#MSCOVID….Long lasting SARS-CoV-2 Antibody is not potent enough to protect everyone against COVID.


We have reported on this but here is evidence that anti-SARS-CoV-2 antibody may not protect against symptomatic omicron. For people who have not made an antibody response because of treatment, you may have thought about taking antibody to build up protection. But we have said that most antibodies are not good enough to control omicron and this study supports that view. This is seen here with immunosuppressed inviduals with a transplant.

Breakthrough Covid-19 cases despite tixagevimab and cilgavimab (Evusheld™) prophylaxis in kidney transplant recipientsBenotmane, I., Velay, A., Gautier-Vargas, G., Olagne, J., Fafi-Kremer, S., Thaunat, O., Caillard, S.10.1101/2022.03.19.22272575 — Posted: 2022-03-19

While the combination of casirivimab-imdevimab (Ronapreve™ Roche Regeneron) has been shown to confer satisfactory protection against the delta variant kidney transplant recipients (KTRs) with COVID-19, it has limited neutralizing activity against the current variants of concern (Omicron BA.1, BA.1.1 and BA.2). In contrast, cilgavimab-tixagevimab combination (Evusheld™, Astra Zeneca) retains a partial neutralizing activity against omicron in vitro. We examined whether preexposure prophylaxis with Evusheld™ can effectively protect kidney transplant recipients (KTRs) against the Omicron variant. Of the 416 KTRs who received intramuscular prophylactic injections of Evusheld™ (150 mg tixagevimab and 150 mg cilgavimab), 39 (9.4%) developed COVID-19. With the exception of one patient, all KTRs were symptomatic. Hospitalization and admission to an intensive care unit were required for 14 (35.9%) and three patients, respectively. Two KTRs died of COVID-19-related acute respiratory distress syndrome. SARS-CoV-2 sequencing was carried out in 15 cases (BA.1, n = 5; BA.1.1, n = 9; BA.2, n=1). Viral neutralizing activity of the serum against BA.1 variant was negative in the 12 tested patients, suggesting that this prophylaxis strategy provides insufficient protection against this variant of concern. Preexposure prophylaxis with Evusheld™ does not adequately protect KTRs against Omicron. Further clarification of the optimal dosing can assist in our understanding of how best to harness its protective potential.

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  • Patient in US here. Lucky enough to get the 300mg dose of Evusheld at end of January. FDA changed dosing to total of 600 as they realized not as much protection to one of omicron variants. I had to get scheduled for an additional 300mg but had to wait two weeks as I had recently had a covid booster.

    In us- Patients who have recently received the COVID-19 vaccine must wait at least 2 weeks prior to receipt of a dose of Evusheld. There is no recommended waiting period by the CDC after Evusheld administration for COVID-19 vaccination.

    Also, infectious disease consult at my medical center said: vaccine should be given at least 2 weeks prior to ocrelizumab

  • I was trying to word an argument and am hung up, as this is out of my league. However, playing devil’s advocate, what would you say to someone who responds to this with “B Cell suppression techniques used with PwMS and Kidney transplanting are two different things, so you can’t extrapolate the findings in one group to another”?

    • Yes it is possible they are different…but with regard COVID vaccine responses the trends have been pretty similar

  • Just got the double dose in the tush on Friday. I hope that the folks doing this study take another look with the new double dose.

  • I’m on fingolimod. 35yo and got the 300/300 dose of Evusheld and IMMEDIATELY got covid. I had assumed that protection would not be complete (given the pre-omicron period in which it was developed and tested) and did not intend to increase my risk-taking, but got outdoor drinks with friends (something I had been doing judiciously during non-surges) and kablammo.

    Very bad aches/malaise first two days, sore throat through day 6, now day 7 and just tired, never any trouble breathing. So I think maybe the Evusheld did something, and it sure was nice not to have to chase a monoclonal infusion while already sick. But it’s going to be back to risk-averse for me, maybe with a little less anxiety?

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