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Last December, the FDA Withdrew the EUA (Emergency Use Authorization) for the Last COVID Monoclonal Antibody Treatment: Bebtelovimab, after tests showed it was no longer effective against the newer omicron variants.
One remaining monoclonal antibody - Evusheld (tm) - (tixagevimab co-packaged with cilgavimab)- remained, but only for pre-exposure prophylaxis in those are moderately to severely immune compromised and unable to take the COVID vaccine.
Earlier this month we saw evidence that Evusheld was losing its effectiveness as well (see PrePrint: Enhanced Transmissibility of XBB.1.5 is Contributed by Both Strong ACE2 Binding and Antibody Evasion), and yesterday the FDA revoked its EUA with the following announcement.
FDA announces Evusheld is not currently authorized for emergency use in the U.S.
Update [1/26/2023] The U.S. Food and Drug Administration today revised the Emergency Use Authorization (EUA) for Evusheld (tixagevimab co-packaged with cilgavimab) to limit its use to when the combined frequency of non-susceptible SARS-CoV-2 variants nationally is less than or equal to 90%. Based on this revision, Evusheld is not currently authorized for use in the U.S. until further notice by the Agency.
Data show Evusheld is unlikely to be active against certain SARS-CoV-2 variants. According to the most recent CDC Nowcast data, these variants are projected to be responsible for more than 90% of current infections in the U.S. This means that Evusheld is not expected to provide protection against developing COVID-19 if exposed to those variants.
Today’s action to limit the use of Evusheld prevents exposing patients to possible side effects of Evusheld such as allergic reactions, which can be potentially serious, at a time when fewer than 10% of circulating variants in the U.S. causing infection are susceptible to the product.
Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight off harmful pathogens such as viruses, like SARS-CoV-2. And like other viruses, SARS-CoV-2 can mutate over time, resulting in certain products not working against certain variants. This is the case with Evusheld and prompted the changes to the authorization that FDA is making today.
Should a patient become infected with SARS-CoV-2 and develop symptoms of COVID-19, they should seek medical attention, including starting treatment for COVID-19 as appropriate. There are several treatments – Paxlovid, Veklury (remdesivir) and Lagevrio (molnupiravir) – that are expected to work against currently circulating variants, and that are authorized or approved to treat certain patients with mild-to-moderate COVID-19 who are at high risk for progression to severe disease, including hospitalization or death. Healthcare providers should assess whether treatments are right for their patients.
The U.S. Government recommends that facilities and providers with Evusheld retain all product in the event that SARS-CoV-2 variants which are neutralized by Evusheld become more prevalent in the U.S. in the future. Retained product must be appropriately held in accordance with storage conditions detailed in the authorized Fact Sheet for Health Care Providers and the Letter of Authorization.
FDA will continue to work with ASPR, the CDC, and the National Institutes of Health on surveillance of variants that may impact the use of the therapies authorized for emergency use. We will provide further updates and consider additional action as new information becomes available. Any updates will be made available on FDA’s website.
And there is the real danger that future variants could render even more of these remaining treatments ineffective.
Getting vaccinated, and staying boosted, however can go a long ways towards reducing the severity of COVID, while wearing a mask in public, practicing good hand hygiene, and avoiding crowds can substantially reduce your chances of getting infected.
