This Week in Managed Care: March 26, 2021

Efficacy data on AstraZeneca’s COVID-19 vaccine are questioned by a US health body, the NCCN 2021 Virtual Annual Conference spotlights innovations in cancer care and opportunities for reform, and COVID-19 poses significant risks to children with poorly controlled type 1 diabetes.

Welcome to This Week in Managed Care, I’m Matthew Gavidia.

Data on AstraZeneca Vaccine Efficacy Questioned by US Health Body

This week, AstraZeneca announced that its COVID-19 vaccine was shown in a US clinical trial to be 79% effective in preventing the virus, with no safety concerns found amid recent unproven links to blood clots in Europe.

However, shortly after the announcement, the Data Safety Monitoring Board, an independent committee overseeing the US trial, expressed concern to the US National Institute of Allergy and Infectious Diseases that the company may have released outdated information on the trial that would create an incomplete view of the efficacy data.

“This kind of thing does...nothing but really cast some doubt about the vaccines and may contribute to the hesitancy,” said Anthony Fauci, MD, on ABC’s “Good Morning America.” “The data really are quite good but when they put it into the press release it wasn’t completely accurate.”

As AstraZeneca moves to publish up-to-date results, Johnson & Johnson saw a setback this week with reports that it may miss its vaccine delivery deadline.

Having promised to deliver 20 million doses of its single-shot COVID-19 vaccine to the federal government by month’s end, early numbers are showing that only 20%, or 4 million doses, have reportedly been delivered thus far, while 4.6 million have been distributed to states and federal vaccine programs.

After months of rapidly declining case numbers, 7-day averages of daily new cases of COVID-19 are on the rise by at least 5% in 27 states, with several European countries also facing a potential third surge.

Despite this, the European Union has drafted legislation that will cut back its export of COVID-19 vaccines manufactured among member countries for 6 weeks. The 3 vaccines approved in the European Union—Pfizer/BioNTech, Moderna, and AstraZeneca—could all be affected, with AstraZeneca reportedly being the main target following its decision in January to reduce its vaccine supply by more than half.

For more, visit AJMC.com.

National Comprehensive Cancer Network 2021 Annual Conference

Last week, the National Comprehensive Cancer Network, or NCCN, held its 2021 Annual Conference in a virtual format.

Addressing topics across the field of cancer care, this year’s keynote session brought a panel of patient advocates and experts together for a timely and necessary discussion about strategies to reduce racial disparities in oncology.

Spanning from implicit bias in care delivery to a lack of representation in the oncology community, panelists discussed root causes and solutions to these complex disparities.

Additional topics of this year’s sessions include:

• better connecting oncologists and primary care physicians
• barriers and interventions for cancer survivors returning to work
• opportunities with CAR T-cell therapies
• and much more.

For full conference coverage, visit AJMC.com.

COVID-19 Poses Significant Risks to Children With Poorly Controlled T1D

According to a study presented this week at ENDO 2021, the Endocrine Society’s annual meeting, pediatric patients with poorly controlled type 1 diabetes have a 10 times greater risk of complications and death from COVID-19 compared with children whose diabetes is well controlled.

Although some data have been published linking type 1 diabetes in adults with higher COVID-19 risks, limited data have been made available for pediatric populations with type 1 diabetes and COVID-19.

Using TriNetX, researchers gleaned real-time electronic medical records data of approximately 2000 children with type 1 diabetes and COVID-19 and more than 300,000 children with COVID-19 without diabetes.

Defining poorly controlled diabetes as glycated hemoglobin, or A1C, levels higher than 9%, data showed mortality rate, endotracheal tube use, and risks of pneumonia and septic shock were higher in children with type 1 diabetes and COVID-19 compared with children who only had COVID-19.

“This study shows keeping diabetic children's blood sugar under control is more important than ever during the pandemic,” said study author Manish Raisingani, MD. “The findings will help children with type 1 diabetes and their families make better choices about the safety of attending school in person and engaging in other in-person activities during this pandemic.”

For more, visit AJMC.com.

Reasons for COVID-19 Vaccine Hesitancy in Patients With Blood Cancer Are Complex

A survey released this month of US patients with blood cancers shows a somewhat surprising level of hesitancy about receiving a COVID-19 vaccine, with those reluctant also less likely to engage in self-protective behavior.

The nationwide survey of more than 6500 individuals found that only about half said they were “very likely” to get vaccinated, and 1 in 3 were unlikely or unsure.

Given that patients with leukemia and lymphoma are more likely than patients with other cancers to get seriously ill or die from COVID-19, Gwen Nichols, MD, chief medical officer of The Leukemia & Lymphoma Society, spoke in an interview with The American Journal of Managed Care^® on the importance of preventive action among these populations, especially for those who are undergoing immunosuppressive therapy.

As Nichols notes, one issue cited by patients is that COVID-19 vaccine trials did not include oncology patients, leading to physicians being unable to give a straightforward answer on efficacy and safety.

“We feel pretty comfortable about saying it will be safe for most patients, but obviously, each patient as an individual needs to talk to their doctor,” Nichols added. ”But the question of efficacy is a real one, and patients are responding to that, because they're concerned that they'll get side effects from the vaccine and no benefit."

Although scientists are not exactly sure why those with hematologic cancers have worse outcomes than other patients with cancer if they contract COVID-19, the general belief is that compromised immunity, in the form of B-cell depletion and fewer CD8+ T cells, is the culprit.

As more states end mask mandates and social distancing measures even as the level of infection nationwide remains high, it is especially important for family members of patients, who may not be able to get vaccinated due to active treatment, to get immunized and to continue wearing a mask and take precautions, said Nichols.

For more, visit AJMC.com.

For all of us at AJMC^®, I’m Matthew Gavidia. Thanks for joining us!