S2095 Retrospective Study Assessing Acceptance of Tixagevimab and Cilgavimab (Evusheld) Among Immunocompromised Patients

Introduction: Immunocompromised patients are more likely to have an inadequate antibody response to Covid-19 vaccination and severe infection requiring hospitalization. On December 8, 2021, the U.S. Food and Drug Administration issued an Emergency Use Authorization to make tixagevimab and cilgavimab (Evusheld) available for pre-exposure prophylaxis of coronavirus disease 2019 (COVID-19). We aimed to assess the number of qualified patients who received Evusheld after clinic visits or in-hospital consults with the gastroenterologists, and administration was documented in the chart. Methods: A retrospective chart review study of high-risk patients for COVID-19 who had been evaluated by a gastroenterologist between December 8, 2021 and January 26, 2023 was reviewed. Inclusion criteria were the following: received a solid-organ transplant within 1 year, used biologic agents, immunosuppressive medications, or high-dose corticosteroids (i.e., ≥20 mg prednisone or equivalent per day when administered for ≥2 weeks). The primary objective was to assess the number of patients satisfying inclusion criteria who were offered Evusheld. Results: Ninety-eight patients satisfied the inclusion criteria. There were 34 female and 64 male patients in the study. Twenty-three patients had underlying alcoholic cirrhosis, 23 patients had autoimmune hepatitis, 24 patients had ulcerative colitis, 4 patients had Crohn’s disease, 2 patients had alcoholic hepatitis, 7 patients had a history of liver transplant, 4 patients had combined liver and kidney transplantation, 5 patients had human immunodeficiency virus, 3 patients had primary sclerosing cholangitis, 2 patients had primary biliary cirrhosis, and 1 patient had neuroendocrine tumor of the pancreas. Thirty-nine patients received 2 or less doses of COVID-19 vaccine. The mean body mass index was 30.1, which highlights a high-risk group of patients. Ninety-two patients were not offered Evusheld. Only 6 patients were offered Evusheld, 5 patients received Evusheld, and administration was documented in the chart. Conclusion: We were disappointed to find how few qualified patients were offered and received Evusheld. Possible barriers included lack of physician education, or a lack of confidence in using Evusheld, leading to underutilization of effective and potentially life-saving treatment. Evusheld recently lost its authorization due to resistance of the new COVID-19 Omicron variants to Evusheld. We consider our study important as we identified evidence of strong underutilization of a potentially life-saving treatment.