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Pre- and Post-Exposure Options for CLL Patients COVID-19 Omicron Variant

This content was current as of the date it was released. In science and medicine, information is constantly changing and may become out-of-date as new data emerge.

CLL Society support group’s facilitator, Jim Werner PhD, MSSA, of Case Western Reserve University in Cleveland, Ohio, put together this update on COVID-19 in January 2022.

I updated it in mid-March as the new variant BA.2 was on the rise, bebtelovimab had just been authorized, sotrovimab was shown to NOT work against BA.2, and the window to treat with all therapies was shortened.

The good news is that all the antivirals seem to be agnostic to which variant of concern (VOC) is circulating. Furthermore, they all work equally well against all the mutations, at least so far.

The mixed news is about the anti-COVID-19 monoclonal antibodies (cMABs). The only ones left standing with strong activity against all the VOCs is bebtelovimab for treatment started within seven days and EVUSHELD for Pre-Exposure Prophylaxis (PrEP).


Before testing positive or being exposed to COVID-19:

If you test positive for COVID-19, move quickly:

  • Start Paxlovid pills as the first choice within five days. Talk with your healthcare team about Paxlovid’s significant drug reactions with ibrutinib and others. This will likely mean holding or reducing CLL drugs.
  • If Omicron is prominent, then infusions of either cMABs, sotrovimab, or bebtelovimab should work.
  • If BA.2 is the dominant strain, the only viable cMAB option is bebtelovimab.
  • According to the PINETREE protocol, three days of short infusions of IV remdesivir works well for all VOC.
  • The last choice is oral molnupiravir.

COVID-19 knowledge keeps about as fresh as fish in the hot sun, so do respect our disclosure that this was up to date when published but may not be for long.

Stay strong. We are all in this together.

Brian Koffman MDCM (retired) MS Ed (he, him, his)
Co-Founder, Executive VP, and Chief Medical Officer
CLL Society, Inc.