Mitigating Risk with Evusheld
One saving grace for immunosuppressed patients was Evusheld, a combination of two monoclonal antibodies (cilgavimab and tixagevimab) that were isolated from two patients who had convalesced from COVID-19, Dr. Kim explains.
The rationale for Evusheld is to limit the systemic spread of virus by administering highly neutralizing antibodies against the spike protein of SARS-CoV-2. Although it’s still possible to acquire a respiratory infection from COVID-19 after receiving Evusheld, the infection should be limited vs. systemic. The original FDA Emergency Use Authorization (EUA) for Evusheld focused on anyone who uses an immunosuppressive agent other than hydroxychloroquine, Dr. Kim says.
Overall, side effects with Evusheld were rare, with several thousand doses given at Dr. Kim’s university with no issues to his knowledge.4 Although an increased risk of cardiovascular disease may occur with Evusheld, this risk is more common in patients with prior cardiovascular events. “You can pick out these people in terms of risk factors and that discussion occurs, but it’s still quite low,” he says.
The emergence of the Omicron variant rendered Evusheld ineffective, and the FDA de-authorized the EUA for Evusheld in late January 2023 (after the release of this podcast). A clinical trial called SUPERNOVA is ongoing and is internationally examining the safety and effectiveness of an updated version of Evusheld, which can neutralize all the variants of concern currently circulating.
As findings from the COVID-19 pandemic continue to shape treatment for immunosuppressed patients, Dr. Kim says he’d like to see research expand in a few additional areas, such as additional dose responses in those on B cell-depletion therapy, mucosal immunity and impacted immunosuppression on durability of antibody responses.
Vanessa Caceres is a medical writer in Bradenton, Fla.
References
- Lucas C, Klein J, Sundaram ME, et al. Delayed production of neutralizing antibodies correlates with fatal COVID-19. Nat Med. 2021 Jul;27(7):1178–1186.
- Grainger R, Kim AHJ, Conway R, et al. COVID-19 in people with rheumatic diseases: Risks, outcomes, treatment considerations. Nat Rev Rheumatol. 2022 Apr;18(4):191–204.
- Bass AR, Chakravarty E, Akl EA, et al. 2022 American College of Rheumatology guideline for vaccinations in patients with rheumatic and musculoskeletal diseases. Arthritis Care Res. 2023 Mar;75(3):449–464.
- Alejo JL, Kim JD, Chiang TPY, et al. Patient-reported outcomes after tixagevimab and cilgavimab pre-exposure prophylaxis among solid organ transplant recipients: Safety, effectiveness, and perception of risk. Clin Transplant. 2023 Apr;37(4):e14913.
