New Therapies and Guidelines Can Boost Your Protection
Over the past two months, new approvals and updated guidelines have offered additional protection against COVID-19 for the immunocompromised. Two of these are preventative: Evusheld (formerly AZD7442) and shorter booster timeframes. One is a treatment option for mild to moderate COVID-19: Paxlovid (nirmatrelvir tablets; ritonavir tablets).
“It is an amazing time to see such a plethora of drugs become available in such a short interval,” says Jennifer Saullo, MD, PharmD, transplant and infectious disease provider at Duke University Hospital.
Evusheld: Boosting COVID-19 Immunity
Evusheld builds COVID-19 immunity in people with compromised immune systems who face elevated risk for severe COVID-19 infections. This monoclonal antibody cocktail received emergency-use authorization from the FDA last December.
For most cancer patients, Evusheld is not a substitute for the COVID-19 vaccine, but it is an additional protection for people who may not mount a full immune response to vaccination. Evusheld may help cancer patients who are in active therapy with biologics that suppress the immune system, including chemotherapy, CAR T-cell therapy, and B cell depleting therapies. It’s been shown to protect against the delta and omicron variants.
“[Evusheld] is being used for patients who have not been exposed to COVID, who do not have COVID, but as a preventive measure after they've received a vaccine. We don't want this to take the place of vaccination in patients who are eligible,” Dr. Saullo says.
Exceptions exist, however. Evusheld may substitute for the vaccine in patients who are ineligible for vaccination. For example, people who’ve had CAR T-cell therapy usually must wait three months after their treatment before receiving the COVID-19 vaccine. In these patients, Evusheld may offer protection to fill the gap.
People who have significant cardiac disease should talk with their doctor before receiving Evusheld, which has a slight increase of severe cardiac events in people with preexisting risk factors.
Shortened Wait Times for mRNA Vaccine Booster
Just last month, the CDC reduced the wait time for the Pfizer or Moderna vaccine booster to five months after the last primary dose. This is timely news for immunocompromised people who received the three-part mRNA vaccine series.
On August 13, 2021, the CDC recommended that immunocompromised people who received an mRNA vaccine get three primary doses versus the two-dose series for those without compromised immune systems. For people who received that third primary dose last August after the CDC’s guidance, that means they are now eligible for their booster.
Paxlovid: Treating Mild to Moderate COVID-19
For individuals who have developed mild to moderate Covid-19, Paxlovid is an antiviral drug that can be taken at home to treat the infection. The FDA issued emergency-use authorization for Paxlovid last December. People must start quickly, however; patients must begin to take Paxlovid within five days of developing symptoms.
“Testing is the biggest thing. You want to get tested as soon as you feel like you’re developing symptoms. [Paxlovid] is for treatment; you have to have the infection to receive treatment,” says Zainab Shahid, MD, an infectious disease expert at Atrium Health Levine Cancer Institute. “We know that it decreases the risk of hospitalization drastically, and it allows people to recover and recuperate at home. It has been very well tolerated with our patients.”
Not all pharmacies carry Paxlovid, however. Dr. Shadid encourages people to reach out to their provider as soon as they test positive so that they can try to get connected to a pharmacy that has it available.
Potential drug interactions do exist. Your doctor and pharmacist will review your medications to determine if you’re a good match for Paxlovid, given your current treatments.
Consider Availability
Availability for Evusheld and Paxlovid has lagged behind demand. When Evusheld first became available, there was only enough for 10% of the patients who needed it. Both are distributed by the federal government to states, and each state decides how to allocate doses. The Therapeutics Distribution Locator for Provider Use, created by the Department of Health and Human Services, shows where doses have been allocated.
One patient struggling to find Evusheld has been Michele Nadeem-Baker, who is on treatment for CLL and is a patient advocate for others with CLL through her organization Kicking Cancer in Heels. She lives in Boston, where insufficient supply has led hospitals to create a lottery system to allocate doses to those who need it.
“[Evusheld] is something we need. It seems vital we receive Evusheld if we’re ever going to be able to no longer stay at home, and to be protected,” Nadeem-Baker says.
Dr. Shahid says that availability for both drugs has seen marked improvements in many areas over the past couple weeks, and supply is expected to continue to improve.
Improving Outcomes with New Tools
Even as new drugs become available, people with cancer cannot succumb to pandemic fatigue, Dr. Shahid says. Masking, handwashing, and avoiding high-risk settings remain important. It is also important for friends and family of those with cancer to get vaccinated to increase the protection of their immunosuppressed loved ones, Dr. Shahid adds.
As more measures layer on top of each other, outcomes will continue to improve.
“Outcomes over the past year for immunocompromised patients have definitely improved, as shown in delta surge and now in omicron surge. I take care of these patients day in and day out, and I know that they are going to be at higher risk because they cannot fight the infection as others can,” Dr. Shahid says. “But given what we have for vaccines, the monoclonal antibodies, and the antiviral drugs, I'm very hopeful. We have more tools in our toolbox than we did before.”