Immunocompromised people should receive treatment that would prevent them from being infected with COVID-19.

[dianthus101]

Many people including cancer patients, people on immunosuppressive medications, transplant recipients, people with primary and secondary remain extremely vulnerable to Covid, even after vaccination. For them lockdown has not ended and if anything, it is even worse than 2020 as COVID-19 infections are very high in the community. Some immunosuppressed people have barely been outside since 2020 and the psychological distress is enormous.

I'm not sure if people realise but an antibody treatment (Evusheld) that would prevent them from being infected was authorised by the UK regulator authority (MHRA) in March this year. Despite the fact that the evidence for this treatment is greater than it was for the COVID-19 vaccines (when they were rolled out) it is still not available in the UK (privately or via the NHs) even though it is available in 32 other countries including the US and many European countries. This is because the UK government have not bought any. There doesn't seem to be much publicity about it and I know many immunocompromised people feel very forgotten.

bloodcancer.org.uk/news/leading-charities-and-clinicians-urge-government-to-secure-evusheld/

In principle, yes. In reality - the MTA I linked to above IS being done fast, for an MTA. They're generally much slower 😬

Why are you talking about MTAs (multiple drug assessment)?. It is a single drug and the assessment will be much easier and (hopefully) quicker.

You’re using two different measures to make a comparison.

Death isn’t the only metric to consider in cost; secondary and primary care costs in treatments during and following an infection, including worsening of existing conditions and death. Given the state of our healthcare services there’s also value of easing pressure overall.

Cost should be no more than £800

That's roughly the equivalent of 2 nights in hospital (not including the actual treatments the patient receives for whatever lands then in there)

No medication is approved for funding on such basic calculations. Thankfully.

Because it's the first example of NICE undertaking an assessment of covid medications under normal procedures, rather than rapid reviews. I'm using it to highlight that the timelines even for covid drugs are back to being many months or, likely, over a year. Also, the process for an STA is not that much shorter than an MTA - the aim is 49 weeks for an STA and 60 for an MTA, although the reality is often longer.

You are clearly not interested in any comments that aren't wholehearted agreement, even from people knowledgeable in the field, so I think I'm going to bow out now. The points I am trying to make are that due process ought to be followed and that MHRA approval is necessary but not sufficient for drug access through most routes. It's a nuanced area and not as simple as 'this drug works therefore people should have it', as many people on the thread understandably seem to believe.

I believe this is the issue.

There isn't sufficient evidence it works on Omicron which make up 98% of cases.

Also the trials were done on unvaccinated people and there is suspicion about the (lack of) impact on vaccinated people, especially if immunocompromised.

If you want to pick an example at least pick something similar. Single drug assessments don't normally take a year at all, particularly in this kind of situation.

You are completely incorrect that MHRA approval is not enough for a drug to be prescribed privately. The problem is that it is just not available in the UK. This does not occur with other drugs regardless or whether NICE have given their approval.

Your comments about me not being interested in the opinions of people “knowledgeable in the field” is a bit laughable and patronising. What makes you think I have "no knowledge in the field" and should bow to your superior wisdom? Given some of your ignorant comments I think I probably have more than you.

Several studies have shown that is effective against omicron actually. The UK hasn't got some superior knowledge over the 40 countries that are now using it. There is also plenty of evidence now that severely immunocompromised people are not mounting a good immune response to vaccination.

There is also plenty of evidence now that severely immunocompromised people are not mounting a good immune response to vaccination.

A good example of why long-term data and thorough evidence is required.

No one would have dared say the vaccines don’t work just a few months ago

They did say that vaccines were not going for severely immcompromised people a few months ago though! That's why evusheld and other monoclonal antibodies were developed in the first place.

I mean to say "They did say that vaccines were not going work for severely immcompromised people a few months ago though! That's why evusheld and other monoclonal antibodies were developed in the first place.

No one would have dared say the vaccines don’t work just a few months ago

… For specific groups. And it’s been said repeatedly since they’ve been available and certainly since the emergence of Omicron.

All 5 vaccines that ive had have been ineffective. I don't have any antibodies at all and am still having to shield. I'm severely immune compromised .

32 other countries are giving it to their citizens with my condition

I was told before I had my first vaccine in january 2021 that it was unlikely to work

Be cause our lives don't matter.
The new variants don't seem to make the general population ill, just those with certain pre existing life limiting conditions so its not a big deal if the half a million of us in this group die, in fact it will save the nhs money in the long term because they wont have the treat us.

£800 doesn't seem that much. Saying that my GP practice complained how expensive my diabetic prescription stuff is!

My mum has written to her MP about the lack of funding for Evusheld and the MP couldn't give a damn - the reply was like a work experience junior had written it.
The charity that supports her and others with immune deficiencies has tried and tried to keep it in the public eye.
And if you are compromised and get Covid, don't bank on getting the antiviral treatment. She was only just given it in the treatment window as nobody would sanction the treatment despite her following all the guidelines.

I think that's the concern. It's all very well for the government to argue that there are covid treatments available and that pre exposure prophylaxis is therefore not important but there are lots of reports of people not getting treatment within the five day deadline.

Also the trials were done on unvaccinated people and there is suspicion about the (lack of) impact on vaccinated people, especially if immunocompromised

You miss the point.

People who do not form as immune response to vaccine are essentially the same as the unvaccinated. This is the absolute closest group for testing the effectiveness.

I mean to say "They did say that vaccines were not going work for severely immcompromised people a few months ago though! That's why evusheld and other monoclonal antibodies were developed in the first place

That vaccination might not work in the severely immune compromised didn't really need saying, because it's the basis fact for all vaccination. It was definitely known and briefed to those affected. It's also a reason why they are the majority of the group which is offered pre-symptomatic advanced covid treatments following a positive test.

No medication is approved for funding on such basic calculations. Thankfully

*Ummm... yes it is! Cost of treating patients without the new drug is very much part of the assessments.

And yes, it is effective against omicron (University of Washington - more effective against 1&2 than 4&5 but still works)

@dianthus101 - it's worrying that so many are being denied the treatment within the window. The NHS line she was instructed to call when she tested positive didn't call back as they were meant to - they cleared off home early because it was a Saturday. Now isn't it inconvenient for seriously compromised people to get I'll outside working hours,

This is what scares me… it says on my email that once I report a positive lateral flow test they will contact me about regarding your antivirals but I’m guessing this isn’t always the case.

This is what scares me… it says on my email that once I report a positive lateral flow test they will contact me regarding antivirals but I’m guessing this isn’t always the case.

@Intellectualmalaise : I can confirm that my mum was not contacted despite being promised "someone would call her back". She had to fight and fight to get them.
Luckily she was not as ill with Covid as we feared she would be having no immune system otherwise she'd not have been M able to persist.
It's criminal and negligent on how these drugs are being wasted by going past the use by date because they are simply not being given to those that require them.

Yes, I bet a lot will be thrown away.

No medication is approved for funding on such basic calculations. Thankfully

Ummm... yes it is! Cost of treating patients without the new drug is very much part of the assessments

I was referring to the calculation that an average covid inpatient stay costs x and the drug should cost the same or less than that. That’s just not true and would mean that loads of drugs would instantly be unavailable for a whole host of conditions that rarely require inpatient treatment.

You miss the point.

People who do not form as immune response to vaccine are essentially the same as the unvaccinated. This is the absolute closest group for testing the effectiveness.

That wasn’t my point. The issue may be that the vaccine has further deteriorated the immune system, hence why multiple vaccinated people keep getting covid over and over again. Might be a different thread but people saying they’ve been vaccinated 5x and had covid 6x just isn’t happening for people who haven’t had the vaccine, especially multiple vaccines.

Im all for prophylactic treatments, we should have done it from the start but I think it’s right to test them properly before committing money to it. These are not inexpensive drugs.

paxlovid for example, it’s now being reported of a very common bounce back effect. People are taking it, it reduces symptoms for a while, then it comes back because the virus was not eliminated, just suppressed. See Joe Biden for a good example.