Drug Helps Prevent COVID-19 for Immunocompromised Patients
Here’s what it’s like living through the COVID-19 pandemic if you take immune-suppressing drugs to prevent your body from rejecting an organ transplant: “It’s a full-time quarantine – 100% all day, every day,” says Glenn Donahue, 50, of Northfield, N.J.
After months of mostly staying home, in January Donahue cautiously went to see his younger son, an eighth-grader, play basketball. He tested negative on a home test, wore a mask, kept his distance from everyone – and the next morning woke up barely able to breathe.
Donahue, who received his new liver at Einstein Medical Center Philadelphia in June 2021, spent eight days in the hospital with COVID-19 and another virus.
“They had to lower my anti-rejection medicines to get the viruses, so I was on this delicate balance,” he says.
Then, in early March, Donahue got some news that has eased his mind and fortified his body.
On a visit to Einstein, Donahue spoke with Transplant Pharmacist John Knorr, PharmD, who offered him a new drug, EvusheldTM, that can help prevent COVID-19 for people like Donahue with compromised immune systems.
Donahue accepted immediately and received the drug soon after.
Antibodies for COVID-19 Prevention
The Food and Drug Administration (FDA) authorized EvusheldTM for emergency use in December.
The medication consists of two types of monoclonal antibodies, which are laboratory-made drugs that act somewhat like the body’s own defense system. EvusheldTM is delivered as two injections, one right after the other.
It’s the first antibody drug that has been shown to prevent, not just treat, COVID-19 infection. Research shows that EvusheldTM may reduce the risk of COVID infection by about 75%.
EvusheldTM is distributed by the U.S. government. Because supplies are limited, it is reserved for people with seriously compromised immune systems.
For most people, COVID-19 vaccines have been highly effective because they prompt the immune system to make antibodies to fight off infection.
But people who take medications or have conditions that suppress the immune system often don’t produce many antibodies in response to vaccination. This means they are still highly vulnerable to COVID-19 infection.
However, vaccines do activate other parts of the immune system that protect immunocompromised people, as well as others, against severe illness and death.
So while others have rejoiced as cases of COVID-19 have fallen and many places have eased restrictions, for immunocompromised people precautions have remained a daily preoccupation.
Doses to Most Vulnerable Patients
“I would say overall our cancer patients have fared well, but we’ve had patients who were affected severely by COVID, meaning that they were hospitalized, wound up on oxygen or died from COVID,” says John Leighton, MD, Chair of Oncology at Einstein Healthcare Network.
“Patients with blood cancers, in particular, their immune systems have a tough time fighting any viral illness,” he says. “The treatments we give, especially monoclonal antibodies such as rituximab, alter the immune system.”
Transplant patients also are “extremely susceptible” to COVID-19 and may have more severe disease when they get it, says Radi Zaki, MD, a transplant surgeon and the Robert G. Somers, MD, Chair of the Department of Surgery at Einstein Healthcare Network. “Unfortunately, we’ve had several patients pass away from it.”
Antibody treatments that attack COVID-19 for people with active infections became widely available in 2021. However, Dr. Leighton noted that most of them did not work well against Omicron and other variants that began to spread widely late in the year.
Einstein Healthcare Network so far has allocated its supply of EvusheldTM to transplant patients and certain cancer patients who take immune-suppressing drugs, says Eric Sachinwalla, MD, Medical Director of Infection Prevention and Control for Einstein Medical Center Philadelphia.
More than 50 Einstein patients have received EvusheldTM since early March.
Donahue says that he will continue to be cautious, but EvusheldTM has given him enough confidence to have his eighth-grade son move back in with him. Since the transplant, both sons had lived nearby with Donahue’s ex-wife.
More Confident After Treatment
“I feel very safe about it,” he says. “It gives me self-confidence, but not so much so that I can take chances, because these variants can change quickly. And some people don’t show any symptoms, so I need to always be aware.”
Cancer patient Kellyann Steblein, the outpatient and Emergency Department registration manager for Einstein in Philadelphia, also signed up quickly to get EvusheldTM when Dr. Leighton told her about it in March.
She continues to work from home part of the week, but appreciates the extra protection.
Steblein, who has non-Hodgkins lymphoma, takes rituximab, a drug that targets cancerous cells in the immune system.
“I know my immune system is compromised,” she says. “I get that. But since I’ve gotten EvusheldTM, I feel that if I do come across COVID it won’t be so severe, hopefully.
“You can get other viruses or illnesses, too. But I’m more relaxed now with COVID, and I’m going to more family functions. But I’m still wearing my mask and trying to keep away, not hugging or kissing, things like that.”
So far, Dr. Sachinwalla says, Einstein has been able to offer EvusheldTM to eligible patients who wanted it. Although supplies remain limited, he says the health system hopes to expand eligibility soon to patients at slightly lower risk but still immunocompromised.
Overall, things are better now for the most vulnerable patients because of better treatments for COVID-19 and preventive measures like EvusheldTM, Dr. Zaki says.
“Now they’re getting through it, even if they get COVID. So I’m cautiously optimistic. But I don’t think we’re done with this.”