Let's Talk Evusheld for Immunocompromised Patients
Introduction to Evusheld:
“Two booty shots 🍑 💉💉, and your antibodies providing prophylactic protection against COVID-19 will skyrocket in minutes!”
That’s more or less the premise of a new medication for immunocompromised patients called Evusheld—at least, according to my cheerful nurse with the pink hair.
In more formal terms, patients with compromised immune systems can now receive two injections, over a single appointment, that will provide them with greater protection against COVID-19 than receiving COVID-19 vaccines alone.
Background information and eligibility:
My immune system is a fun little monster thanks to a mix of an autoimmune illness called encephalitis and the immunotherapies I’ve been on to curb it over the years. One of those therapies is rituximab (Rituxan), which destroys the B cells necessary to create antibodies. So big fat surprise that 3 Pfizer vaccines failed to stimulate my immune system enough to produce a robust antibody response.
For patients like me, AstraZeneca has developed a product called Evusheld. It’s two long acting monoclonal antibodies (tixagevimab and cilgavimab), co-packaged together and dispensed as two injections one after another, developed to provide pre-exposure prophylaxis against COVID-19 infection. The US FDA granted emergency use authorization (EUA) for Evusheld in December 2021 , with the federal government now controlling its supply and distribution.
Different medical systems are using varying criteria to distribute their doses, as the number of eligible patients outstrips current federal supply. In patient support groups, I’ve heard everything from recipient's names being drawn lottery-style from a medical system’s internal list of immunocompromised patients, to doctors offering it to patients outright by virtue of the immunosuppressive treatments they’re on.
Examples of medications that would typically make one eligible for Evusheld include:
antimetabolites including methotrexate, sulfasalazine, leflunomide, mycophenolate
immunosuppressive or immunomodulatory biologics 
Individuals who have had severe adverse reactions to the COVID-19 vaccine are also eligible under the EUA. You can read more from the official Evusheld website here: https://www.evusheld.com/
My experience receiving the injections:
Evusheld is dispensed as two separate, consecutive intramuscular injections. Following administration, individuals must be clinically monitored for at least 1 hour to ensure no hypersensitivity reaction or anaphylaxis occurs.
Practically speaking, you’ll be taken into a private room to be given one injection into each buttock; one right after the other. I’ve also heard the odd report of a patient receiving Evusheld into their upper arms—as with typical vaccines—but this seems to be rare practice. Pink-haired nurse guessed that the butt/gluteal muscles are used because they accommodate larger injectable volumes more easily than upper arm/deltoid muscles.
For the benefit of the unacquainted and slightly reluctant, who ducked out of taking anatomy in university (that’s me 🙋♀️): the gluteal muscle extends up higher than you might think. Yay—no awkward pull-your-pants-down maneuvers required! My nurse had me face a counter and lean forward on it slightly as she positioned the needle in an area on each side that *felt* more like my lower back.
The injections stung for a few seconds and were sore to the touch for a few hours; but other than that, everything was A-okay. I experienced no downtime, no next-day soreness, and no delayed malaise—no sign of the typical discomforts that you would expect with COVID-19 vaccines. This seems to be the experience of most Evusheld recipients I’ve heard from.
Cost-wise, Evusheld itself is covered by the federal government. However, administration costs are not. My insurance was billed but I could not get a concrete answer as to whether I would be seeing a co-pay bill in the mail later.
If you’re immunocompromised, concerned about COVID-19, received suboptimal benefit from the vaccines, and want to be better protected against infection: ask your doctor if Evusheld is a good option for you.
Many patients are having trouble securing Evusheld, but the situation is changing weekly as new shipments are distributed and more medical providers become aware that Evusheld even exists as an option. The rollout has been poorly organized, with short supply in some jurisdictions and unused doses in others . Many patients I’ve spoken with have had to do their own legwork to secure a dose of it.
You can use the tools below to help you find a location that might administer Evusheld to you:
To those pursuing this option: good luck and happy hunting!
This post has been adopted from writing that first appeared at wherearemypillows.com.
WhereAreMyPillows is a writer and autoimmune encephalitis survivor. Some of her favorite activities include writing on her health blog, taking photos, doing yoga, and finding her next spot to take a nap. You can connect with her further on her WhereAreMyPillows Facebook Page, Instagram, and Twitter.
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