Sotrovimab-Acalabrutinib

[jonathan7176]

Hi everyone

I have been triaged to receive Sotrovimab. I envision it will be tomorrow now. I have a couple of questions.

First, do I need to stop acalabrutinib beforehand? I missed my morning dose for a second day in a row today in anticipation that I might be called in. I'll take my evening dose tonight. Second, how long do I have to stay off acalabrutinib after the sotrovimab infusion?

Third, the (2023) literature on sotrovimab efficacy seems a bit mixed/luke warm. I don't know if there are any additional community insights about that?

I'm doing OK - I'm just following the good advice I received here to take it as a precaution.

Many thanks

Jonathan

[gardening-girl]

Jonathan, according to what I've read you should not need to stop taking acalabrutinib when getting Sotrovimab. First I checked for drug interactions on the Lexicomp® Drug Interactions web site which gave the following results: "No known interaction"

Then I looked at the FACT SHEET FOR HEALTHCARE PROVIDERS: EMERGENCY USE AUTHORIZATION FOR SOTROVIMAB

fda.gov/media/149534/download

"Clinical drug-drug interaction studies have not been performed with sotrovimab. Sotrovimab is not renally excreted or metabolized by cytochrome P450 (CYP) enzymes; therefore, interactions with concomitant medications that are renally excreted or that are substrates, inducers, or inhibitors of CYP enzymes are unlikely."

(my emphasis). Acalabrutinib is mainly metabolized by CYP3A enzymes, so any interaction is unlikely.

I don't think that sotrovimab is being used in the US anymore. When I looked at the NHS website below, it said the following:

"If you are eligible for COVID-19 treatment you will usually be offered an antiviral medicine called Paxlovid as a first treatment. However, if it’s not suitable for you, you may be offered sotrovimab."

nhs.uk/medicines/sotrovimab...

If you do get Paxlovid instead of sotrovimab, you would need to stop taking acalabrutinib, because one of the ingredients in paxlovid is metabolized by CYP3A enzymes. Also, if you have renal impairment you would need to reduce the dose of Paxlovid, but not sotrovimab.

[jonathan7176 in reply to gardening-girl]

Thanks so much - I'm booked in for Sotrovimab at 12. I don't really feel I need it, but conscious of advice from this community to minimise any risk.

[Skyshark]

drugs.com says no interactions. Also not yet approved in US. NHS approval was on basis of :

"The cost-effectiveness estimates for sotrovimab are also within what NICE considers an acceptable use of NHS resources, but only for people for whom nirmatrelvir plus ritonavir is contraindicated or unsuitable. So, sotrovimab is recommended in this group."

nice.org.uk/guidance/ta878/...

I think the only possible problem is bleeding from/during the IV.

Contact your CNS, it's what they are there for.

[jonathan7176 in reply to Skyshark]

Thanks - much appreciated.

[bennevisplace]

Hi, I too would be interested to see data supporting the use of Sotrovimab for prophylactic use or indeed as a treatment for current Covid variants.

[Zeus52]

My experience with Sotrovimab was not very satisfactory, last September I tested Covid positive (very mild symptoms)and was offered this as I am taking Acalabrutinib. The infusion went well. However 4 weeks later I ran a fever and felt unwell and in line with CLL recommendations I was admitted via A&E to our local hospital. I tested Covid negative on admission and was told I had some kind of infection maybe viral. As per protocol I was given a strong antibiotic infusion as a precaution- continued to be unwell with the antibiotics causing upset stomach as well - on day 4 I tested Covid positive- they said it was a rebound of the Covid 4 weeks prior - all in all spent 11 nights in hospital on paracetamol and dexamethazone. The following February I tested Covid positive again, this time I paused the Acalabrutinib and got Paxlovid which worked a treat (this plan of action was as per a discussion with my Haematology consultant). I guess the Sotrovimab didn’t work so well for me, but hope it does for you!

[jonathan7176 in reply to Zeus52]

Sorry to hear that. How sure are you that the infection 4 weeks later was rebound, and not a new one? Seems like quite a gap.

Anyway, I had the sotrovimab yesterday without incident. I remain fine in myself with some mild cold symptoms. If it does bounce back, then I guess I'll put my hand up for Paxlo.

[Zeus52 in reply to jonathan7176]

This was the hospital discharge diagnosis, and is on my haematology notes. I had been told the Sotrovimab gave antibodies for at least 4 weeks so guess I was just unlucky. I had felt unwell for quite a few days before I went to A&E but not with normal Covid symptoms. I had several scans whilst in hospital which confirmed the damage in my lungs attributed to Covid. My second dose of Covid the following February was heavy cold symptoms and with the help of Paxlovid I tested negative quickly. Wishing you a speedy recovery. Can I ask how it went reporting your test to 111 or did you contact your GP now the system has changed?

[jonathan7176 in reply to Zeus52]

I went through the oncology hotline at Warwick Hospital. Worked pretty well. I got a follow up call from the haematology specialist nursing team today as well. So far so good …