Evusheld and booster timing

[ElMaga]

I still cannot get a straight answer (even called Evusheld) about how long after my evusheld shot do I need to wait to get my next booster. I have heard 30-60 to 90 days; Evusheld says two weeks but that's not based on anything except to wait two weeks after vaccine for Evusheld. Does anyone have more definitive information?

[SofiaDeo]

It doesn't seem there is one. Here's a link to what one practice group is doing:

aaaai.org/Allergist-Resourc...

There's some research coming out of Europe indicating having a 4th shot spaced like the first 3 may not be optimal. It may turn out that, similar to hepatitis vaccination, after the initial shots a longer interval is needed for the final one(s) to once again provoke a strong response. Just giving shot after shot of a vaccine doesn't always mean the shots automatically cause a response, sometimes if it's too soon, not much happens.

healthline.com/health-news/...

I had my Evusheld today, instead of a 4th vaccination. Since data indicates it is generally good for 6 months, I will look at data again in 4 months to see what new information has been collected. We are still early into the "what is the optimal immunization strategy for Covid" question. Not to mention, if a newer variant arises that a different vaccine is needed for, I don't want my immune system to be in "recovery phase" from a previous shot. So I am going to wait.

[ElMaga in reply to SofiaDeo]

thank you; this is more than I have seen; appreciate

[Sadjemf in reply to ElMaga]

I was told that I needed another shot of evushield in 6 months .

[SofiaDeo in reply to Sadjemf]

Yes, my understanding is they think it's probably good for 9 months but are recommending 6 months as a precaution. Since we don't have a lot of hard data yet as to the "optimal" antibody titer number. Every 6 months is easier to remember and schedule patients, versus every 9 months IMO.

[Justasheet1 in reply to SofiaDeo]

Sofia,

Thanks for the info and congrats on getting your Evusheld too.

Jeff

[lexie in reply to SofiaDeo]

Then there is the guy in Germany who has had at least 90 Covid vaccines so he could sell the vaccine cards. abcnews.go.com/Business/wir...

[bennevisplace]

Hi, as a participant in the Provent sub-study I need to know the official advice from the trial sponsor Astrazeneca. I have asked the question and tomorrow should get an answer, which I will post.

Up to now my instinct was to forget about a fifth vaccination and go with Evusheld, in case one would interfere with the other - albeit that such risks are AFAIK unquantified.

[SofiaDeo in reply to bennevisplace]

In the first link I posted, there was a link inside that one, where another physician member of The American Academy of Allergy Asthma and Immunology wrote regarding his beliefs of the potential data around interactions of Covid vaccine and Evusheld:

aaaai.org/allergist-resourc...

The recommendation that doctor stated was 90 days, post monoclonals of some sort, given in response to infection. But since this doc thinks there isn't hard data, just theoretical concerns, I didn't post it as a "recommendation". Without hard data, they are guessing. And since it's possible (as seen with hepatitis vaccine schedules) a "later rather than sooner" approach might turn out to be optimal, I didn't want to post as if "I found a source and this recommendation is based on hard data".

I am extremely interested in what Astrazeneca has to reply. And if it's based on actual data, or the aforementioned theoretical thought process.

[bennevisplace in reply to SofiaDeo]

Firstly, thanks for posting that link.

The author expressed two somewhat divergent opinions: that the response to the Novavax vaccine "may be more inhibited by the presence of pre-existing antibody", and on the other hand "I am skeptical that the presence of monoclonal antibody or passive antibody will significantly modify the vaccine response".

NB The (FDA?) recommended 90-day delay between monoclonal antibody treatment and next vaccination is based on a much shorter half-life than Evusheld's.

But really, who knows?

[bennevisplace in reply to SofiaDeo]

healthunlocked.com/cllsuppo...

[bennevisplace]

FWIW, a recent UK study of immune responses to Covid vaccines in CLL patients found no added protective benefit in having more than 3 shots . See paper discussed in healthunlocked.com/cllsuppo...

[SofiaDeo in reply to bennevisplace]

Exactly, European nations are further into the research than the US and are publishing results. This is the basis for my deciding to wait, if in fact there is more of an extended "recuperation" time like in hepatitis. In case it turns out T-cell exhaustion is a major influencer of antibody production, and if it occurs sooner rather than later. I am getting some coverage from the Evusheld, and will wait and see if a variant that escapes current vaccines arises.

If T-cells as well as B-cells are exhausted or impaired, there is less ability to provoke an immune response. This has been documented in other long term viral illnesses like HIV and hepatitis.

pubmed.ncbi.nlm.nih.gov/186...

In addition to changes of the immune system as we age:

ncbi.nlm.nih.gov/pmc/articl...

[bennevisplace in reply to SofiaDeo]

The Birmingham (UK) study of immune reponses to Covid vaccination in CLL patients sciencedirect.com/science/a... is interesting in this regard. If I remember rightly their early findings had pointed to humoral responses being broadly indicative of cellular responses. But in the final analysis "85% of those with no antibody response had a detectable T cell response" per healthunlocked.com/cllsuppo...

[bennevisplace in reply to bennevisplace]

Edit: "...no added protective benefit..."

[Patc890USA]

I had my booster about 2-3 weeks after the second round of Evusheld. I ask my doctors at NIH if I should get it and they said yes.

[SofiaDeo in reply to Patc890USA]

Yes, I think there is agreement all round about getting 3. It's "should there be a 4th or 5th" where there doesn't seem to (as yet) be a definitive answer. Some places are recommending it, and I am sure they are collecting data, since they are countries who have been doing so since Covid reared up.

The US is still struggling to get many at #1 let alone #2, let alone mask. And as more people become vaccinated, and more of those getting hospitalized are vaccinated, the anti-vaxx movement is now twisting that into "see, you will get sick and hospitalized even IF you get vaccinated!" Sigh. At least I am no longer getting comments on my choice to mask.

[Patc890USA in reply to SofiaDeo]

I may not have been clear. I meant to say I had my second booster after Evusheld. So two vaccines and two boosters + Evusheld. Actually I had 4 Pfizer vaccines. The first two were while I was just ending my two years of Venetoclax and my doctor at NIH said they did nothing at that time so go get the two vaccines again.

[SofiaDeo in reply to Patc890USA]

To clarify.....you didn't have venetoclax treatment, you had V&R? Because leaving out that piece of information affects the answer. Anti CD20 drugs have been tested out 12 months after stopping anti CD20 drugs like rituximab, and people are not making antibodies. So if it's been 12 or less months since your last dose of that, vaccination may probably not work. I have not seen any data regarding 18 months, or 24 months, or later. Nor have I seen any data regarding venetoclax and viruses, only relative to it helping T cells and NK cells fight cancer. Studies regarding venetoclax response to mRNA vaccination are reported to include common combo therapies, so IMO hard to say what effect venetoclax alone may have. Or how long it may last.

If you are seeing researchers at NIH, they would be the best to ask IMO. Until then, get your Evusheld every 6 months. No sense having even the tiny risk of vaccine adverse reaction if you aren't likely to make antibodies IMO. Other think the opposite, that they are willing to take the small adverse reaction risk for a chance at some antibody stimulation. I don't know which answer is best for you, personally. I do think that the researchers who released the 12 month data are continuing this work, so eventually we will get some answers as to antibody production time. But I haven't seen it, and only someone close to that research would know if there are any positive results. You would have to know someone who can ask those researchers if continuing data is indicating that any patients are responding 18 months out, or whatever. I know this is possible, it's how I was informed of study results in the fall, that were going to get published the following June. The facility was a research site, and my doc there knew about the results from personal experience. Maybe an NIH researcher can find out?

[Patc890USA in reply to SofiaDeo]

Sorry. Yes V&R

[Cindi73]

I was told 2 weeks after Evusheld.

[Cindi73]

I had the Evusheld on April 21st and booster on May 11th. Everything went fine.

[bennevisplace]

I had my study visit today, 3 months after being injected with Evusheld. According to the doctor the study protocol does not specify or recommend a waiting period until subsequent vaccination. In our discussion of the issues she seemed to say that in the absence of solid evidence, influencing clinical trial participants to delay their vaccinations would be seen as unethical.

Anyhow I told them I would not be having another booster vaccination unless persuasive evidence came to light. Next dose of Evusheld in August.

[G1llHa1n in reply to bennevisplace]

Sorry if I have missed information somewhere. How did you manage to get on a study with Evushield? Do all participants get Evushield, ie no control participants not getting Evushield. Is this study still open and to whom? Please.

[bennevisplace in reply to G1llHa1n]

As you can imagine I've been asked this before. I joined the Provent trial in Feb 2021, which was a controlled study running for a year. Then they recruited about 10 percent of the original participants into an open label sub-study, running another 18 months, to further investigate dosing and durability of protection, especially in subjects with weakened immune systems.

AFAIK, no new studies and no new recruits needed ☹️

[G1llHa1n in reply to bennevisplace]

Thanks for the info - I did think your answer might be along these lines.