Ask the Doctor Question:
Are you recommending pre-exposure prophylactic IV monoclonal antibodies for severely immunocompromised CLL patients? Will insurance cover this?
Answer: The only treatment that is approved for this (yet) is Regeneron’s product called Regen-COV. And the emergency authorization has very strict criteria for those who are allowed to use it prophylactically. We would encourage you to read the article we wrote on it here: https://cllsociety.org/2021/08/fda-okays-regeneron-covid-19-antibody-as-preventive-for-chronic-lymphocytic-leukemia-cll-and-other-immunocompromised-patients/.The main issue with the Regen-COV product is that you have to go in and receive it every month, which that in itself poses its own set of challenges and risks.
Where we believe the future might be even brighter for those with CLL is with the AstraZeneca LONG-ACTING monoclonal antibodies. Because they are instead given as a subcutaneous shot (not an infusion where you have to sit for a while in a clinic) and it is looking like you would only need a dose every 6 months (if not 12 months). You can read more here on the preliminary results of the trial, which were very promising: https://cllsociety.org/2021/08/azd7442-provent-phase-iii-prophylaxis-trial-met-primary-endpoint-in-preventing-symptomatic-covid-19/. The main problem with the AZ product is that it is not yet approved under the emergency use authorization.
Please talk with your CLL expert. Make sure you have had your booster (we are hearing of many CLL patients who are reporting they had no response prior, but after the booster have had an incredibly robust antibody response) and ask your healthcare provider to check your spike protein antibody level. If you still haven’t responded after the booster, then it would be worth discussing utilizing the Regen-COV product at this time.
And last, but not least, please make sure you have completed your COVID-19 Action Plan. It is best to know ahead of time where you can go to get the monoclonal antibodies should you need them right away after a known exposure. You can read more about that here: https://cllsociety.org/2021/07/covid-19-plan-checklists-for-chronic-lymphocytic-leukemia-cll-preparing-for-pre-and-post-covid-19-exposure/