Patient worried about changing treatments after monoclonal antibodies reserved for COVID

The Saskatchewan government has made monoclonal antibodies available to COVID-19 patients during the fourth wave, but immunocompromised patients who regularly rely on those treatments feel like they’re getting the short end of the stick.

Tammy Peters has been receiving monoclonal antibodies as a treatment for her rheumatoid arthritis for almost a decade. When COVID first hit Saskatchewan, however, she was told she might need to change her treatment so others can receive the medication.

“At the beginning of the pandemic, we were kind of notified that Actemra could become in short supply via the IV form of it,” Peters said.

There are different types of monoclonal antibodies. Some of the antibody treatments for patients who are sick with COVID can help strengthen their immune systems. The form Peters uses helps depress her immune system, and can be used to help “reset” their immune systems, Peters explained.

She was willing to make the switch when she first heard the news if it meant someone who was sick might benefit, especially without other treatments known at the time for COVID.

Now, with a vaccine available, Peters is less willing to compromise her treatment for people requiring the same medication, especially given the consequences she faces every time she changes her treatment.

Even the same drug in different forms can result in a different reaction, she explained, and sometimes changing to the same drug in a different form — like moving to an injection version of Actemra instead of the IV version — could lead to her developing an allergic reaction to the initial form of the drug.

In this case, as it has been a long-time solution for her, such a change would be devastating for Peters.

Her fear isn’t unfounded. While developing an allergy based on changing medications isn’t extremely uncommon, Peters said it already has happened to her a few times with different treatments.

“I have a fairly wonky immune system. I’ve been at this a little while so anytime I tend to start and stop a medication, I tend to develop an allergy to it,” Peters said.

“I do not like changing my medications.”

A life of chronic illness

Asked how she’s doing, Peters replied: “As well as can be expected when you’re immunocompromised during a pandemic.”

She’s giving that answer a lot these days.

Peters was first diagnosed with rheumatoid arthritis when she was 14. She’s now 49, and “as people do with autoimmune issues, I’ve collected some over the years.”

Multiple surgeries on her knees and a wrist and a diagnosis with fibromyalgia further complicated her health status, eventually forcing Peters to leave her work as a chemist.

“I do think my interest in it would stem from having to rely on medications at such a young age,” she reflected, adding she has always found it “kind of curious” how much faith society puts in medications to repair bodies.

Her current drug, Actemra, is an immunosuppressive drug that’s used to treat some forms of arthritis. Every month, for an hour, she reports to a clinic in downtown Saskatoon to receive her infusion of the drug. The alternative, which she has been warned she may need to switch to, is a weekly injection.

Peters has been receiving IVs for 17 years.

“I find it fairly low stress,” she said. “They hook me up to my little IV bag and I sit there and crochet for an hour, hour and a half, and then I’m good for another four weeks.

“My infusion almost lasts the four weeks. I can definitely feel it waning towards the end.”

Crocheting is a form of relaxation for Peters, especially since the pandemic started. She has been connecting with other crocheters online through “crochet tok” or “yarn tok,” a genre of videos on the popular social media platform TikTok dedicated to crocheting.

“This old dog has actually got a TikTok account,” she said with a chuckle.

Her recent projects have involved a lot of plushy pop culture characters like Baby Yoda, Chewbacca and Groot, as well as dinosaurs and unicorns. She also makes the traditional sweaters, scarves and hats — basically whatever someone asks for.

“I do it as pain management, actually,” she explained. “Whenever I feel fibro pains coming on … if I just sit calmly, quietly and crochet something, I can get through a lot of it without having to take extra painkillers.”

Peters called it her coping strategy — it’s a constant for her to help her get through some of the unknowns surrounding her health, like when the government announced monoclonal antibodies would be coming to the province to help COVID patients.

She said there wasn’t any surprise “at all” when the government made the announcement, and she has been grateful to have avoided having to change her medication up to this point.

“Of course that means it’s going to apply (to) a lot more people,” she said. “I was like, ‘Crap.’ ”

The switch to injections would help keep Peters on the same medication, something her doctors want to avoid the risk of her pain increasing.

Province reports low uptake in treatment use

As of Oct. 28, the Saskatchewan Ministry of Health told 650 CKOM in an email that only four COVID-19 patients had been treated with monoclonal antibodies.

During a provincial technical briefing on Tuesday, Saskatchewan Health Authority CEO Scott Livingstone confirmed the total patients in the province who had received the treatment was “under 10.”

The chief medical health officer for the province, Dr. Saqib Shahab, emphasized the COVID-19 vaccine is still a much better and preferred course of treatment for COVID-19. He also noted fewer positive cases combined with an already-strict set of eligibility requirements mean the treatment is only available to some patients.

“Everywhere in the world, monoclonals have a specific and limited role,” Shahab said Tuesday. “Their scope is quite limited.”

But Peters is within that limited scope, and the situation is frustrating for her.

“It seems like the majority of the people who are going to need these interventions are people who refuse to get vaccinated. I’m starting to feel like, ‘Should my health be taking a backseat to somebody who couldn’t be bothered to get a vaccination?’ ” she said.

“I’ve got enough problems in my life right now, I just don’t want to do the shot (of Actemra) if I don’t have to.”