Rapid Surveillance on the Use of Neutralising Monoclonal Antibodies and Antivirals in Patients With COVID-19 in Scotland Using Administrative and Purposely Collected Data

Background: Due to the rapidly evolving nature of COVID-19 clinical treatment guidelines are constantly changing. Since December 2021, three drugs have become available for the prevention of disease progression in vulnerable patients in Scotland: sotrovimab, molnupiravir, and Paxlovid (nirmatrelvir & ritonavir). These drugs are offered to immuno-compromised patients following a positive COVID-19 test, with treatment to be initiated within 5-7 days of symptom onset.

Objectives: To provide timely information on the use of neutralising monoclonal antibodies and antivirals, including medication uptake across Scotland; and descriptive summaries of patient characteristics and hospital admissions and/or deaths within 28 days of administration.

Methods: Data on drug exposure have purposely been collected between 21st December 2021 and 3rd May 2022 from the majority of Scottish Health Boards and supplemented with data obtained from the Hospital Electronic Prescribing and Medicines Administration (HEPMA) system to maximise data coverage. Patients’ Community Health Index (CHI) numbers (a unique patient identifier used across the Scottish Health System) have been used to facilitate linkage with other relevant datasets. Analyses were descriptive.

Results: Overall, a total of 4467 patients have been treated with the drugs of interest during the study period. Most patients (2041, 45.7%) received sotrovimab; molnupiravir and Paxlovid were prescribed to 1038 (23.2%) and 1341 (30.0%) patients, respectively. A small percentage of patients (47, 1.1%) received more than one drug over the study period.

The majority of patients were female (2628, 58.8%), and the median age was 55 years (IQR 42 – 67); the vast majority had received three or four vaccine doses prior to treatment (3062, 68.5%; 1015, 22.7%, respectively).

Among the 2547 non-hospitalised patients with sufficient follow-up time receiving treatment in an outpatient setting, 26 (1.0%) were admitted to hospital and seven (0.3%) died within 28 days of treatment with COVID-19 as the primary reason.

Conclusions: While there are limitations to these data, this study offered valuable insights into current COVID-19 treatment patterns among immunocompromised patients in Scotland; no immediate concerns about the use of the three drugs available have been raised.