Evusheld for covid - post transplant

[okarol]

My daughter showed no detectable antibodies after 3 Pfizer shots so am grateful for the Evusheld, which gave her some. But she is still being cautious and probably will get a 4th shot and later, more Evusheld, when available, as her transplant hospital recommends following CDC guidelines “COVID-19 Vaccines for Moderately to Severely Immunocompromised People” https://www.cdc.gov/.../vaccines/recommendations/immuno.html

[Simon Dog]

ID MD recommended I get a 5th vaccine 4 months after the 4th, followed by Evusheld 2 weeks later.

[okarol]

Daughter Jenna had her Evusheld in March and the Johns Hopkins study checked her antibodies at 30 days and just now at 3 months, I look forward to see if she still has some. Getting 4th covid vaccine next week. She never got antibodies from the prior 3 shots but her doctor says no harm in getting another, and it might help somewhat?

[UkrainianTracksuit]

Really interesting how even the younger folk are receiving the Evusheld. That's a big win for everyone who has received it!

I learned that I am Tier 3 to receive out of 3 tiers. Priority tier to receive Evusheld are lung transplant patients. Totally understandable. Second tier includes those 65+. Third tier is those under 65.

I'll be waiting until the cows come home. I am looking to schedule my own antibody tests because I would like to have an idea where I stand.

[UkrainianTracksuit]

In a twist of fate, I received the two doses of Evusheld at my transplant hospital.

[UkrainianTracksuit]

Just some questions after receiving Evusheld.

1. Should I still pursue antibody testing now? This has to be arranged privately as in I will have to pay out of pocket.
2. With Evusheld and the fifth shot of Pfizer (or Moderna), is it safer to take a short vacation?

[Simon Dog]

My transplant center (Boston area) makes it easy for xplantees to get Evusheld, but they run you through an infectiou$ di$ea$e $peciali$t instead of the nephrologist to have it prescribed.   The ID doc was excellent - told me I had to listen to him explain the results of fide effects hinted at by some studies and what an EUA was as part of informed consent. 

[cassandra]

What is an EUA?

[Xplantdad]

Hi Cassandra

Emergency Use Authorization     

[cassandra]

Thanx Xplantdad 

[UkrainianTracksuit]

The Up the Antibodies campaign seems to be in full swing in the land of the free.

This ad was on television during one of the news hour shows. I wasn't really paying attention until the end and had a wha? whaaaa? moment at the target base: https://youtu.be/57bkLxpJcT4

Long acting monoclonal antibodies, woo yeah.

[iolaire]

The Up the Antibodies campaign seems to be in full swing in the land of the free.

This ad was on television during one of the news hour shows. I wasn't really paying attention until the end and had a wha? whaaaa? moment at the target base: https://youtu.be/57bkLxpJcT4

Long acting monoclonal antibodies, woo yeah.

That's a good one, thanks for sharing.  Since I don't watch TV I don't see the occasional ok ad like that. (I only stream specific shows and movies)

Noted: "AstaraZeneca is thankful for the support of the patient advocacy community."

[MooseMom]

For the life of me, I cannot understand why they don't just use the name "Evusheld".  If you see this video and are urged to speak to your doctor, what exactly are you going to ask for, keeping in mind that most GP's and PCP's will probably have no idea what what you're talking about.  Most people are not "medically literate" like we are, so they're gonna ask for something like "monblahsomething antiboblahblahs because I saw a video with Jeff Bridges saying something about cancer and wanting to go to his daughter's wedding."

I think this is a missed opportunity.  It's like getting to 4th and inches and your coach calls a play with the QB in the shotgun.

Also, they need to define "long lasting" because this is currently a set of two injections that is recommended to be repeated every two months (as long as there is enough money for it and your insurance approves it.)  There should also be a warning about administration fees.

[UkrainianTracksuit]

I agree in that it was a missed opportunity.

When I realized that this campaign was directed to the immunocompromised and "upping the antibodies", I followed the message but was kinda lost at the how. I checked out the affiliated website because I wanted to see if there was anything "new" or they would call out Evusheld by name. No such luck.

[SooMK]

Great commercial but I agree on how confusing it is. I'm pretty confused myself. My clinic told me I could repeat Evusheld this month, 6 months after my first (although I'm on my own to track it down and get it). I thought I just read that it wasn't very effective on the latest variants. I've been procrastinating.

[okarol]

Great commercial but I agree on how confusing it is. I'm pretty confused myself. My clinic told me I could repeat Evusheld this month, 6 months after my first (although I'm on my own to track it down and get it). I thought I just read that it wasn't very effective on the latest variants. I've been procrastinating.

Evusheld probably still works against Omicron BA.5, and that is 90% of the covid infections now. BA4.6 is <10%

[SooMK]

Thanks for that info! This thread got me moving. I'll make the appointment once I get proof of a negative covid test next week.

[UkrainianTracksuit]

Evusheld has now been approved as a treatment of COVID in immunocompromised people. So, not just about protection, but a treatment if you get sick. In Canada, that is.

https://www.cbc.ca/news/health/evusheld-treatment-covid-1.6621272

[jenb]

I hade my second Evushield last month.  My local kidney doctor said I didn't need any more covid vaccines. Then I saw my transplant doctor last week and she said I should still continue on with covid vaccines.  I asked her about risks and she said that it was highly unlikely but in some cases it was causing kidney rejection, I am assuming only for transplanted patients.  Anyone else hear this?  That's all it took for me to know I was not having any more covid vaccines.  I try to be very careful when out and about.

[MooseMom]

I hade my second Evushield last month.  My local kidney doctor said I didn't need any more covid vaccines. Then I saw my transplant doctor last week and she said I should still continue on with covid vaccines.  I asked her about risks and she said that it was highly unlikely but in some cases it was causing kidney rejection, I am assuming only for transplanted patients.  Anyone else hear this?  That's all it took for me to know I was not having any more covid vaccines.  I try to be very careful when out and about.

I am stunned and horrified that you've been told this by the very people who are supposed to be caring for you.

Have you had to bi-valent booster?  If you have, then no, you don't need more vaccines because none are yet authorized.

Look to see if the BQ variants are dominant in your area.  They now account for over 50 percent of Covid infections in the country which, by definition, makes them the dominant strains.  BQ variants are evasive from Evusheld and bebtelovimab.  Your Evusheld is now most likely useless, and the FDA has pulled the EUA from beb, meaning you now have one fewer treatment option.

I have attended MANY CDC/ASPR webinars on the subject of Covid and the immunocompromised, and not once have I heard of any study that links vaccination to solid organ rejection.  I know of no specialist in the field that is warning his/her patients not to get boosted, especially now that Evusheld and beb are no longer tools at our disposal.

[kristina]

Today I read an article saying that:

"Thousands of triple vaccinated Britons reporting same Covid symptom - 54% of all cases and experts explain that with each new Covid variant the proportion of people reporting symptoms increases and symptoms affect their everyday activities “a lot”, new research has found. The four main “cold-like” symptoms affecting include sneezing and a hoarse voice, sore throat, runny nose, blocked nose, persistent cough and headache."

... What to make of this? It even seems that information about Covid and how to go about Covid-vaccination seems really difficult to come by, especially about some (permanent?) side-effects of it and, last but not least, information about Covid itself and what to do about it and how to go about Covid-vaccination seems to get a bit conflicting with some other information about it, leaving the reader unclear about what to do, how to go about it and what is going on ... ?

[UkrainianTracksuit]

In terms of organ rejection after COVID-19 vaccination, there is an especially small chance of it occurring, and in this case, the medical team threw the kitchen sink at the issue.

Even in the patient that experienced the unfortunate event, the conclusion of the paper still reads: By comparison, risk of COVID-19–related morbidity and mortality is much greater compared with the risk of vaccination-related allograft rejection.

See case study here: https://journals.lww.com/transplantationdirect/fulltext/2022/02000/acute_kidney_allograft_rejection_following.8.aspx

Second paper shares: A range of solid organ rejections post-SARS-CoV-2 vaccination or following COVID-19 infection may occur at an extremely rare rate and is likely to be immune-mediated. [...] The number of reported cases is relatively small in relation to the hundreds of millions of vaccinations that have occurred, and the protective benefits offered by SARS-CoV-2 vaccination far outweigh the risks.

See paper here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9412452/

Another case study and in the conclusion: Case reports of acute allograft rejection after vaccination against SARS-CoV-2 can help us stratify the risk group of patients with hyperimmune reactions after SARS-CoV-2 vaccines (mainly young patients with autoimmune diseases) but it is possible that such a group of patients may develop acute allograft rejection upon COVID-19 re-infection, especially in those with a mild form of primary COVID-19 infection. Therefore, it is worth considering monitoring graft function after vaccination against COVID-19 by examination of serum creatinine, proteinuria, and dnDSA.

See case study here: https://www.nature.com/articles/s41541-022-00445-5

I've had 5 shots and my egfr function has remained consistently over 110 with creatinine staying the same. So yeah, rejection happens rarely, but the rate of COVID spread has a bigger opportunity of kicking us on our behind for awhile. It's a rough virus to get over. When I had COVID and they lowered my immunosuppression (now known as a bad move...but everyone was still learning), my creatinine and egfr was checked once a week. And it was all good each time.