COVID-19 Update for the LAM Community: Delta Variant, Vaccines, and Sirolimus

Posted on July 23, 2021   |   

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Just when we thought we had overcome the threat of COVID-19, we are now reading reports about the highly contagious Delta variant, an increasing number of cases, and persistent questions regarding vaccine efficacy. Will it ever end?

If you find yourself with thoughts along this line, you are not alone. The reality is that the detection and subsequent spread of another variant of the novel coronavirus is a part of the natural evolution of this virus and a common survival strategy employed by many viruses. In that regard, the surging cases of this new variant are not surprising. The most important factor driving this surge is the relatively large proportion of individuals who have not received the COVID-19 vaccination. Almost all serious infections and hospitalizations due to COVID-19 in the United States currently are among individuals who have not been vaccinated. A potential implication of this spread is that the current pool of infected individuals could act as a reservoir for more mutations and lead to another wave of infections in the future. It is important for you to continue to stay vigilant and informed about local and national trends.

In the meantime, and on a more positive note, the current vaccines seem to be providing excellent protection against this serious disease, including the new variants. Simply stated, COVID-19 vaccination is the best and the most powerful strategy for you to stay safe. So, if you have not yet received the vaccination, please do so at the earliest opportunity. For individuals who are unable to receive vaccination, be mindful of the local community's spread of COVID-19 and continue to take all precautions such as social distancing, wearing a mask, avoiding crowded spaces, and frequent hand washing. More information regarding COVID-19 vaccines, including how to find your nearest vaccination center is available here. Guidance for vaccinated patients with LAM and other COVID-19 related information relevant for the LAM community can be accessed here.

Another question we commonly hear concerns the degree of protection following vaccination, especially for LAM patients taking sirolimus. This concern has been intensified by the recent publication of a few studies showing suboptimal responses to vaccination in organ transplant recipients. It is worth highlighting that post-transplant patients are generally on multiple immunosuppressants compared with most LAM patients who are on sirolimus alone. To our knowledge, no LAM patient who has received the vaccination while being on sirolimus has acquired severe illness from COVID-19. We have also measured antibody levels following COVID-19 vaccination in about a dozen LAM patients on sirolimus and the majority (>90%) of the patients have mounted a response to the vaccination. While we don’t know what level of antibody response is protective, the above-mentioned observations are reassuring and suggest that LAM patients are getting decent protection from the COVID-19 vaccination, whether on sirolimus or not.

As some of you might know, we conducted a pilot study to investigate whether sirolimus might benefit hospitalized patients with COVID-19. The results of the study are being analyzed currently; however, it is clear that, at a minimum, the administration of sirolimus to patients with COVID-19 was safe. This provides another layer of reassurance not to delay or hold sirolimus treatment for LAM due to the pandemic. The downside of lung function loss due to unchecked progression of LAM outweighs any potential benefit of protection against COVID-19.

Lastly, a group of scientists has compiled outcome data from the worldwide network of LAM clinics to better understand the impact of COVID-19 on patients with LAM. The good news is that it appears the vast majority of LAM patients have done well and successfully recovered following COVID-19. We will share more details regarding these findings in the near future, following the completion of our data analysis.

These are uncertain times, and it can feel as though there are always more questions than answers. We are fortunate to have a well-connected and active network of world-class pulmonologists who are listening, learning, and sharing their experiences treating LAM, COVID-19, and other lung conditions. We hope the above-mentioned insights from our collective experiences provide helpful information and reassurance to the LAM community. Staff at The LAM Foundation and The LAM Foundation’s Scientific Advisory Board are closely monitoring the COVID-19 pandemic, and we will continue to update you as new developments arise.

 

About Nishant Gupta, MD:  Dr. Gupta is The LAM Foundation’s Scientific Director, and an Associate Professor in the Division of Pulmonary, Critical Care and Sleep Medicine at the University of Cincinnati, where he serves as the director of the interstitial and rare lung diseases program. Dr. Gupta’s clinical and research focus is on the field of rare lung diseases such as LAM, and his work is aimed at better defining the natural history, improving detection, and developing novel treatment modalities and monitoring strategies for LAM patients.



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