When should myeloma patients consider using EVUSHELD vs a COVID-19 booster? 

This week's "Ask Dr. Durie" comes from a patient concerned about whether or not he should take a second COVID-19 booster or consider the intramuscular shot treatment called Evusheld. 

This is an excellent treatment and the answer depends upon the status of the myeloma and also the type of treatment being used currently. 

If there has been just a recent diagnosis of myeloma and early induction therapy, or if there has been a recent relapse with an aggressive new therapy, then this is a situation where antibodies to a booster shot could be very poor. The reaction is poor in the setting of aggressive active treatment. And so, in this situation, it is a good idea to consider the intramuscular shot with the Evusheld, which gives the patient the anti-COVID-19 antibodies. 

So, this is an excellent way to boost the antibody levels without getting a booster shot, but by actually giving the antibodies. Now, if the myeloma is in remission, and you're maybe off treatment, or maybe taking some very low-level maintenance, it is reasonable to go ahead and just consider that second booster and perhaps check the antibody levels after that and go from there. 

Another important consideration is what is the level of COVID-19 infection within your community. If there's a high level of infection, you know five-to-ten percent level, then it might be important to get those antibody levels up as quickly as possible. And so, then again the Evusheld shot is a good idea.

So, BOTTOM LINE:  It's excellent that we do have this Evusheld option available. I have discussed this in more detail in different blogs and also prior Ask Dr. Durie videos, but the answer to this question is strongly consider the Evusheld, particularly if you are on very active treatment for the myeloma.