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Pre-exposure Prophylaxis with Evusheld

Pre-exposure Prophylaxis with Evusheld
Updated Sept. 2, 2022

Pre-exposure prophylaxis for COVID-19 for those who are moderately to severely immunocompromised

What You Need To Know

  • In addition to following the recommended COVID-19 vaccination schedule, tixagevimab/cilgavimab (Evusheld), a combination of two monoclonal antibodies, should be administered to people who are moderately or severely immunocompromised every 6 months for pre-exposure prophylaxis to supplement vaccine protection. Per the product EUA, Evusheld can be given at least 2 weeks after COVID-19 vaccine. People may initiate Evusheld at any time after this interval, including between doses in the primary series and between any primary and booster doses.
  • This medication can provide protection for those not expected to mount an adequate immune response following vaccination, including those who are immunocompromised due to a medical condition or immunosuppressive medication, or for those individuals for whom COVID-19 vaccination is not recommended due to a history of severe adverse reaction to COVID-19 vaccination.
  • Evusheld is administered by intramuscular injection by a healthcare provider at an office or healthcare facility.
  • Current locations of EVUSHELD distribution can be found here.

The current treatment guidelines [5.4 MB, 456 pages] on the use of Evusheld as pre-exposure prophylaxis:

  • Tixagevimab 300 mg plus cilgavimab 300 mg (Evusheld) administered as two 3-mL intramuscular (IM) injections for adults and adolescents (aged ≥12 years and weighing ≥40 kg) who do not have SARS-CoV-2 infection, who have not been recently exposed to an individual with SARS-CoV-2 infection AND who:
    • Are moderately to severely immunocompromised or
    • Are not able to be fully vaccinated with any available COVID-19 vaccines due to history of severe adverse reactions
  • Tixagevimab plus cilgavimab should be repeated every 6 months.
  • Individuals who received tixagevimab 150 mg plus cilgavimab 150 mg should be given a second dose as soon as possible.
    • If the initial dose was administered ≤3 months prior, the second dose should be tixagevimab 150 mg plus cilgavimab 150 mg.
    • If the initial dose was administered >3 months prior, the second dose should be tixagevimab 300 mg plus cilgavimab 300 mg.
  • Individuals should be clinically monitored after injections and observed for at least 1 hour.
  • Evusheld is contraindicated in individuals with previous severe hypersensitivity reactions, including anaphylaxis, to Evusheld.
  • There is not currently sufficient evidence to recommend either for or against the use of SARS-CoV-2 serologic testing to assess for immunity or guide clinical decisions about using Evusheld for pre-exposure prophylaxis. For more information, see NIH’s COVID-19 Treatment Guidelines.

Evusheld and timing with COVID-19 vaccination

  • Evusheld may be given at least 2 weeks after any COVID-19 vaccine.
  • After this interval, Evusheld may be initiated at any time between primary series and booster doses.
  • COVID-19 vaccines may be administered at any time after Evusheld administration.
  • Use of monoclonal antibodies is not a substitute for COVID-19 vaccination.