Sunday, May 22

Covid-19: the “double penalty” of immunocompromised patients

In some hospitals, 70% of patients admitted to intensive care are unvaccinated. Among the remaining 30%, the majority are immunocompromised, and at very high risk of contracting a severe form of the disease, even though they have already received three or even four or five doses of the vaccine. A population that feels helpless in the face of the difficulty of obtaining treatment.

“It’s still a double or a triple sentence: we do not manufacture antibodies, we are at risk of serious Covid, and there is no treatment currently”, deplores Sylvie, 62, kidney transplant. Diagnosed at a very young age, she has a long medical career behind her, including dialysis and several transplants. She is on immunosuppressive therapy, “tough enough” in her words, so that her body does not reject her transplant. “I have antibodies against foreign bodies, but on the other hand I have not made any against the Covid virus, despite three doses of vaccines,” she explains.

Immunocompromised people represent between 270,000 and 300,000 people in France. Because of their pathology or heavy treatments they can take, their immune system is weakened. While the antibody threshold used by the WHO to guarantee some protection against the coronavirus is 264 BAU / mL of blood, “for lung transplant recipients, this threshold was reached for 15 to 20% of patients while they had already received their 4th dose ”, indicates Pierre Foucaud, president of the association Vaincre la Mucoviscidose, which called on the government, with other associations, on the fate of the immunocompromised in a column published last weekend in the Sunday Newspaper.

“We understand the anxiety that they are experiencing again with this real surge of the Omicron variant because they feel particularly vulnerable. Mortality, for them, is between 15 and 20% “, more than residents of nursing homes when vaccines did not exist, he explains. Figures that are verified in some resuscitations, since immunocompromised patients represent up to 30% of hospitalized in Paris, as indicated by the Minister of Health Olivier Véran. “What we fear is that these patients with severe immunodeficiency pay the cost of sorting out access to resuscitation, by favoring patients with a better prognosis, unvaccinated people”, regrets Pierre Foucaud. .

A treatment based on little exploited antibodies …

For these patients, hope therefore lies in other types of treatment. Last August, some were able to receive an “early access authorization” to the Ronapreve treatment developed by the Swiss laboratory Roche, based on monoclonal antibodies. It is a “cocktail” of artificial antibodies designed to resist Covid-19. However, its intravenous administration every month represented too much organization and investment for hospitals, which have been very few to offer this treatment to patients. According to associations, only 10% of some 60,000 severely immunocompromised patients were able to receive these antibodies. Sylvie made one of the few who had access to it: “I was a little reassured, but the antibody treatment did not really work on me. After 15 days I had only half the required rate, and by the time of the second infusion, I had none at all. Then Omicron arrived, ”says this former doctor, now retired.

According to recent scientific data, Ronapreve is no longer effective against this new variant, now the majority in France. A new source of anxiety for these patients, while the virus is circulating very widely and rapidly in France. Another antibody-based treatment, Evusheld, developed by AstraZeneca, however, received the green light from the French National Authority for Health on December 11. Easier to use, it is administered intramuscularly and is presumed to be effective for six months, compared to one month for Ronapreve. Sylvie was recently able to benefit from it. “I hope it will be widely distributed to people with immunosuppression because the previous one was still underused,” she laments. The other problem is that for people who are immunocompromised who are currently taking Omicron, there will be no treatment for several weeks ”.

… And no curative treatment for several weeks

The other glimmer of hope lies in two other treatments which should arrive in the coming weeks in France: Paxlovid, an antiviral treatment developed by Pfizer, and Xevudy from the British laboratory GSK. The latter has been approved by the European Union, and the drug developed by Pfizer has received a favorable opinion from the European Medicines Agency for early access, but no marketing authorization yet.

Temporary solutions: self-containment or extreme caution. Actions that have sometimes been part of the lives of these patients for years. This is particularly the case of Odile, 53, suffering from cystic fibrosis. “Masks, gloves, hydroalcoholic gel, they have been used for over thirty years,” she says. Living with her husband also at risk of serious Covid, placed back in telecommuting since the arrival of Omicron, and with her 80-year-old mother, barrier gestures are not an option for her. “To go out at the moment, I always put on gloves, which I leave outside when I get home and which I disinfect.” Same story for Sylvie, who drastically limits her outings: “I hardly ever go out of my home except to do errands quickly, and at times when there is no one there. Even if people wear the mask, I always go out now with an FFP2 mask. “

According to one survey published at the end of October by the Renaloo association, which accompanies kidney patients, 77% of patients with renal failure, dialysis and transplant continue to “take the same precautions as at the start of the crisis, when strict isolation was the rule”. However, self-containment cannot be a real solution, especially for patients who work, or who have a working spouse, or children who go to school.

Patients sometimes not sufficiently informed

For the founder of Renaloo, Yvanie Caillé, the public authorities must organize themselves to guarantee access to new treatments, preventive and curative, for immunocompromised patients. “Paxlovid and Xenudy should be administered as soon as possible after the first symptoms, which means that patients have rapid access to PCR tests. When we see what is happening at the moment and the delays in obtaining the test and the results … It could pose a real problem if the situation remains the same when the treatments arrive, ”she emphasizes. Pierre Foucaud also pleads so that some of the treatments can be administered at home, because “asking such a fragile patient to go to the hospital in full epidemic outbreak is very risky”. The reimbursement of FFP2 masks for severely immunocompromised people is also part of the associations’ requests.

Finally, they urge the government to make a real effort to provide information, through national campaigns aimed at these patients. “We keep our members as informed as possible, but unfortunately associations do not reach all patients,” recalls Yvanie Caillé. The good news is that among our strong requests which are in the process of succeeding, health insurance will send a letter to immunocompromised patients next week, with information on the precautions to be taken, the vaccination strategy and the preventive treatments… This is a very good thing and we are currently involved in the drafting of this letter ”, indicates the founder of the Renaloo association.

Also a member of the Vaccine Strategy Orientation Council (COSV), chaired by Alain Fischer, she often has the opportunity to talk about the situation of immunocompromised people. If the government and the health authorities take their situation into account, she nevertheless feels that there is sometimes “a form of acceptance that the immunosuppressed massively go to intensive care”.

1 Comment

  • Ileana

    Paxlovid can cause toxicity if you take tacrolimus, so a transplant Recipient can’t take this antiviral. Please don’t suggest this pill for us.

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