Comparison of the risk of hospitalisation among BA.1 and BA.2 COVID‐19 cases treated with sotrovimab in the community in England

Harman, Katie; Nash, Sophie; Webster, Harriet; Groves, Natalie; Hardstaff, Jo; Bridgen, Jessica R E; Blomquist, Paula; Hope, Russell; Ashano, Efejiro; Rokadiya, Sakib; Hopkins, Susan; Brown, Colin S; Chand, Meera; Dabrera, Gavin; Thelwall, Simon

doi:10.1111/irv.13150

Cited by 12 publications

(6 citation statements)

References 10 publications

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“…Our large, population-based study across England contributes to the overall favorable weight of evidence to support the clinical benefit of sotrovimab as an early treatment for COVID-19 through Omicron subvariant predominance periods, especially for patients at higher risk of developing severe symptoms, such as those with severe renal diseases and active cancer. Moreover, our findings also confirm those of a recent study that reported similar proportions of hospital admissions between sequence-confirmed Omicron BA.1 and BA.2 cases treated with sotrovimab [ 25 ]. In addition, our study further extends these findings by also assessing patients treated during periods of Omicron BA.5 prevalence.…”

Section: Discussionsupporting

confidence: 91%

Characteristics and outcomes of COVID-19 patients presumed to be treated with sotrovimab in NHS hospitals in England

Patel,

Levick,

Boult

et al. 2024

BMC Infect Dis

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Background The impact of the constantly evolving severe acute respiratory syndrome coronavirus 2 on the effectiveness of early coronavirus disease 2019 (COVID-19) treatments is unclear. Here, we report characteristics and acute clinical outcomes of patients with COVID-19 treated with a monoclonal antibody (mAb; presumed to be sotrovimab) across six distinct periods covering the emergence and predominance of Omicron subvariants (BA.1, BA.2, and BA.5) in England. Methods Retrospective cohort study using data from the Hospital Episode Statistics database from January 1–July 31, 2022. Included patients received a mAb delivered by a National Health Service (NHS) hospital as a day-case, for which the primary diagnosis was COVID-19. Patients were presumed to have received sotrovimab based on NHS data showing that 99.98% of COVID-19-mAb-treated individuals received sotrovimab during the study period. COVID-19-attributable hospitalizations were reported overall and across six distinct periods of Omicron subvariant prevalence. Subgroup analyses were conducted in patients with severe renal disease and active cancer. Results Among a total of 10,096 patients, 1.0% (n = 96) had a COVID-19-attributable hospitalization, 4.6% (n = 465) had a hospital visit due to any cause, and 0.3% (n = 27) died due to any cause during the acute period. COVID-19-attributable hospitalization rates were consistent among subgroups, and no significant differences were observed across periods of Omicron subvariant predominance. Conclusions Levels of COVID-19-attributable hospitalizations and deaths were low in mAb-treated patients and among subgroups. Similar hospitalization rates were observed whilst Omicron BA.1, BA.2, and BA.5 were predominant, despite reported reductions in in vitro neutralization activity of sotrovimab against BA.2 and BA.5.

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Section: Discussionsupporting

confidence: 91%

Characteristics and outcomes of COVID-19 patients presumed to be treated with sotrovimab in NHS hospitals in England

Patel,

Levick,

Boult

et al. 2024

BMC Infect Dis

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“…For sotrovimab-treated patients, we also report a reduced risk of hospitalisation or death during BA.1 predominance and non-significant trends for reduced risk during BA.2 and BA.5, possibly not significant due to low event rate and small sample size for this comparison. Harman et al previously reported low proportions of hospitalisations between sequencing-confirmed Omicron BA.1 and BA.2 cases treated with sotrovimab 29. Another retrospective cohort study using Hospital Episode Statistics data in England reported low levels of COVID-19-attributable hospitalisations and deaths in patients presumed to be treated with sotrovimab (based on NHS data showing that 99.98% of COVID-19-mAb-treated individuals received sotrovimab during the study period), with no significant differences in hospitalisation rates during Omicron BA.1, BA.2 or BA.5 predominance 30.…”

Section: Discussionmentioning

confidence: 97%

“…Harman et al previously reported low proportions of hospitalisations between sequencing-confirmed Omicron BA.1 and BA.2 cases treated with sotrovimab. 29 Another retrospective cohort study using Hospital Episode Statistics data in England reported low levels of COVID-19-attributable hospitalisations and deaths in patients presumed to be treated with sotrovimab (based on NHS data showing that 99.98% of COVID-19-mAb-treated individuals received sotrovimab during the study period), with no significant differences in hospitalisation rates during Omicron BA.1, BA.2 or BA.5 predominance. 30 Zheng et al used the OpenSAFELY platform to evaluate the comparative effectiveness of sotrovimab and molnupiravir for preventing severe COVID-19 outcomes from 16 December 2021–10 February 2022.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of sotrovimab versus no treatment in non-hospitalised high-risk COVID-19 patients in north west London: a retrospective cohort study

Drysdale,

Galimov,

Yarwood

et al. 2024

BMJ Open Resp Res

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BackgroundWe assessed the effectiveness of sotrovimab vs no early COVID-19 treatment in highest-risk COVID-19 patients during Omicron predominance.MethodsRetrospective cohort study using the Discover dataset in North West London. Included patients were non-hospitalised, aged ≥12 years and met ≥1 National Health Service highest-risk criterion for sotrovimab treatment. We used Cox proportional hazards models to compare HRs of 28-day COVID-19-related hospitalisation/death between highest-risk sotrovimab-treated and untreated patients. Age, renal disease and Omicron subvariant subgroup analyses were performed.ResultsWe included 599 sotrovimab-treated patients and 5191 untreated patients. Compared with untreated patients, the risk of COVID-19 hospitalisation/death (HR 0.50, 95% CI 0.24, 1.06; p=0.07) and the risk of COVID-19 hospitalisation (HR 0.43, 95% CI 0.18, 1.00; p=0.051) were both lower in the sotrovimab-treated group; however, statistical significance was not reached. In the ≥65 years and renal disease subgroups, sotrovimab was associated with a significantly reduced risk of COVID-19 hospitalisation, by 89% (HR 0.11, 95% CI 0.02, 0.82; p=0.03) and 82% (HR 0.18, 95% CI 0.05, 0.62; p=0.007), respectively.ConclusionsRisk of COVID-19 hospitalisation in sotrovimab-treated patients aged ≥65 years and with renal disease was significantly lower compared with untreated patients. Overall, risk of hospitalisation was also lower for sotrovimab-treated patients, but statistical significance was not reached.

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“…An English retrospective cohort study of COVID-19 outpatients treated with sotrovimab reported that 133 of 3,230 (4.1%) BA.1 cases and 140 of 3566 (3.9%) BA.2 cases were hospitalized with an adjusted hazard ratio of 1.02 (95% CI: 0.70–1.47) [ 8 ]. Although this study adjusted for age group and vaccination status to account for confounders, additional risk factors such as immunocompromised status were not accounted for.…”

Section: Discussionmentioning

confidence: 99%

“…As BA.2 emerged before large-scale discontinuation of sotrovimab in clinical practice, a few observational studies had been able to evaluate BA.2-infected patients who received sotrovimab as treatment [ 8 – 10 ]. These studies demonstrated no significant differences in hospitalizations in BA.1 versus BA.2-infected patients treated with sotrovimab, although the analyses were either unadjusted for baseline risks or adjusted for age and immunization status only.…”

Section: Introductionmentioning

confidence: 99%

Evaluating in vivo effectiveness of sotrovimab for the treatment of Omicron subvariant BA.2 versus BA.1: a multicentre, retrospective cohort study

Lo,

Komorowski

et al. 2024

BMC Res Notes

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Background In vitro data suggested reduced neutralizing capacity of sotrovimab, a monoclonal antibody, against Omicron BA.2 subvariant. However, limited in vivo data exist regarding clinical effectiveness of sotrovimab for coronavirus disease 2019 (COVID-19) due to Omicron BA.2. Methods A multicentre, retrospective cohort study was conducted at three Canadian academic tertiary centres. Electronic medical records were reviewed for patients ≥ 18 years with mild COVID-19 (sequencing-confirmed Omicron BA.1 or BA.2) treated with sotrovimab between February 1 to April 1, 2022. Thirty-day co-primary outcomes included hospitalization due to moderate or severe COVID-19; all-cause intensive care unit (ICU) admission, and all-cause mortality. Risk differences (BA.2 minus BA.1 group) for co-primary outcomes were adjusted with propensity score matching (e.g., age, sex, vaccination, immunocompromised status). Results Eighty-five patients were included (15 BA.2, 70 BA.1) with similar baseline characteristics between groups. Adjusted risk differences were non-statistically significant between groups for 30-day hospitalization (− 14.3%; 95% confidence interval (CI): − 32.6 to 4.0%), ICU admission (− 7.1%; 95%CI: − 20.6 to 6.3%), and mortality (− 7.1%; 95%CI: − 20.6 to 6.3%). Conclusions No differences were demonstrated in hospitalization, ICU admission, or mortality rates within 30 days between sotrovimab-treated patients with BA.1 versus BA.2 infection. More real-world data may be helpful to properly assess sotrovimab’s effectiveness against infections due to specific emerging COVID-19 variants.

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Comparison of the risk of hospitalisation among BA.1 and BA.2 COVID‐19 cases treated with sotrovimab in the community in England

Cited by 12 publications

References 10 publications

Characteristics and outcomes of COVID-19 patients presumed to be treated with sotrovimab in NHS hospitals in England

Characteristics and outcomes of COVID-19 patients presumed to be treated with sotrovimab in NHS hospitals in England

Comparative effectiveness of sotrovimab versus no treatment in non-hospitalised high-risk COVID-19 patients in north west London: a retrospective cohort study

Evaluating in vivo effectiveness of sotrovimab for the treatment of Omicron subvariant BA.2 versus BA.1: a multicentre, retrospective cohort study

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