Ontario has started giving Evusheld, a COVID-prevention drug, to the vulnerable

With terrifying certainty Dr. Eric Hurowitz knew he was especially vulnerable to COVID-19.

Even after four vaccines, blood tests showed Hurowitz, who was diagnosed with acute myeloid leukemia in 2019, had no antibodies to fight the virus.

Months of chemotherapy following a stem-cell transplant had wiped out his immune system. And the constant flow of immunosuppressive drugs he must take for his cancer treatment continues to subdue it.

To protect himself, Hurowitz has spent much of the pandemic isolating at his Toronto home, only seeing family and friends masked and outdoors, even on the coldest days.

“My immune system is essentially paralyzed,” said Hurowitz, a gastroenterologist at Scarborough Health Network. “It puts me at really high risk. All those who surround me have had to share the same kind of diligence — and vigilance — to do everything we can to avoid infection.”

But now, some of his fear has eased. In May, Hurowitz received the COVID-prevention drug Evusheld. He knows his body has strong, long-lasting antibodies to fight the virus.

Evusheld (tixagevimab and cilgavimab) was approved by Health Canada in April.

“I’ve got the real thing, the antibodies my own body couldn’t make,” he said.

“It doesn’t mean I don’t wear a mask going into a grocery store. But it does mean I can go into a grocery store, something I wouldn’t normally do. … For people who can’t develop antibodies because of their immune systems, this drug is life-changing.”

Approved by Health Canada in April, Evusheld is authorized for people 12 and older with weakened immune systems, including transplant patients and some cancer patients, who are at high risk of getting severely ill or dying of COVID.

The drug is now available in Ontario at select hospitals following a provincial rollout last month.

While experts say many of those who have received the drug are overwhelmed with relief, they also warn more needs to be done to alert eligible patients to this additional layer of COVID protection.

“I talk about Evusheld with the majority of my patients and almost universally none of them have heard about it; it wasn’t on anyone’s radar,” said Dr. Matthew Cheung, a hematologist at Sunnybrook Health Sciences Centre who treats patients with blood cancers.

“It would be useful, from a systems standpoint, for there to be more outreach to raise awareness.”

Developed by AstraZeneca, Evusheld is a combination of two monoclonal antibodies — tixagevimab and cilgavimab — that have been modified from natural human antibodies. They have been designed to be long-lasting and work by stopping the SARS-CoV-2 virus from infecting healthy cells.

The drug is offered as a preventative measure — it must be given before someone gets sick with COVID — and data suggests antibodies last for up to six months, said Cheung.

“We still emphasize that vaccinations offer the best protection,” he said. “We explain (Evusheld) is an added layer of protection in addition to vaccination.”

In Ontario, people at highest risk of getting severely sick or dying of COVID are eligible for the drug, according to the Ministry of Health. This includes solid organ transplant and stem cell transplant recipients, patients receiving CAR-T therapy (a form of targeted immunotherapy for some cancer patients) and blood cancer patients undergoing treatment.

Asked whether there are plans to expand eligibility in the coming months, a ministry spokesperson said in a statement that it “will continue to evaluate the eligibility criteria and access to Evusheld to determine the appropriateness of any changes.”

So far the province has distributed about 6,000 treatment courses to select hospitals sites, including cancer centres and transplant clinics, the spokesperson said, adding it has “approximately 5,300 additional doses on hand and ready to ship … when they need them.”

“The best way for eligible patients to learn how to access Evusheld is to reach out to their specialist,” the spokesperson said.

Cheung said physicians at Sunnybrook are reaching out directly to the highest-risk leukemia and lymphoma patients who are eligible for Evusheld, according to tiers set out by Ontario Health. The team will offer the drug to the roughly 700 patients who qualify at their clinics over the next two to three months, he said.

While some well-informed patients contact the hospital, Cheung said most haven’t heard of Evusheld. He would like more public awareness surrounding the drug so eligible patients know to contact their doctor.

“Some patients, they’ve been worrying about the loosening of restrictions while their immune systems are low; they feel a bit left behind,” he said. “I see other patients — especially those currently on treatment — who are very isolated. They’re still following the original suggestions from March 2020, like having their groceries left on their front porch. They’re grateful there is this option that has been designed with them in mind.”

At Canada’s largest organ transplant program, staff are contacting organ recipients to let them know about Evusheld and to assess them for the drug, said Dr. Deepali Kumar, director of transplant infectious diseases at University Health Network’s Ajmera Transplant Centre.

Currently, Evusheld is recommended for all transplant recipients, she said, noting it’s a simple medication to administer to patients who get two injections into their gluteal muscles, or the buttocks.

The original study on Evusheld found those who received the drug had a 77 per cent lower risk of developing symptomatic COVID at three months and an 83 per cent lower risk at six months, Kumar said. A more recent study also found it largely prevented COVID infections, and any breakthroughs were mild, she said.

“At this point, it seems to work quite well to both reduce COVID and reduce COVID infection to a mild disease,” Kumar said, adding that in the first pandemic year about 15 per cent of transplant recipients who got COVID died.

Dr. Susan John, an infectious diseases physician at Scarborough Health Network, said its COVID-19 Prophylaxis Service launched in May, initially offering Evusheld to eligible blood cancer patients in its cancer care program. SHN is now accepting referrals for Scarborough residents receiving transplant or cancer care at downtown Toronto hospitals, making it easier to for them to get the drug, she said.

The Ministry of Health confirmed to the Star the province has put in a “care close to home model” that will “support equitable access in rural, remote and northern areas,” meaning eligible patients who typically travel to a specialty clinic can get Evusheld at their local hospital.

John said clinicians are hopeful that rolling out the drug will help prevent the devastating experience of the winter Omicron wave that saw many transplant patients sick with COVID in hospital.

She said she has seen “a lot of relief” while giving Evusheld to vulnerable patients who’ve spent years isolating and remain deeply afraid of getting COVID.

“They are strictly eliminating their activities and are very fearful, despite all they’ve done to protect themselves,” John said. “The patients I’ve given Evusheld to, they were so pleased and said they were hoping to go back to a more normal life, they way they lived before COVID days.”


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