Evusheld, aggressive therapy may reduce COVID-19 severity in patients on B-cell depletion
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Pre-exposure prophylaxis with Evusheld, combined with aggressive outpatient treatment, may reduce COVID-19 severity in patients with immune-mediated inflammatory disease on B-cell depletion, according to a letter published in RMB Open.
“It is well-known that this group of patients is at very high risk for severe COVID and death, even when fully vaccinated, and it has become clear that more strategies are needed to protect this vulnerable group, including use of tixagevimab/cilvagimab as well as aggressive treatment if infected,” Cassandra Calabrese, DO, of the Cleveland Clinic, told Healio. “Evusheld has been available in the United States since mid-January 2022, and at present there are many barriers to getting Evusheld to the right patients, including lack of awareness as well as logistical/access issues.”
To investigate the impact of tixagevimab/cilvagimab (Evusheld, AstraZeneca) in vulnerable patients, Calabrese and colleagues electronically searched the Cleveland Clinic health care system’s pharmacy records to identify patients with immune-mediated inflammatory diseases (IMIDs) or with inborn errors of humoral immunity. Patients needed to meet the requirements to receive tixagevimab/cilvagimab as set forth by Cleveland Clinic COVID-19 Pharmacy and Therapeutics subcommittee.
Patients were included in the analysis if they were receiving B-cell depleting therapies or had inborn errors of humoral immunity. Additionally, patients who had received at least one dose of tixagevimab/cilvagimab and were subsequently diagnosed with COVID-19 were included. Patients were excluded from the analysis if they were receiving B cell-depleting therapy for a cancer diagnosis.
The analysis included 412 patients with IMIDs or humoral inborn errors of immunity who received Evusheld between Jan. 18 and May 28. Of those, 2.9% had a breakthrough COVID-19 infection — all of them receiving B-cell depleting therapy — according to the researchers. Six infections developed at a median of 19 days after receiving a single150mg/150mg combination of tixagevimab/cilgavimab. The other six infections occurred a median of 38.5 days after patients received a single 300 mg/300 mg combination or the second dose of a 150 mg/150 mg combination. There was one hospitalization and no deaths.
Additionally, all patients who experienced breakthrough infections were vaccinated against COVID-19, the researchers wrote. Nine of the patients who experienced breakthrough infections received additional therapy, including oral antivirals or monoclonal antibodies, Calabrese said.
“Our data suggest that Evusheld pre-exposure prophylaxis in combination with aggressive outpatient treatment of COVID-19 is likely effective in lowering risk of severe COVID in this vulnerable group,” Calabrese said. “Practitioners who care for patients with immune-mediated inflammatory diseases should triage high-risk patients for Evusheld, as well as rapid diagnosis if infected and aggressive outpatient therapy.”
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