Uptake of monoclonal antibodies and anti-viral therapies for COVID-19 in Scotland

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Summary in Plain English

Mutation of the coronavirus (SARS-CoV-2) has had an impact on the effectiveness of vaccines and treatments for COVID-19. In Scotland, some vulnerable groups are now eligible for COVID-19 treatments, including:

• Sotrovimab: a neutralising monoclonal antibody
• Nirmatrelvir/ritonavir: an antiviral drug, also known as Paxlovid
• Molnupiravir: an antiviral drug

These treatments are designed to prevent mild-to-moderate COVID-19 from progressing. There are also existing therapeutics given to people in hospital with COVID-19.

Why did we carry out this study?

We wanted to understand how many people have used these new treatments, and check if they were used in line with Scottish guidelines.

What data did we use?

Data for this study came from the Hospital Electronic Prescribing and Medicines Administration system (HEPMA) from 6 out of 14 Scottish Health Boards, and requested data from the remaining health boards. It covered the period between 21 December 2021 and 26 September 2022.

These records were linked with de-identified patient data on Scotland’s national COVID-19 surveillance platform Early Estimation of Vaccine and Anti-Viral Effectiveness (EAVE II).

Watch: What is EAVE II?

What did we find?

Uptake

We identified 28,660 people eligible for these new Covid-19 treatments, based on a positive PCR test and identified comorbidities. Of these, 40.0% (i.e. 11,465) required, and received, treatment:

• 3,056 (26.7%) were treated with Sotrovimab
• 5,436 (47.4%) with Paxlovid
• 2,793 (24.4%) with Molnupiravir
• 180 (1.6%) received multiple therapies (a.k.a. ‘treatment cocktail’)

Uptake of COVID-19 therapeutics varied in different groups who are at higher risk of being seriously unwell with COVID-19. The following proportions of potentially eligible patients were treated:

• 21.9% people identified with HIV/AIDS
• 22.5% people identified with rheumatoid arthritis or systemic lupus erythematosus
• 71.7% identified stem cell transplant recipients
• between 26.8 and 61.2% people with other identified coexisting diseases.

Treatment timing and compliance with recommendations

We found that 98.5% of treated patients were given treatment within five days of diagnosis.

Treatment was started on average one day post diagnosis for Paxlovid, and two days for molnupiravir, Sotrovimab and treatment cocktails.

Additionally, it was impossible to establish eligibility for these new Covid-19 treatments in 28.2% of people.

Were there any limitations?

The study was limited in three ways. First, it lacked data on cancer in the estimation of coexisting diseases. Second, data used did not include maternity or mental health inpatient records. Finally, there was no data on Covid-19 symptoms in eligible people: if they were very mild, or were getting better without treatment, they would not be offered treatment.

Why is this study important?

We have shown that less than half of potentially eligible, high-risk, PCR-positive people in Scotland were treated for COVID-19. However, those who did, received treatment within the recommended time frame.

Identifying groups of people who were less often treated can help to improve care pathways, and in turn reduce the need for hospital or intensive care admission.

The process of thorough data collection will also allow us to continue monitoring COVID-19 treatments, given in Scotland in outpatient settings.

Note

This plain English summary was written by our Public Advisory Group (PAG) member Kamil S, with the support and feedback of PPI Lead Dr Lana Woolford, PAG member Lynn L and EAVE II researchers.