLAZE-1, 30% were 65 years of age and older and 10% were 75 years of age and older. Based on population PK analyses, there is no difference in PK of bamlanivimab or etesevimab in geriatric patients compared to younger patients [see Clinical Trial Results and Supporting Data for EUA (18.1)].. 11.5 Renal Impairment. Bamlanivimab and etesevimab are not eliminated intact in the urine, thus renal impairment is not expected to affect the exposure of bamlanivimab or etesevimab.. 11.6 Hepatic Impairment. Based on population PK analysis, there is no difference in PK of bamlanivimab or etesevimab in patients with mild hepatic impairment compared to patients with normal hepatic function. Bamlanivimab and etesevimab have not been studied in patients with moderate or severe hepatic impairment.. 11.7 Other Specific Populations. Based on population PK analysis, the PK of bamlanivimab and etesevimab was not affected by sex, race, or disease severity. Body weight had no clinically relevant effect on the PK of bamlanivimab and etesevimab in adults with COVID-19 over the body weight range of 41 kg to 173 kg.

WARNINGS AND PRECAUTIONS SECTION.

5 WARNINGS AND PRECAUTIONS. There are limited clinical data available for bamlanivimab and etesevimab. Serious and unexpected adverse events may occur that have not been previously reported with use of bamlanivimab and etesevimab together.. 5.1 Hypersensitivity Including Anaphylaxis and Infusion-Related Reactions. Serious hypersensitivity reactions, including anaphylaxis, have been observed with administration of bamlanivimab and etesevimab. If signs and symptoms of clinically significant hypersensitivity reaction or anaphylaxis occur, immediately discontinue administration and initiate appropriate medications and/or supportive care.Infusion-related reactions, occurring during the infusion and up to 24 hours after the infusion, have been observed with administration of bamlanivimab and etesevimab together. These reactions may be severe or life threatening.Signs and symptoms of infusion related reactions may include [see Overall Safety Summary (6.1)]:fever, difficulty breathing, reduced oxygen saturation, chills, fatigue, arrhythmia (e.g., atrial fibrillation, sinus tachycardia, bradycardia), chest pain or discomfort, weakness, altered mental status, nausea, headache, bronchospasm, hypotension, hypertension, angioedema, throat irritation, rash including urticaria, pruritus, myalgia, vasovagal reactions (e.g., pre-syncope, syncope), dizziness and diaphoresis.Consider slowing or stopping the infusion and administer appropriate medications and/or supportive care if an infusion-related reaction occurs.Hypersensitivity reactions occurring more than 24 hours after the infusion have also been reported with the use of bamlanivimab and etesevimab under Emergency Use Authorization.. fever, difficulty breathing, reduced oxygen saturation, chills, fatigue, arrhythmia (e.g., atrial fibrillation, sinus tachycardia, bradycardia), chest pain or discomfort, weakness, altered mental status, nausea, headache, bronchospasm, hypotension, hypertension, angioedema, throat irritation, rash including urticaria, pruritus, myalgia, vasovagal reactions (e.g., pre-syncope, syncope), dizziness and diaphoresis.. 5.2 Clinical Worsening After Bamlanivimab and Etesevimab Administration. Clinical worsening of COVID-19 after administration of bamlanivimab and etesevimab together has been reported and may include signs or symptoms of fever, hypoxia or increased respiratory difficulty, arrhythmia (e.g., atrial fibrillation, sinus tachycardia, bradycardia), fatigue, and altered mental status. Some of these events required hospitalization. It is not known if these events were related to bamlanivimab and etesevimab use or were due to progression of COVID-19.. 5.3 Limitations of Benefit and Potential for Risk in Patients with Severe COVID-19. Treatment with bamlanivimab and etesevimab has not been studied in patients hospitalized due to COVID-19. Monoclonal antibodies, such bamlanivimab and etesevimab, may be associated with worse clinical outcomes when administered to hospitalized patients with COVID-19 requiring high flow oxygen or mechanical ventilation. Therefore,Bamlanivimab and etesevimab are not authorized for use in patients years and older who are hospitalized due to COVID-19,Bamlanivimab and etesevimab are not authorized for use in patients, regardless of age, who:require oxygen therapy and/or respiratory support due to COVID-19, ORrequire an increase in baseline oxygen flow rate and/or respiratory support due to COVID-19 and are on chronic oxygen therapy and/or respiratory support due to underlying non-COVID-19 related comorbidity [see Limitations of Authorized Use (1.1)]. Bamlanivimab and etesevimab are not authorized for use in patients years and older who are hospitalized due to COVID-19,. Bamlanivimab and etesevimab are not authorized for use in patients, regardless of age, who:require oxygen therapy and/or respiratory support due to COVID-19, ORrequire an increase in baseline oxygen flow rate and/or respiratory support due to COVID-19 and are on chronic oxygen therapy and/or respiratory support due to underlying non-COVID-19 related comorbidity [see Limitations of Authorized Use (1.1)]. require oxygen therapy and/or respiratory support due to COVID-19, OR. require an increase in baseline oxygen flow rate and/or respiratory support due to COVID-19 and are on chronic oxygen therapy and/or respiratory support due to underlying non-COVID-19 related comorbidity [see Limitations of Authorized Use (1.1)].

WARNINGS SECTION.

Warnings. There are limited clinical data available for bamlanivimab and etesevimab. Serious and unexpected adverse events may occur that have not been previously reported with use of bamlanivimab and etesevimab together.Hypersensitivity Including Anaphylaxis and Infusion-Related ReactionsSerious hypersensitivity reactions, including anaphylaxis, have been observed with administration of bamlanivimab and etesevimab. If signs and symptoms of clinically significant hypersensitivity reaction or anaphylaxis occur, immediately discontinue administration and initiate appropriate medications and/or supportive therapy.Infusion-related reactions, occurring during the infusion and up to 24 hours after the infusion, have been observed with administration of bamlanivimab and etesevimab together. These reactions may be severe or life threatening.Signs and symptoms of infusion related reactions may include:fever, difficulty breathing, reduced oxygen saturation, chills, fatigue, arrhythmia (e.g., atrial fibrillation, sinus tachycardia, bradycardia), chest pain or discomfort, weakness, altered mental status, nausea, headache, bronchospasm, hypotension, hypertension, angioedema, throat irritation, rash including urticaria, pruritus, myalgia, vasovagal reactions (e.g., pre-syncope, syncope), dizziness and diaphoresis.Consider slowing or stopping the infusion and administer appropriate medications and/or supportive care if an infusion-related reaction occurs.Hypersensitivity reactions occurring more than 24 hours after the infusion have also been reported with the use of bamlanivimab and etesevimab under Emergency Use Authorization.Clinical Worsening After Bamlanivimab and Etesevimab AdministrationClinical worsening of COVID-19 after administration of bamlanivimab and etesevimab together has been reported and may include signs or symptoms of fever, hypoxia or increased respiratory difficulty, arrhythmia (e.g., atrial fibrillation, sinus tachycardia, bradycardia), fatigue, and altered mental status. Some of these events required hospitalization. It is not known if these events were related to bamlanivimab and etesevimab use or were due to progression of COVID-19.Limitations of Benefit and Potential for Risk in Patients with Severe COVID-19Treatment with bamlanivimab and etesevimab has not been studied in patients hospitalized due to COVID-19. Monoclonal antibodies, such as bamlanivimab and etesevimab, may be associated with worse clinical outcomes when administered to hospitalized patients with COVID-19 requiring high flow oxygen or mechanical ventilation. Therefore, [see Limitations of Authorized Use (1.1)]:Bamlanivimab and etesevimab are not authorized for use in patients years and older who are hospitalized due to COVID-19,Bamlanivimab and etesevimab are not authorized for use in patients, regardless of age, who:require oxygen therapy and/or respiratory support due to COVID-19, ORrequire an increase in baseline oxygen flow rate and/or respiratory support due to COVID-19 and are on chronic oxygen therapy and/or respiratory support due to underlying non-COVID-19 related comorbidity. fever, difficulty breathing, reduced oxygen saturation, chills, fatigue, arrhythmia (e.g., atrial fibrillation, sinus tachycardia, bradycardia), chest pain or discomfort, weakness, altered mental status, nausea, headache, bronchospasm, hypotension, hypertension, angioedema, throat irritation, rash including urticaria, pruritus, myalgia, vasovagal reactions (e.g., pre-syncope, syncope), dizziness and diaphoresis.. Bamlanivimab and etesevimab are not authorized for use in patients years and older who are hospitalized due to COVID-19,. Bamlanivimab and etesevimab are not authorized for use in patients, regardless of age, who:require oxygen therapy and/or respiratory support due to COVID-19, ORrequire an increase in baseline oxygen flow rate and/or respiratory support due to COVID-19 and are on chronic oxygen therapy and/or respiratory support due to underlying non-COVID-19 related comorbidity. require oxygen therapy and/or respiratory support due to COVID-19, OR. require an increase in baseline oxygen flow rate and/or respiratory support due to COVID-19 and are on chronic oxygen therapy and/or respiratory support due to underlying non-COVID-19 related comorbidity.