Real‐world effectiveness of sotrovimab and remdesivir for early treatment of high‐risk hospitalized COVID‐19 patients: A propensity score adjusted retrospective cohort study

Abstract

Early treatment of high‐risk COVID‐19 patients may prevent disease progression. However, there are limited data to support treatment of hospitalized or fully vaccinated patients with mild‐to‐moderate disease. In this retrospective cohort study, we studied the effect of early use of sotrovimab and remdesivir in high‐risk hospitalized COVID‐19 patients. We included PCR‐confirmed COVID‐19 patients admitted to the National Centre for Infectious Diseases who presented within the first 5 days of illness, and who were not requiring oxygen or ICU care at presentation. Sotrovimab‐ and remdesivir‐treated groups were compared with control (no early treatment). A multiple propensity‐score adjusted multivariable regression analysis was conducted with a composite primary endpoint of in‐hospital deterioration (oxygen requirement, ICU admission, or mortality). Of 1118 patients, 841 were in the control group, 106 in the sotrovimab group and 169 in the remdesivir group. The median age was 63 years (IQR 46–74 years) and 505 (45.2%) were female. In unvaccinated patients, both remdesivir and sotrovimab treatment were protective (adjusted odds ratio [aOR] 0.19, 95% CI 0.064–0.60 and 0.18 [95% CI 0.066–0.47]), respectively. Contrarily, among the vaccinated patients there was no significant treatment effect with early remdesivir treatment (aOR 2.51, 95% CI 0.83–7.57, p = 0.10). Remdesivir and sotrovimab treatment, given early in the disease course to unvaccinated high‐risk patients, was effective in reducing the risk of in‐hospital deterioration and severe disease. This effect was not seen in fully vaccinated patients, which may be due to a small sample size or residual confounding.

Effectiveness of Oral Nirmatrelvir/Ritonavir vs. Intravenous Three-Day Remdesivir in Preventing Progression to Severe COVID-19: A Single-Center, Prospective, Comparative, Real-Life Study

“…A retrospective study from Israel, among 3761 high-risk patients treated with NMV/r, showed that NMV/r was associated with a greater decrease in the composite end-point of severe COVID-19 and mortality (hazard ratio 0.43, 95% CI 0.85–0.64) [ 22 ]. In a study from Singapore, the authors compared the effectiveness of 3RDV vs. the monoclonal antibody sotrovimab (at the time approved and effective for circulating viral variants) and found that even though 17.8% of remdesivir participants proceeded to require supplemental oxygen when studied after propensity score matching, 3RDV would reduce the danger of hospitalization by 82% [ 23 ]. Larger studies from the US using propensity score matching showed that NMV/r reduced the risk of deterioration by 85% [ 24 ].…”