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Latest Guidance on COVID-19 Preventative & Treatment Options from the MS Center Medical Team

By August 23, 2022August 25th, 2022Covid-19, eMS News

The COVID-19 vaccines and boosters remain the best defense against COVID-19. It is very important to receive your vaccine and boosters as soon as possible. Please see our current chart of vaccine and booster guidance and our frequently asked questions page.

A new booster designed specifically to target the omicron subvariants – BA.4 and BA.5 — and the original coronavirus strain could be available in the United States as soon as next month. Pfizer and BioNTech asked the FDA to authorize its booster for people age 12 and older and submitted clinical data for review on August 22.  Moderna submitted its application to the FDA authorization of its updated COVID-19 vaccine booster for people age 18 and older on August 23. Please stay tuned and we’ll continue to keep you updated.

The below preventative and treatment options are not a substitute for vaccinations, but are important to be aware of:

Preventative Medication

Evusheld:  For those who may not have adequate immune responses to the vaccine, Evusheld is a monoclonal antibody prophylactic therapy for moderately to severely immunosuppressed patients who have been vaccinated but not developed protective antibodies. Evusheld is a combination of two monoclonal antibodies against the spike protein of SARS-CoV-2 and is given as two intramuscular injections in the same visit. It is likely useful for up to six months, and present suggestion is to repeat every six months. Evusheld has been distributed to hospitals only, so will not be available in doctor’s offices. The U.S. Food and Drug Administration (FDA) authorized Evusheld for some individuals 12 years and older in December 2021, and ample supplies are available.

If you currently take certain disease modifying therapies (DMTs) including Rituxan, Ocrevus, Kesimpta, Gilenya and its generics, Mayzent, Zeposia, Ponvory, Lemtrada, Mavenclad, and any chemotherapy drugs, you may qualify for Evusheld because development of antibodies after vaccination may be inadequate. Talk with your healthcare provider about this medication. Evusheld should not be used in people with known heart disease, and risk of allergic reaction, though low, may be higher in those who had a severe allergic reaction to COVID vaccines. It should not be taken within two weeks of a COVID vaccine, or recent COVID infection. There is no need to change MS medication cycles with Evusheld.

Treatment Options

If you do contract COVID-19, there are treatments available that can reduce your risk of being hospitalized or dying from COVID-19. These medications must be prescribed by a healthcare provider. You must start these medications as soon as possible after testing positive to be effective.

You may be eligible for these treatments regardless of the MS DMT you are using, but if you are taking MS DMTs that suppress parts of your immune system, including Rituxan, Ocrevus, Kesimpta, Gilenya and its generics, Mayzent, Zeposia, Ponvory, Lemtrada, Mavenclad, and any chemotherapy drugs you may be at slightly higher risk of a severe COVID infection. Thus, use of these medications may be more important in this context.

Discuss these options with your health care provider as soon as possible if you test positive for COVID-19. You will need a prescription for these treatments.

Below is the summary of current COVID-19 treatment options from the CDC and the U.S. Department of Health & Human Services:

If you’re not hospitalized and have had symptoms for 5 days or less, here are the treatment options that your healthcare provider could recommend:

  • Paxlovid: This is an oral medication (pill) to treat mild to moderate symptoms of COVID-19. It must be given within 5 days after the first symptoms of COVID-19 appear. Paxlovid is for adults and children who are 12 years of age and older, weighing at least 88 pounds and is generally well-tolerated.  Treatment is two pills three times daily for five days. In order to qualify for a prescription, you must also have had a positive COVID-19 test result and be at high risk for developing severe COVID-19. That means you must either have certain underlying conditions (including cancer, diabetes, obesity, or take medicines that place you at high risk of severe COVID) or be 65 or older. An unknown percentage of individuals using Paxlovid have had a rebound, ie, they may test negative after treatment and then positive a few days later. This may, or may not, be associated with return of symptoms. The significance of this remains unclear, but patients may be able to transmit COVID to others if they have a rebound, so usual precautions should be taken until it is clear a negative test is persistent.
  • Lagevrio (molnupiravir): This is an oral medication (pill) to treat mild to moderate symptoms of COVID-19. It must be given within 5 days after the first symptoms of COVID-19 appear. Lagevrio is for adults 18 years and older, and is four capsules twice daily for five days. It is generally well-tolerated, but should not be taken if breastfeeding or pregnant.

If you’ve had symptoms for 7 days or less, here are the treatment options that your healthcare provider could recommend:

  • Bebtelovimab: This is a monoclonal antibody for adults and children 12 years or older (weighing at least 88 pounds) who have tested positive for COVID-19, have mild to moderate symptoms, are not in the hospital, and are at high risk for serious COVID-19. Bebtelovimab must be given within 7 days after the first symptoms of COVID-19 appear. This treatment is for when other COVID-19 treatment options approved or authorized by the FDA are unavailable or not clinically appropriate. It is a single IV infusion, and should not be used in those hospitalized for COVID or with severe oxygen requirements.
  • Veklury (remdesivir): This antiviral treatment is for people staying in the hospital and people who are not in the hospital. People who are not in the hospital must go to an IV infusion center to receive this treatment. Veklury must be given within 7 days after first symptoms of COVID-19 appear. It is given as a daily IV infusion for 5-10 days depending on response.

These treatments are all very similar, with the exception of molnupiravir which is a bit weaker.

Please note that as strains and variants of COVID change, treatments will also change, especially the monoclonals.

Seeking Treatment

You must start these medications as soon as possible after testing positive to be effective. The most expeditious way to get treatment is to schedule a telehealth appointment through urgent care facility. For more information and resources to get COVID-19 treatment here is a helpful link for Colorado residents: https://covid19.colorado.gov/getting-covid-19-treatment.

Here is a link with more information about Telehealth appointment options:  https://covid19.colorado.gov/telehealth-treatment

Again, it is important to reinforce: The COVID-19 vaccines and boosters remain the best defense against COVID-19. It is critical to receive your vaccine and boosters as soon as possible. Please see our current chart of vaccine and booster guidance and our frequently asked questions page.

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