An infectious disease expert explains the new and upcoming treatment modalities that are improving COVID-19 outcomes for patients with cancer and other conditions that compromise the immune system.
At the start of the COVID-19 pandemic in 2019, there was neither a vaccine to prevent infection with the virus nor any drugs to treat it. In less than two years, that has changed, explained Dr. Sanjeet Dadwal.
Dadwal is a clinical professor of infectious diseases at City of Hope in Duarte, Calif., and member of the Advisory Committee on COVID-19 Vaccination and Pre-exposure Prophylaxis and the National Comprehensive Cancer Network (NCCN) Guidelines Panel for Prevention and Treatment of Cancer-Related Infections. In an interview with CURE®, he outlined what is currently available for immunocompromised patients — like those undergoing treatment for cancer — to protect them from COVID-19.
There are now monoclonal antibodies that can be given prophylactically to the most vulnerable individuals who may not benefit from the vaccine. There are also two mRNA vaccines and the Johnson and Johnson (J&J) vaccines. Additionally, health care providers can use pills to treat the virus, and more clinical trials are underway.
In regards to monoclonal antibodies, have a discussion with your physician — very important — and they will let you know where that stands in terms of how much supply they may have, what the guidance is, who gets it first. That's number one. So definitely (you) should explore if (your) doctor says you’re immunocompromised, and you would benefit. It's a good development, which is now available.
And as far as the vaccines go, you have the regular mRNA vaccines and (the) J&J (option), but there are other clinical trials going on too. So they can always inquire about those. I mean, we have a vaccine trial at City of Hope as well, which is actually a unique vaccine because it covers both the spike protein and the nucleocapsid protein, but right now it is mostly for City of Hope patients.
Yes, they are new developments, too. There are also two pills (being investigated). One is known as Paxlovid (nirmatrelvir), made by Pfizer. And the other one is molnupiravir, which is made by Merck. They both reduce hospitalization risk, although the Pfizer drug has 80% efficacy in preventing (hospitalization) as opposed to 30% with the Merck drug. So those are two other options.
And the third one is Veklury (remdesivir), which a study was just published in the New England Journal of Medicine (about).
So these things are now available when somebody gets exposed, or they have infection. They can still get outpatient remdesivir for three days, because that also cuts down hospitalization by about 70 to 80%.
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