Among immunocompromised people, many do not respond to the Covid-19 vaccine and they are most at risk of developing a severe form of the disease.
However, for the past few weeks, three effective treatments against Covid-19 have been supposed to protect them.
But in reality, very few immunocompromised people have access to it.
A situation that could change with new recommendations from the High Authority for Health (HAS) published this Friday on access to Evusheld, the only preventive treatment.
From now on, all immunocompromised patients over the age of 12 will be able to access it.
“Fragile people are condemned to self-confinement”,
feared Tuesday Magali Leo, head of the Renaloo Advocacy Division, an association of patients with kidney disease.
Since Monday, the masks have fallen, the more required passes to the cinema or to the restaurant… Good news for many French people, but anxiety for immunocompromised people.
Especially since the cases of Covid-19 are rising in a context of the lifting of restrictions.
“It is an excluding measure when we have the means to protect them!
“, Moves Magali Leo, who launched a call for solidarity on Monday to continue to wear the mask indoors.
Indeed, immunocompromised people respond little or badly to vaccination and are the first to risk ending up in intensive care.
But since December 2021, new effective treatments against Covid-19, prescribed in “early access” that is to say before obtaining its marketing authorization, are available in France.
Treatments that change the lives of these patients… Problem: access to these three treatments remains very limited.
But new recommendations from the High Authority for Health (HAS), published this Friday, could improve things.
Three treatments available in France for the immunocompromised
“Today, we have a mortality rate between 15 and 20% among immunocompromised people who are hospitalized for Covid-19”, insists Magali Leo.
However, three treatments have been available and effective in France against Covid-19 for a few weeks.
Two curative treatments: Xeludy, a monoclonal antibody with an intravenous injection.
And Paxlovid, an antiviral, in tablet form, therefore easier to use.
But with a limit for this pill: there are contraindications for patients who have anti-rejection treatment (thus transplant recipients).
“We will use one or the other”, warns Alban Dhanani, deputy director of Covid treatments at the National Medicines Safety Agency (ANSM).
And in both cases the patient must obtain it within the first five days after the symptoms or the positive test.
But there is a third treatment, arguably even more important.
Because it is the only one today that is used upstream, in prevention.
Indeed, Evusheld is a monoclonal antibody that requires intramuscular injection and protects against severe forms.
But a use that remains rare
“Today there is an under-use of these two types of treatment, both preventive and curative, worries Magali Leo.
Especially for the Evusheld, which is of great concern to us.
There are 100,000 immunocompromised people who fall within the indication and only 16,000 patients who received Evusheld.
With a lot of inequalities.
There are regions, notably Hauts-de-France and Brittany, where Evusheld is not prescribed very much.
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#OuiAuMasque 😷
✅ Let's stand in solidarity with immunocompromised people:
✔️ At very high risk
✔️ Badly protected by the vaccine
✔️ Having very low access to preventive and curative treatments #COVID19
👉 At work, inside #JeGardeMonMasque
Protect yourself, protect us !
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— Renaloo (@Renaloo) March 14, 2022
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A limited proportion confirmed by data from the ANSM (National Agency for the Safety of Medicines and Health Products).
For Evusheld, 16,291 requests have been accepted since the start of early access.
From February 28 to March 6, 2022, 816 new requests were accepted while from February 14 to 20, 2022, we reached 1,067.
So the pace slows down.
On the side of the AP-HP (39 hospitals and 10 million patients treated per year), "deliveries amount to more than 3,150 vials of Evusheld since January 2022, around 700 treatments with Xevudy and 240 treatments for the Paxlovid.
»
How can this low access be explained?
Is it a stock issue?
Not according to our interlocutors.
When asked, the Ministry of Health assures us that “the health authorities have been committed since the start of the crisis to allow rapid access to innovative drugs for patients who need them.
For example, French patients were the first in the world to benefit from Evusheld.
France has a large stock of all Covid treatments authorized today.
" Without specifying these figures ... " We are not lacking, confirms the ANSM.
On the Paxlovid, if the number of infections decreases, its use decreases, it is logical.
In fact, the numbers for this treatment are going up.
»
And on the Evusheld?
“Patients are misinformed, caregivers too and doctors who refuse to prescribe this preventive treatment, underlines Magali Leo.
Based on testimonials from patients who face refusals.
“However, the public authorities have implemented information channels on these treatments, she continues.
But we would have liked a firm message from the minister to doctors on this urgency to prescribe Evusheld.
There is undoubtedly the fact that all these treatments are in early access, so they have not passed all the stages of verification.
But there is also an organizational issue.
We fought for Evusheld not to be injected only in the hospital.
»
The Evusheld accessible at home
Clearly, and this is a first, it is always a hospital pharmacy that delivers the product, but it can be injected at home by a private nurse.
A huge boost to facilitate this access while relieving the hospital.
“But it does not work, regrets Magali Leo.
It is almost systematically injected in day hospitals.
However, “the hospital sector cannot absorb this demand, recognizes Alban Dhanani.
Relays are needed, city doctors, local hospitals, nurses….
»
And also bet on hospitalization at home (HAD).
What the AP-HP does in particular: "an in-depth reflection is carried out with Hospitalization at Home (HAD) to complete the offer proposed by the Hôtel-Dieu, this support is done on a case-by-case basis. cases, especially for patients who cannot move around.
»
What changes now?
But things could change on this complicated access to the Evusheld.
Provided that the information reaches the first interested parties, patients as well as prescribers.
Indeed, a notice from the HAS, which has just been published, has increased the number of beneficiaries of this treatment.
Until now, dialysis patients, people undergoing chemotherapy and minors did not have access to Evusheld.
From now on, all immunocompromised patients over the age of 12 will be able to benefit from it.
“We have received additional data which show us that it is possible to administer Evusheld to children from the age of 12 and weighing more than 40 kg, continues the ANSM expert.
They show that there is no major negative impact if they receive an adult dose.
»
Two other modifications, not necessarily known, also facilitate this access.
At the beginning, this preventive treatment was not prescribed to people with cardiovascular risks.
“With the hindsight we have today, we have reduced this recommendation.
In addition, a 72-hour PCR test had to be carried out, it is now possible to replace it with an antigen test.
Will this be enough to shelter the thousands of immunocompromised people?
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