- Kidney Wales
HomeNews

COVID-19 Treatments and Neutralising Monoclonal Antibodies

An Update with Dr Mike Stephens

Consultant Transplant Surgeon, University Hospital of Wales

 

Kidney Wales Facebook Community

25 January 2022

 

On the 25th of Jan 2022, Dr Mike Stephens, Consultant Transplant Surgeon at the University Hospital of Wales in Cardiff, answered your questions relating to the latest COVID treatments including neutralising monoclonal antibodies in this live session hosted on the Kidney Wales Community Facebook Group. A big thank you to Dr Stephens for dedicating his time once again. In this item you will find a break down of the questions and answers from his latest live.

 

Questions were submitted in advance by 18 people with over 100 joining the live session.

 

The video can be viewed on the Kidney Wales YouTube page here

 

Find the key messages from the live session here

Your questions answered

Qp1) What percentage of transplanted patients develop antibodies after immunisation?

Qp2) Has the vaccination programme reduced the incidence of infection in the transplanted population?

Qp3) Has the mortality rate changed since the vaccination programme?

A) Research has shown that antibodies are detectable in a most transplant patients’ blood after two doses of the vaccine around two thirds of the time. A third primary dose for immunocompromised patients increases the number of antibodies. Though there is a proportion of patients who have not shown any signs of antibodies even with a third and fourth dose.

This is still developing information, based on a modest sample size of transplant patients, we should bear in mind that even if blood tests do not show signs of antibodies, it does not mean that individual has no protection against COVID. Antibodies are not the only part of the immune system that we need to fight against coronavirus, with some studies showing patients who do not have many antibodies on a blood test still having a level of protection from the virus, which is preventing them from getting severely sick.

Some analysis has been taken from patients in South Wales, again an exceedingly small cohort of patients. It is clear those who have antibodies in their blood are less likely to pick up and get severely unwell from COVID.

The vaccine program was reducing the cases of COVID. However, the Omicron variant is much more contagious although less harmful. There are signs of an increase in patients testing positive of COVID. Omicron cannot be compared to the first and second waves of coronavirus, when most patients were still shielding, because we know that a lot of patients are not shielding now. It’s possible the increase in patients with the virus may be related to people being more mobile in addition to Omicron being more contagious. We do know that only an exceedingly small number of those infected are going into hospital care. A stark difference from the first and second wave, when we were seeing around 40% of patients with the virus becoming unwell and ending up in hospital, along with a high fatality rate.

Currently we have the highest number of patients with COVID. This is being monitored very closely. Dr Mike Stephens looks after over a thousand patients in South-East Wales, sixty of the patients he sees have contracted COVID since Christmas. A peak since the beginning of the pandemic.

Only a small number of positive patients require hospital care, with no deaths. Medical professionals are seeing a different phase of the pandemic, much of which is down to the vaccinations.

 

Q) When will the 4th Covid 19 vaccination be rolled out in Wales? I’m worried that I’ve fallen off the radar and my GP doesn’t have any information.

A) Most patients should now have been given a date or had their fourth dose. Although we know some third primary doses had been labelled booster, the vaccination teams have worked hard organising the information over the past few weeks to make sure patients who are eligible have been contacted for their fourth dose or booster. If you are still concerned, please contact your kidney team, they can confirm your vaccines are labelled correctly with the vaccination centres.

 

Q) With increased calls for children to be vaccinated do you support this and if so, why? Are there any additional risks to children with kidney disease?

I only ask because of all the children I know who have tested positive, the vast majority have been totally asymptomatic. With such a strong take up by the adult population and there seemingly being very little serious risk to children who catch it why would they need a vaccine?

A) If children are considered vulnerable or are living with kidney disease catch COVID they have a higher chance of getting unwell. Children in general are more likely to have a mild illness. The benefits of vaccinating children in the general population are less than that of adults. The vaccines are extremely safe and very rarely do you see complications. Understandably there may apprehensions to put your child forward for anything that has a risk to. These vaccines have been carefully tested before being introduced to the population. An incredible number of people been vaccinated, with several millions being delivered in Wales alone and rarely are we seeing complications. There are a small number of cases, but they are exceptionally small. Having your child vaccinated reduces the risk to themselves and others.

Please be aware, further guidance is being sought regarding vaccinations in children under the age of twelve.

 

Q) Why do you think an experimental vaccine is an effective way to protect vulnerable people? There is no long data and the short-term data. i.e., the yellow card scheme does not read well. Being a scientist, I cannot see how you can recommend this as a treatment. My child who is a kidney transplant patient ended up having adverse reactions with hospitalisations after having this experimental drug. Surely this experiment needs to stop.

A) There are no experimental drugs being introduced to the public. Experiments were completed before it was introduced, it is most certainly not causing widespread harm. It is important that you make your own informed decisions. Deciding whether to be vaccinated is your choice and will be fully respected.

 

Q) Are there any research available yet regarding the anti-viral treatment? If I was positive what is the process to follow?

A) There is information available. Sitrovimab, the nMAB is very safe and highly effective. We know the oral antiviral Molnupiravir is safe for kidney patients to take, with minimal side effect, however, isn’t very effective in kidney and transplant patients. The newest anti-viral drug, Paxlovid, is much more effective at treating the Omicron variant of COVID but is complicated to give to kidney and transplant patients. It can’t be given to patients with low kidney function, and it interacts with some of the anti-rejection medications taken by transplant patients.

The current treatment process relies on a central team, made up of pharmacists and drug experts. They monitor the PCR results daily cross referencing with a list of those eligible for treatment. When a patient tests positive on a PCR they will contacted to discuss the options available.

You should take a lateral flow test if you have no symptoms but are concerned you may have caught COVID. Kidney patients should get PCR tested, if you test positive on a LFT you need to book a PCR to activate this new treatment system.

More and more patients are taking up the options for treatment. There is lots of evidence to show that this is a good and safe drug and reduces your risk of getting severely unwell from COVID.

 

Q) PCR tests are important. How do patients get a hold of PCR tests, and will there be any monitoring for reaction to the new treatment? How soon after they have had a confirmed test should they attend clinic to check any change to Kidney function?

A) Wales has not yet introduced home testing kits unlike England where patients have a home PCR test automatically sent to them. Kidney Wales as well as Dr Mike have been in contact with Welsh Gov about this topic. There is no plan to change this in Wales, you can book a PCR test very quickly, with results being back in 24hrs. The new treatment does not need to be given within the first 24hrs of testing positive. Patients can be treated from day three to five.

You should discuss any concerns around treatment access with the team when they phone you about your symptoms cover your treatment options. If you are not eligible for treatment or unable to get to a hospital, oral antivirals will be offered instead, there is an efficient system in place for home deliveries.

 

As of 07/02/2022 Welsh Gov have confirmed that you can use either a LFT or PCR test to access treatment options “If you have symptoms of COVID-19 you can use either a Lateral Flow or PCR test when testing.  If you use a Lateral Flow test you must report the result or by calling 119. If you have a PCR test you do not need to report the result.”

Providing you report the LFT results as guided on the government website, this will trigger the process of an expert getting in touch to discuss if there would be a benefit to having one of the new treatments. 

Read more here – https://gov.wales/covid-19-treatments 

 

Q) If I have COVID, will I need to ring the Transplant Clinic straight away or wait till it becomes worse?

A) It is important that you get a PCR test. The teams should be picking up who is positive, they are notified of every positive PCR test. Transplant patients in Cardiff are recognised as some of the most vulnerable, the team goes through the list of patients who have tested positive daily. If you are concerned or want to update them yourself, please give your kidney team a call and inform them that you have tested positive.

 

 Q) Hi Mike, you were all utterly amazing with my recent COVID-19 infection. I found the communication from the antiviral team quite distressing and was full of mis information. When the Pharmacist rang it was very efficient and again, your team were excellent. Has this now been more streamlined?”

A) This has become a more streamlined process. In the beginning this was the experience many patients had. The calls were being received by unexpecting patients who felt they were not given enough information. This has been modified and a better service is now in place with great pharmacists’ assistance.

 

 Q) I was transplanted March last year, I caught covid Dec 30th 2021, I was rough for a while and was given molnupiravir and also a course of steroids, I’m still testing positive on lateral flow (only symptoms I got is headache and cough) I’m still isolating, transplant clinic in Morriston has said about antibodies treatment if I’m still testing positive at 30 days, what does this involve and is it normal for immunosuppressed to be testing positive this long (Dr told me to carry on isolating until I get 2 negative lateral flow tests)”

A) It is normal to still be testing positive. Transplant patients will clear this virus slower than someone who is not on antirejection medication. We have seen some patients still be positive on a LFT two weeks later and sometimes longer. There is still a bit of uncertainty as to whether this means you are still in infectious. If you are still testing positive on the lateral flow tests then there is a possibility you can still pass this on, if this is the case remain careful with what you do and who you see. Inform your clinic so they can advise when you can return.

The team in Cardiff don’t anticipate the virus causing problems with kidney function. Anti-rejections may have been adjusted while you were positive, but there would be no need to go back to clinic in the first three weeks. If you must visit there are procedures in place to make this as safe as possible.

 

Q) What are the outcomes in research of COVID vaccination in transplant patients and antibody production?

A) There are many ongoing antibody and treatment studies. We expect papers to be released soon based on a study in Cardiff. A recent UK study has shown that the AstraZeneca vaccine was better for transplant patients. The data in Wales is varies, there is no significant evidence to say that one vaccine is better than another, we do know that with transplant patients the response rate is not as high. It is important to note that the vaccines are working, fewer patients are going to hospital and ICU. We are in a better place now and even though we have treatments we should still be careful and considerate.

 

Q) I had a negative antibody test, done as part of the Melody Study 3 months after 3 doses of Pfizer, then paid for a private antibody test (run through NHS lab) 1 month after my fourth vaccination with Moderna and again it was negative. What are the options for someone like me? I will take whatever is offered to protect myself, but I feel so disheartened that after 4 vaccines I have little to no protection. I feel like unless I shield indefinitely (hard to do when you live with a school going teenager and a doctor husband at home) I am just waiting to catch it and hoping that the monoclonal antibodies will work for me when I do. I’m enrolled in PROTECT V trial of Niclosamide also.

A) It is understandable that this situation would cause some anxiety. Although antibodies may not be detected in the blood, this does not necessarily mean there is no protection against COVID. Studies are showing patients who do not have many antibodies on a blood test still have a level of protection from the virus, which is preventing them from getting severely sick. The good news is medical teams are seeing a less harmful virus in Omicron.

 

Q) Does this treatment give us any more freedom i.e., visiting large venues knowing that if we catch Covid there is a safety net. Also is this only available in the U.K. meaning that foreign travel is still not advisable?

A) This is not the time to drop our guard. You should still be sensible, especially for the next few months. There has been a lot of research into this and as time passes more treatments will become available.

 

Q) Do you think those with organ transplants will need more jabs in the future?

A) Vaccinating every six months is very unlikely to be long-term solution. In the next year or two, while we are developing a natural immunity and learning more of the e virus, we could reach a point of annual vaccines, like flu, and will have better treatments.

What you said about the Q&A session

 

“Most interesting and informative – thank you”

 

“Thank you for giving up your time. Very grateful and as always you are down to earth and very reassuring❤”

 

“Thank you for the in-depth information.”

 

“Thanks for this session all. Once again very helpful and is very reassuring.”

 

“Thank you for giving up your time to help inform so many people”

 

“Very helpful thank you so much appreciate it a lot thank you both so much as always very very helpful”

 

“Thank you so much. Very helpful and positive ”

 

“Thank you both so much. informative and reassuring as always.”

 

“Diolch yn fawr.”

 

“Informative as ever and [we were] very grateful for your call to check and advise [us] this week after [he] tested positive. Thankyou”

 

 

Helpful Resources