EvuSheld in the Uk

[Me2AsWell]

Dear All,

After six emails I got a response from my MP ... nothing spectacular but nonetheless helpful. However, the apparent preference to depend on treatment rather than prevention is worrying.

"Thank you for your correspondence of 25 April on behalf of your constituent, about COVID-19 treatments.

I am grateful to you for raising his concerns.

Immunocompromised individuals are a priority group for research into therapeutic and prophylactic (preventative) treatments such as monoclonal antibody therapies, novel antivirals and repurposed compounds. Identifying effective new treatments is especially important for people who cannot take a vaccine for medical reasons, or for whom vaccines may be less effective.

The prophylactic monoclonal antibody treatment Evusheld is a mixture of tixagevimab and cilgavimab. It received a conditional marketing authorisation from the Medicines and Healthcare products Regulatory Agency (MHRA) on 17 March.

However, the Evusheld trial took place before the emergence of the Omicron variant. This means there is not yet enough data to know how effective Evusheld is against Omicron, or the duration of any effects it may have against this variant. The MHRA will continue to work to establish this.

The UK Health Security Agency is also carrying out further testing on Evusheld’s effectiveness against this variant. The results of these tests will help inform any decisions on the next steps for this treatment, including procurement.

The RAPID C-19 collaboration has enabled multi-agency oversight of national and international trial evidence as it emerges for potential treatments and promising prophylactic therapies. This collaboration reviews all promising compounds to assess whether these should be considered for use in the NHS.

To date, the evidence has most strongly supported treatment rather than prophylaxis. The evidence on preventative therapies will continue to be reviewed to ensure efficacy and safety.

Non-hospitalised individuals who are in the highest risk group and receive a positive COVID-19 test result are able to access treatments. Eligible patients who receive a positive test result will be contacted by a clinician from a COVID Medicines Delivery Unit to discuss what treatments would be most suitable for them. This could be either sotrovimab or nirmatrelvir with ritonavir (Paxlovid), and those who are unable to receive these treatments will be offered remdesivir (Veklury) and then molnupiravir.

Further information on COVID-19 treatments, including monoclonal antibody and antiviral treatments, can be found at cas.mhra.gov.uk/help/corona....

I hope this reply is helpful.

LORD KAMALL

[annmcgowan]

Hi thank you for posting this. I don't understand the need to research evusheld in the U.K. as to my knowledge it is currently being distributed in Europe, the USA and Canada. Do these countries not have omicron?Ann

[RogerPinner]

Hello Me2AsWell, if you intend replying to your MP, and if it were me I would, the point to make is the one you highlighted; if as they say "To date, the evidence has most strongly supported treatment rather than prophylaxis", why are they bothering to vaccinate the population, why don't they wait for all them all to catch covid and then treat them?

You could make a second point, but I always think making a second less strong argument leaves space to be attacked, that by the time they conclude that Evusheld is effective against Omicron, it probably won't be the dominant variant and they will have to start again.

Is it money, or is this an uncaring Government, or perhaps both?

Roger

[Yuck]

Hi, I feel your frustration. Here is the link once again to research showing Sotrovimab and Evusheld are “both” effective against the BA.2 variant.

The U.S pulled Sotrovimab treatment shortly before the early mouse research was published (and it has not been reinstated), but the U.K.did not. Good for them!

While it is true, Evusheld research in various immunocompromised people was done before Omicron, earlier lab results and now mouse results show it does offer some protection against BA.2.

Also, now that the Evusheld dosage was doubled, breakthrough cases are less of a concern. Of course, no protection is 100%.

With or without Evusheld protection, the immunocompromised often remain cautious, especially if there is little to no protection from the vaccines and BA.2 is so contagious.

Unless more money is voted on, Evusheld could some day be unavailable in the U.S.

Hope the scientists and governments sort things out.

Best,

~ Yuck

biorxiv.org/content/10.1101...

[lemsford]

Have looked at the Astra Zeneca coronavirus website and in December 2021 they published evidence from trials in America and Oxford uk which showed Evusheld worked agained Omnicron variant. The Government are wrong to use that as a excuse for not procurring it for immunocompromised

[kitchengardener2]

Well at least it's a detailed reply. The more of us who write must make the powers that be more aware. xx

[Psmithuk]

Thank you for this, however I must take issue with the MPs comment 'the evidence has most strongly supported treatment rather than prophylaxis'.If they had a cancer preventative medicine, would they say 'it’s far better to get cancer and have it treated than to prevent it'? Yet blood cancer is what we have.

Chrisx

[kensim9]

Don't forget that (as a group we were excluded from trials that give Covid-19 emergency approval) we were given with no clinical data (just an assumption that it would work) the original Covid-19 Vaccination !

[bennevisplace]

Thanks for posting this. Just to be clear to readers, the written response came not from the MP you wrote to but the Under Secretary for Innovation, Department of Health, Syed Kamall gov.uk/government/people/lo... who should be well informed but may be inclined to parrot Department ideology. Did I say may?

Whatever the UK government's reasons for not supporting the purchase of Evusheld as a Covid pre-exposure prophylaxis, I have to admit that the clinical evidence in favour is somewhat out of date. The Provent sub-study, which will collect relevant data, is scheduled to run until August 2023. Hitherto the deployment of Evusheld in the US and elsewhere seems very patchy and the results not systematically recorded, so as far as Omicron is concerned all we have to go on is a couple of contradictory lab studies.

Meanwhile in the rich western countries we do have Covid treatments which, as long as you can get hold of them in good time, are proving effective against variants now in circulation. We should be thankful for current R&D work on vaccines for future use against a broad range of sarbecoviruses, and hopeful that we have them in time for the next big one.

[BellaBee10]

I got exactly the same reply.

[G1llHa1n]

It's a great shame that so many of these powerful and supposedly knowledgeable, though clearly disinterested people where CEV are involved, have not come across the concept of prevention being better than cure. Humanitarian? - what price? 🥶

[Sumoldbloke]

Thank you for sharing this reply. The reply suggests the immuno-compromised should wait until we succumb to the disease and then seek treatment or remain in a permanent personal lockdown. Disgraceful

[stevesmith1964]

Thank you. I tend to agree as I am not sure there is a strong case for wide spread use of prophylaxic treatment for people like me, stage 4 CLL on treatment but with no comorbidities. I believe a case can be made for a immunocompromised with other comorbidities I.e lung or heart issues etc. There would need to be a strong financial healthcare risk benefit study at a population level before the evidence for mass prophylaxic's use would be authorised.

[G1llHa1n in reply to stevesmith1964]

Doesn't need be mass. Just immunocompromised and other really vulnerable groups. We deserve to be allowed to live with COVID - at least as much as anybody else.

[stevesmith1964 in reply to G1llHa1n]

I am immunocompromised only went into remission in July, no Covid antibodies. I live a full life, 58 , full time dad of a 4 and 2 Yr old. There is nothing I do now that I didn't before CLL and Covid. Currently in Cyprus enjoying the sun.

[G1llHa1n]

Long may you continue to be in your fortunate position.