Evusheld and Paxlovid Issue

[Drago1941]

I asked my oncologist (in Canada) for a prescription for Evusheld, but was told that if I got infected with Covid or one of its variants, then Paxlovid would not be an option. He recommended that Paxlovid would be a much better and more effective treatment option. In other words, the oncologist ruled out Evusheld because you cannot get Evusheld, and if infected, Paxlovid cannot be precribed! Has anyone had received Evusheld and then after getting infected with on of the Covid 19 or one of its variants, got the Paxlovid treatment? Are the two not compatible?

[lankisterguy Volunteer]

Hi Drago1941,

In the USA Evusheld is only used as a preventive/prophylactic (prior to COVID exposure) and Paxlovid is only used as a treatment after COVID is detected/confirmed.

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My CLL expert doctor recommended that I get the latest bivalent vaccine booster, since it is effective preventive against all the known variants at this time. Evusheld works against some of the older variants, but not all.

Paxolovid is believed to be an effective treatment for all the current variants.

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Len

[mdsp7 in reply to lankisterguy]

Paxlovid helped me tremendously. I had the 4/5 variant. I needed a second treatment because I was abroad, started to be sick 8 days after finishing the first round, and we worried about what to do with me if the illness progressed. The second round of Paxlovid knocked it out, I think. I feel fine, tested negative by PCR, and finished the second round 9 days ago.

[hayleym1004 in reply to mdsp7]

You were very lucky that you were able to get a 2nd dose of the Paxlovid (perhaps being abroad helped with that), as the CDC feels a second dose isn't necessary unless you're a public figure (Biden and Dr. Fauci)...after my European vacation I was still testing positive...3 days after I finished the first course of Paxlovid, my symptoms came back along with a fever....I tried doing a virtual visit in my home town, but that was actually useless...the provider told me she couldn't prescribe another dose of Paxlovid...the only thing she could do was prescribe cough medicine. I called Moffitt Cancer Center in Tampa where my oncologist is and left a message...five minutes later the nurse practioner called back and said she couldn't prescribe Paxlovid, I would just have to let the virus run its course, and drink plenty of fluids! Yesterday, October 29th I tested negative (first time in 13 days)! I immediately made an appointment to see my local health care provider...she tested me for covid and the flu-both we're negative...I am currently being treated for bronchitis.

[mdsp7 in reply to hayleym1004]

Yes, I was lucky. But because I was stranded in Paris where the hotels are almost fully booked and cost around $500 a day, and because my viral load on the second round PCR was high and my daughter's baby had covid too, so it was a poor idea to stay with her, it was felt that the Paxlovid could help me get fly home more safely for everyone. Note that the doctor in France needed a note from my US oncologist, who has always been a fighter in my corner.

[mdsp7 in reply to hayleym1004]

I hope you get over the bronchitis soon. My daughter in Paris had covid in her last trimester, which turned into bronchitis, very painful coughing, but she recovered. I am very glad to hear that you got over the covid and don't have the flu. Get well soon!

[mdsp7 in reply to hayleym1004]

And I am glad to hear that you got safely home! Whew! What a trip!

[Imalpn in reply to lankisterguy]

my specialist’s gave the green light for the Omicron vaccine which I did and I also got the flu vaccine and in 2020 I got the first Shingrix vaccine and within the recommended time frame I got the second shingrix plus I still take Acyclovir 400 mg twice a day. I was very sick and covered with chicken pox when I was 12. In 2008 I had an outbreak which was caught early and was very mild. I believe in science but always do the research but that’s the nurse in me.

[Emgeegee]

Hi Drago1941. I, too, am in Saskatchewan - and my oncologist has never mentioned this. I received Evusheld and as far as I know, the plan if I contract Covid has not changed - Paxlovid. I know I will have to stop ibrutinib (and probably my statin) while I take Paxlovid, but that’s the only contraindication I have been told about. I have not heard about any problems with Evusheld and Paxlovid - the public health authorities here have not made any mention of that, and there is no mention on the government website of any restriction, policy-wise, on being prescribed Paxlovid after receiving Evusheld.

[freddog in reply to Emgeegee]

I had the same advice when I went to get Evusheld last week and saw my haem-onc. She said protocol for a COVID positive test was Paxlovid, stopping Ibrutinib for the duration.

[Drago1941 in reply to Emgeegee]

Hi Emgeegee,

Are you being looked after out of Regina or Saskatoon?

[Emgeegee in reply to Drago1941]

Saskatoon

[Drago1941 in reply to Emgeegee]

I'm in Saskatoon too. I must have a different doctor!

[KMac1969]

I have had Evusheld, from my Oncology office. Also plan to get Paxlovid if I get Covid. Both my specialist at MD Anderson, and my local oncologist agree on this.

[DanBro1 in reply to KMac1969]

I received Evusheld at MD Anderson/ Mays Cancer Center in San Antonio. I also received the new Moderna Covid injection and flu shot 15 days later. No problems.

[bennevisplace]

The way I read it, your question is: having had a prophylactic injection of Evusheld, would Paxlovid be an effective treatment for any foreseeable variant of Covid-19?

I know of no evidence to support the theory that these two drugs interfere with each other. They work in entirely different ways. I am in a clinical trial on Evusheld and have not been advised of such a risk.

Paxlovid has been challenged by a range of Covid variants and has remained effective. There's no guarantee that this will remain the case in the future, but against Omicron subvariants BA.4.6, BA.2.75.2, BF.7, BQ.1, and BQ.1.1 the CDC still supports the use of Paxlovid covid19treatmentguidelines....

[Drago1941]

Thank you to all who responded. I'll have to think about how to challenge my oncologist on this. I believe I had seen a post a week or two ago from someone who had the Evusheld shots, contacted a Covid-19 variant and was prescribed Paxlovid to treat it. My concern is that if I asked for the Evusheld shot and after receiving it got Covid 19 or one of the variants, would I be able to get the oncologist to prescribe Paxlovid? In my last conversation, he said he would not prescibe the Paxlovid treatment. This is my dilemma.

[mbbinbrooklyn in reply to Drago1941]

I would challenge your doctor. When I got Covid, about a month after getting Evusheld, my symptoms were pretty mild and the Paxlovid helped greatly. Try to take it asap. The earlier you take it, the better.

[bennevisplace]

Frankly, I would find another oncologist.

[Drago1941 in reply to bennevisplace]

Good idea, but in the province of Saskatchewan, Canada it is socialized medicine and so you have no option but to stick with what the medical system assigns you. Ugghhh!

[bennevisplace in reply to Drago1941]

Hmm. Similar to the UK then, though if push came to shove one could switch hospitals.

Absence of evidence abounds in these sources:

covid-vaccine.canada.ca/inf...

covid19-druginteractions.or... (key in pax in one box and tix in the other, the system will fill in the full names for you. The result is "No Interaction Likely" and qualifies this: Quality of Evidence: Very Low. Summary: Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Nirmatrelvir/ritonavir is metabolized by CYP3A. Tixagevimab and cilgavimab are IgG1 monoclonal antibodies and are likely to be eliminated via intracellular catabolism, similarly to endogenous IgG. Tixagevimab and cilgavimab are not metabolized by CYP enzymes. Interactions with concomitant medications that are substrates, inducers, or inhibitors of CYP enzymes are unlikely.

[CLL_Canada_Group in reply to Drago1941]

You can ask for a second opinion, either from another hematologist/oncologist or from an immunologist. If you really want to change doctors, that is the way to do it. If you like the second opinion doctor, see with him or her how they can take you on as a patient.

That being said, I have difficulty understanding your oncologist's statement, as he seems to rule out both Evusheld and Paxlovid. You might want to write on paper what you have understood him to say and give it to him to make sure that there is no miscommunication between you and him.

[Emgeegee in reply to Drago1941]

Maybe you could say that you are a bit confused because you know of a patient in Saskatoon whose oncologist seems to have a different view and perhaps your doc could point you to a study, or Saskatchewan Health Authority guideline, that he is relying on for direction? Not sure what else to suggest……I did (very politely) “challenge” my oncologist on a matter concerning Evusheld (in fact, it was whether or not he should even prescribe it for me), and found that after we discussed/clarified my situation/concern (and in fact, I did point to experiences and studies I became aware of because of this forum, and similar ones), he agreed that it would be appropriate to give it to me after all. I only mention this to illustrate that sometimes asking for clarification and explaining your concerns can make a difference, even if switching doctors isn’t an option. Good luck!

[Drago1941 in reply to Emgeegee]

Thank you. Greatly appreciate your comments and advice!

[Vizilo]

I received Evusheld a few months ago from the local hospital on instructions from my oncologist in the Niagara region. At that time, she mentioned that at the first sign of COVID, I phone the local hospital for Paxlovid. She confirmed again last week that since I was being treated (Acalabrutinib), Paxlovid would be available one day after I stopped Acal and any other meds (eg statins) that might interfere with Paxlovid.

[Drago1941 in reply to Vizilo]

Thank you. This is good to know.

[sandybeaches]

I am wondering if your doctor will not prescribe Paxlovid due to you taking a BTK inhibitor. Try to get a further explaination if possible.

Also, to note, Health Canada has very recently approved Evusheld as a treatment for a Covid infection. I cannot find any information about which provinces are planning on using it as yet.

Sandy Beaches

[Cornhusker]

Hi Drago1941: I received Evusheld in July and was exposed to Covid Sept. 11-12. On Sept 13th I had a sore throat but tested negative by PCR until Sept 16th. I started Paxlovid on the 16th and then tested negative by the 19th. It was such a mild case that if I didn't know Covid was around, I would have thought I had a sore throat from the dry weather.

[Drago1941 in reply to Cornhusker]

Good report and confidence booster. Thank you.

[sandybeaches]

Evusheld is now authorized for treatment for an " active Covid " infection by Health Canada - last week - and provinces are awaiting for guidelines. SB

[Drago1941 in reply to sandybeaches]

Great news! Here is the link for those who may be interested in the source of this information:

astrazeneca.ca/en/media/pre...

[hayleym1004]

I had Evusheld on September 27th, nothing was ever discussed about treatment if I should come down with covid. However, I knew that Paxlovid was the latest anti-viral for treatment should I get covid....which is what happened while I was away on vacation in France. Before prescribing the Paxlovid, the French doctor who I had a virtual visit with went thru any medications that I might be taking because there are contra-indications...I am on watch and wait so no medications to interfere with treatment.

[Drago1941 in reply to hayleym1004]

Thank you for your confirmation.

[lisapam7]

they should not be contraindicated; find another opinion; however, evusheld efficacy is starting to wane against the new subvariants.

[Drago1941 in reply to lisapam7]

Thank you. You make a good point in that Evusheld is not very effective against the new variants.