The ever-mutating omicron virus threatens to outpace the preventative monoclonal antibody cocktail that hundreds of thousands of immunocompromised individuals have relied on for enhanced protection against Covid.
Recent findings indicate the advent of new omicron subvariants that elude not just AstraZeneca’s Evusheld, the antibody medicine authorized to prevent Covid infection, but also Eli Lilly’s bebtelovizumab, the only antibody therapy that has preserved effectiveness as a treatment for Covid.
As per NBC News, studies reveal that Evusheld, a long-acting antibody injection administered every six months, provides an effective buffer for immunosuppressed patients. 29-July-published Israeli research on this demographic indicated that Evusheld was related with a 50% reduction in the incidence of coronavirus infection and a 92% reduction in the chance of hospitalization or death.
According to medical professionals, the dual-antibody cocktail has been grossly underutilized in the United States. 7 million U.S. individuals are immunocompromised, according to estimates. According to the Administration for Strategic Preparedness and Response, since Evusheld obtained its emergency license in December, only 582,361 doses have been provided, many of which are presumably second doses.
For individuals such as Laura, who permitted her mother to speak on her behalf due to a speech impediment, Evusheld’s additional layer of safety has provided at least a measure of independence. Immunocompromised individuals are anxiously awaiting the pandemic projection to determine if the subvariants that research indicates are resistant to monoclonal antibodies will become prevalent.
On Wednesday, the Covid-19 Treatment Guidelines Panel of the National Institutes of Health issued a statement stating that the prevalence of these subvariants “is now low to moderate.”
Epidemiologists are concerned that Evusheld may give inadequate protection within a month or two. Friday, the Centers for Disease Control and Prevention announced that strains resistant to Evusheld or bebtelovimab have consistently increased in the United States.
XBB, a second subtype, has been a source of considerable concern. The XBB subvariant evades both Evusheld and bebtelovimab, according to a preprint published by Peking University in China last month and revised on October 4th.
On Wednesday, the World Health Organization said that XBB is “the most antibody-evasive” strain of the virus to yet and that it has been detected in 26 nations. According to GISAID, an international database of influenza and Covid viruses, around 0.5 percent of U.S. sequences were XBB as of about two weeks ago, but the proportion is approximately increasing weekly. (XBB is not yet included in the CDC’s variation tracking database.)
The NIH advisory council continues to endorse Evusheld. It also continues to prescribe bebtelovimab for outpatients at risk for severe Covid, but only if Pfizer’s Paxlovid antiviral tablets or Gilead Sciences’ intravenous medication remdesivir are unavailable. In addition, the NIH researchers argue that the duo of antivirals, as well as Merck’s molnupiravir, will continue to be effective against monoclonal antibody–resistant subvariants.
However, each of these three antivirals has significant limitations as a safety net for immunocompromised individuals. Paxlovid can interact adversely with other medications that immunocompromised individuals, particularly organ transplant recipients, rely on. The oral drug molnupiravir provides just a moderate level of Covid protection. Remdesivir takes three consecutive days of a two-hour intravenous infusion, a technique that is challenging and uncomfortable for many patients.
Dr. Jonathan Li, a virologist at Harvard Medical School, stated that doubts exist as to whether the normal five-day course of Paxlovid reliably eradicates the infection in immunocompromised individuals.
The patient advocacy group TRAIPAG (for those who are transplant and immune compromised), chaired by Janet Handal, has encouraged the federal government to increase the number of outpatient facilities that supply remdesivir and to pressure insurance to cover the prescription without prior authorization.
Still, it is anticipated that vaccines would give a reasonable level of overall protection for the immunocompromised population. Covid vaccinations administered during the omicron wave reduced the risk of hospitalization in this cohort by 32% to 67%, depending on the prevailing subvariants at the time, the number of vaccine doses received (two to four), and the length of time since the last vaccination. The CDC advises immunocompromised individuals to take the bivalent coronavirus booster vaccine.
Otherwise, immunocompromised patients and their healthcare providers will rely on the Covid therapy and preventive pipeline, which contains investigational antibodies from multiple businesses. However, it will likely be many months to over a year before they are allowed for usage. Dr. Natasha Bagdasarian, Michigan’s chief medical officer, cited the minimal adoption of Evusheld and Congress’ opposition to more Covid financing as causes for concern on this front.
“If fewer individuals are taken Evusheld,” she noted, “drug companies will have less incentive to research new therapies.” If the federal government does not incentivize the manufacture of the next generation of pharmaceuticals, we may have nothing to replace the drugs we’re losing.”
