What is it about?
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: a viral replication inhibitor. 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. We wanted to understand how many people have used these new treatments, and check if they were used in line with Scottish guidelines. 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). We identified 28,660 people eligible for these new Covid-19 treatments. Of these, 40.0% (i.e. 11,465) 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 eligible patients were treated: • 21.9% people with HIV/AIDS • 22.5% people with rheumatoid arthritis or systemic lupus erythematosus • 71.7% stem cell transplant recipients • between 26.8 and 61.2% people with other coexisting diseases. 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. It was impossible to establish a diagnosis date in • 76.3% cases treated with Paxlovid • 61.5% with molnupiravir • 47.5% with Sotrovimab • 46.1% for treatment cocktails. It is likely that this because a positive lateral flow test (LFT) result was not officially recorded. Additionally, it was impossible to establish eligibility for these new Covid-19 treatments in 28.2% of people. The study was limited in three ways. First, it lacked data on cancer in the estimation of coexisting diseases. Second, data used only came from general/acute inpatient records but not from other departments, for example maternity or mental health. Finally, there was no data on Covid-19 symptoms in eligible people: if they were very mild, they would not be offered treatment.
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Why is it important?
We have shown that only a fraction of people eligible for new COVID-19 treatments received them in Scotland. However, those who did, received treatment within the recommended time frame. Identifying people who miss out on available treatments 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.
Perspectives
There was no way to work out who had actually contacted the helpline to get treatment, and that in itself is an important finding to me. In the future, we need to make sure we build ways of collecting that data into the set up so we can monitor if certain people are less aware that they are eligible for treatment. This did, however, give us a great first insight into potential population groups we need to work harder to engage with, to make sure they let people know when they need treatment, and they get it quickly. A huge thank you to our amazing patient contributors, who gave us really valuable perspectives to help understand the data, and suggested really interesting analyses that we included in the paper.
Holly Tibble
University of Edinburgh
Read the Original
This page is a summary of: Uptake of monoclonal antibodies and antiviral therapies for COVID-19 in Scotland, The Lancet, December 2022, Elsevier,
DOI: 10.1016/s0140-6736(22)02398-4.
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Contributors
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