As the world continues to gain a better understanding of COVID-19 and ever present and new variants, Global Liver Institute wants to ensure that we are here to continue to guide, educate, and support the liver cancer community and other immunocompromised patients.
Liver cancer patients currently have the second highest risk of breakthrough infection compared with other cancers. Since advanced liver disease and liver transplant may increase the risk of severe COVID-19, it is important to know what therapies are available to you. It also remains important to avoid delays to care for any new liver diagnosis or to maintain your existing care path. Additionally, patients with underlying health conditions or people who already have a difficult time accessing care or maintaining distancing precautions given life circumstances may be more at risk for developing “long COVID” or post-COVID conditions.
As a patient, you may feel overwhelmed with updated guidelines, therapies, and treatments. Despite the uncertainty for high risk individuals, there are many options available to prevent infection or serious disease from COVID-19. Below, we have provided a guide on how you can take proactive steps to give yourself the best chance to stay COVID-free during this time.
As always, it is important to consult your doctor and care team to learn more about prevention or treatment decisions.
What’s Available Today?
- Prevention
- Evusheld antibody treatment
- Vaccines
- Schedule and receive additional doses in accordance with the CDC guidelines, in addition to receiving a second COVID-19 booster shot
- mRNA vaccines (such as from Pfizer-BioNTech and Moderna)
- Vector vaccines (such as from Janssen/Johnson & Johnson and AstraZeneca)
- Protein subunit vaccines (such as from Novavax)
- Schedule and receive additional doses in accordance with the CDC guidelines, in addition to receiving a second COVID-19 booster shot
- Treatment
- Monoclonal antibody treatments must be taken shortly after presenting symptoms and testing positive for COVID-19: baricitini (Olumiant), tolcilizumab (Actemra), Bebtelovimab
- Antiviral treatments:
- Pills: nirmatrelvir plus ritonavir (Paxlovid)* and molnupiravir (Lagevrio)
- Intravenous: remdesivir (Veklury)
- COVID-19 convalescent plasma
Please consult your doctor prior to making any prevention or treatment decisions. Also, recognize that not all physicians have access to all these interventions. *Paxlovid is not recommended for people with serious kidney or liver disease, or should be prescribed with caution in patients with liver conditions or liver enzyme abnormalities since ritonavir is capable of causing liver damage.
Prevention:
FDA Emergency Authorization Approved Therapies before COVID-19 Exposure
Evusheld is an antibody treatment that you can receive if you are someone who has a moderate to severe compromised immune system, and thus might not receive full protection from the COVID-19 vaccines. This treatment is also available to individuals who cannot receive the COVID-19 vaccination due to having severe adverse effects. You can receive this treatment from a medical provider as two intramuscular injections, given one after the other. Please contact your medical provider for more information on how to receive this treatment.
COVID-19 vaccines for immunocompromised patients: Patients who are taking immunosuppressants or who are immunocompromised might not have the same immune response after the COVID-19 vaccine as other patients. Because of this, per the CDC, immunocompromised individuals who are 12 years or older are recommended to receive 4 doses of the mRNA COVID-19 vaccine. For more information on vaccination protocol and schedule please consult your medical provider or local pharmacy. Check out the CDC guidelines here.
Consult with your providers prior to making any prevention decisions.
Treatment:
Available Therapies after COVID-19 Exposure or Diagnosis
The Biden-Harris Administration launched a new nationwide Test to Treat initiative to give people a faster and easier way to access COVID-19 treatment information. With this program, individuals can get tested – and if they test positive for COVID-19 – and find appropriate treatment options, receive a prescription from a health care provider, and get their prescription filled– all at one location. A locator for these “one-stop Test to Treat” can be found here.
Monoclonal antibodies can be taken shortly after presenting symptoms and testing positive for COVID-19 infection. These include Bebtelovimad, Olumiant, and Actemra.
Antiviral treatments are administered through pills or intravenous drugs used to treat mild to moderate COVID-19 infections. Paxlovid* and Lagevrio are pills that should be taken as soon as possible after diagnosis. Veklury is an IV antiviral treatment that is administered for high-risk, non-hospitalized individuals that have tested positive for mild to moderate COVID-19 infection.
*It is important to note that Paxlovid should be prescribed with caution in patients with liver conditions or liver enzyme abnormalities since ritonavir is capable of causing liver damage.
Individuals who previously tested positive for COVID-19 and have developed antibodies can donate their plasma to help immunocompromised patients fight against this infection. This COVID-19 convalescent plasma treatment is available in hospitals to help fight severe infection.
Consult with your providers prior to making any treatment decisions.
As always, it is important to stick to the basics to prevent COVID-19 infection:
- Wash your hands. Clean your hands frequently, with soap and water for at least 20 seconds or use hand sanitizer with at least 60% alcohol.
- Stay up-to-date with COVID-19 vaccination and boosters.
- Wear a mask when appropriate to protect yourself and others, especially when indoors. As mask-use guidelines change, it is critical that high risk individuals continue to wear a high-quality mask.
- Avoid crowds and poorly ventilated areas. The more exposure you have to individuals, the higher the chance of infection.
- Monitor your health daily.
- Avoid close contact with people who are sick.
- If you have traveled or been exposed, get a COVID-19 test 3-5 days after exposure or event.
From the Transplant Patient-in-Chief
Hello and welcome to Spring! The world is reopening, and we want to be a part of it.
As one of my favorite Peloton instructors says, “I make recommendations, you make decisions.” I am not even going that far, but am just telling you what actual decisions I have made – which you can take or leave. I have been part of the Johns Hopkins Vaccine Effectiveness Study, so I knew I had no antibody response to the 1st two shots. At this point, I have had 2 Pfizer vaccines and 3 Moderna vaccines with no worse side effects than feeling sleepy and having a sore arm for a day. I have kept all my regular doctor’s appointments and procedures. I have been out to dinner, a concert, several meetings, and 3 large events in the US and Europe. I wear a mask, carry hand sanitizer, and wash my hands (which, frankly, I did before COVID-19 as well!). I do intend to ask my transplant team to receive Evusheld. I also take a home antigen test before each event to protect others with whom I would interact. I am enjoying life following the best medical advice and common sense.
Donna R. Cryer, JD
President & CEO
Global Liver Institute
Additional resources:
American Association for the Study of Liver Disease (AASLD) COVID-19 and the Liver | AASLD
American Society of Clinical Oncology (ASCO) ASCO Coronavirus Resources | ASCO
American Society of Transplantation (AST) COVID-19 Information | American Society of Transplantation (myast.org)
The European Association for the Study of the Liver (EASL) COVID-19 and the liver – EASL-The Home of Hepatology
The European Society for Organ Transplantation (ESOT) COVID-19 Vaccine Studies • ESOT
