End of year update on Evusheld27 October 2022 Recently, the pharmaceutical company AstraZeneca have announced that their prophylactic treatment against COVID-19 ‘Evusheld’, has been made available to purchase privately. Here’s what we know so far. Please note that this information aims to help you decide whether the treatment is of interest to you and to help prepare you for conversations with your specialist team about receiving Evusheld, if appropriate on private prescription. NRAS are not able to assist patients in accessing the treatment directly. What is Evusheld? Evusheld is a preventative (or prophylactic) antibody treatment made by AstraZeneca to combat Coronavirus. It is made up of two monoclonal antibodies: ‘tixagevimab’ and ‘cilgavimab’. The goal of the treatment is to prevent infection with the virus and act to protect those who contract the virus from becoming seriously ill. What is the dosage? One dose of the treatment is 600mg made up of 300mg of tixagevimab and 300mg of cilgavimab. This is the recommended dosage for one individual. How often are individuals recommended to have Evusheld treatment? AstraZeneca had advised that the Evusheld treatment be repeated every 6 months to continually protect individuals, following clinical trial data demonstrating 6 month effectiveness for a 600mg dose. However, this information does not yet contain data collected from clinical trials examining boosters at 6 months. How is the treatment administered? The Evusheld treatment is given in the form of two separate injections intramuscularly (into a muscle). Treatment should always be prepared and administered by a trained healthcare professional in a sterile environment and with sterile practices. You will also need to be observed following injection for signs of reaction in a safe environment. What makes Evusheld different to the vaccinations already available? The big difference between Evusheld and the various vaccines currently available is the mechanism by which it protects individuals. Where vaccines contain a non-live version of the virus to promote an antibody response, Evusheld already contains the antibodies. This means that for those who fail to mount an adequate response to the vaccines and the boosters, those individuals are in effect “given” the antibodies which have failed to be produced following vaccination efforts. What makes it different to the other COVID-19 treatments? Like some of the treatments available to treat Coronavirus (e.g. sotrovimab), Evusheld is a ‘monoclonal antibody treatment’. However, it is the only one which can be administered prior to contracting the COVID virus. Whereas the other antibody treatments on the UK market are ‘post-exposure’ treatments, which aim to increase the rate of recovery from the virus, reduce the number of individuals needing hospital treatment as well as reduce the number of those dying from the virus. These antibody treatments are still invaluable in protecting the immunocompromised, but are limited to after these individuals become infected and their optimal window for administration. Can Evusheld be purchased privately in the UK? AstraZeneca have announced that effective from the 19th of October 2022, the Evusheld treatment will be made available privately, not via the NHS prescribing. Despite this announcement, it is, as yet, unclear how many private practices across the UK will be offering the treatment, where they’ll be, nor how soon they’ll be able to administer it to patients. As more information becomes available about how, when and where this treatment will be accessible and to whom, we will endeavour to reflect this on our website. What’s the story with whether the NHS will be providing Evusheld treatment? It is important to note that the potential for this treatment to be used under the NHS is still ongoing. The therapy is undergoing a rapid technology appraisal by NICE for its clinical and cost-effectiveness. NICE will then give their decision based on their findings from the scientific and efficacy evidence yielded by the appraisal. A decision is expected to be given by the end of May 2023. What is the associated price tag for Evusheld treatment? So far, all that is known is the cost to private healthcare providers for purchasing the treatment £1,000 per dose (£1,200 including VAT). Although this is the purchase price, the price for patients is likely to be higher than this but at this time we cannot say how much more. This will vary depending on the private health provider among other factors. The increased cost to patients is because the charge to patients will include the price of the dose, as well as, fees such as consultation charge, staff time, and whether the individual receiving treatment has health insurance that will cover the treatment among other variables. How will Evusheld be accessible to private patients? Patients will require a prescription from their relevant healthcare specialist in order to access the treatment, in the case of those with rheumatoid or juvenile idiopathic arthritis this will likely be your rheumatology consultant. Currently, little is known about which private clinics may be rolling out the treatment. It is known that AstraZeneca entered into conversations with several major health insurance and healthcare providers as well as private hospitals, but beyond this we just don’t know. That said; If you already hold private health insurance you can ask your provider if they can offer the Evusheld treatment to you IF you feel you are eligible. If you do not have private health insurance, there are some private healthcare companies (for instance, ‘BUPA’) who you can approach to ask if they are able to offer Evusheld to eligible patients. Similarly, some private hospitals (inc. NHS hospitals with private care departments) and private clinics may offer the treatment but you would need to contact each individually to find out. Eligibility criteria for private access: The Evusheld treatment is licensed for use in over 18s only in the UK. Specifically, those who: have failed or are unlikely to have mounted an adequate immune response to immunisation with the COVID-19 vaccines and booster programme. or; are not recommended to have the coronavirus vaccines (e.g. allergic to ingredients). and; have been prescribed the prophylactic treatment by their specialist (or other relevant healthcare professional). Who cannot have Evusheld? Evusheld is not suitable for anyone who is hypersensitive or allergic to any of the ingredients contained within the medication or those under the age of 18.. Aside from this, no guidance has been given about specific medical conditions or medication interactions which would prevent someone from being able to have the drug. How effective is Evusheld? In April 2022, the PROVENT trial (AKA ‘AZD7442’ previously) published their findings around the effectiveness of Evusheld. It is important to first note that these results were published prior to the emergence of the Omicron variant of coronavirus. Despite this, the treatment was shown to reduce the likelihood of developing symptomatic COVID-19 by 77% (Delta variant). Further research has however now been conducted examining later strains of the virus. In this work, the treatment has shown to be effective against the Omicron BA.1 and BA.2 mutations. Alas, it is not good news across the board, for the treatment does seem to have a reduced efficacy against the Omicron BA.4 and BA.5 strains which remain (as of October 2022) the dominant versions of the virus here in the UK. As with the vaccines against the virus, Evusheld cannot 100% guarantee that individuals will not contract the virus nor get seriously ill nor pass away, but it may reduce the risk of these things happening. It forms another key tool in the fight against COVID but does require individuals to still remain aware of the risks and take actions to mitigate these such as keeping up with “hands, face, space” principles where possible. What happens if after having Evusheld, I contract COVID? As yet there have not been studies conducted which examine whether Evusheld interacts with other drugs or medicines including the other post-exposure COVID treatments. Therefore there is nothing to suggest that individuals cannot receive these treatments should they catch COVID. If you receive Evusheld treatment you will be given appropriate information at the time. Timings for Evusheld treatment around medications Talk to your NHS rheumatology team about Evusheld if you are interested and eligible in getting this treatment. This will ensure you know what to do about other medications you are taking for your arthritis and/or other conditions. They can advise you around the timing of treatments. What are NRAS doing about addressing access to Evusheld for RA patients? NRAS is in correspondence with other MSK patient organisation members of the Arthritis and Musculoskeletal Alliance (ARMA | The Arthritis and Musculoskeletal Alliance). We will collaborate on joined up thinking and share relevant information on this topic and will in due course take appropriate action to ensure fair and appropriate access to this treatment. Please also see: Leading charities and clinicians urge Government to secure Evusheld | NRAS We have since received a response from government, stating that the treatment has been sent to NICE for appraisal for consideration for NHS rollout. The results from the appraisal are expected at the end of May 2023.