Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan 13;2(1):e000276.
doi: 10.1136/bmjmed-2022-000276. eCollection 2023.

Trends, variation, and clinical characteristics of recipients of antiviral drugs and neutralising monoclonal antibodies for covid-19 in community settings: retrospective, descriptive cohort study of 23.4 million people in OpenSAFELY

Amelia C A Green  1 , Helen J Curtis  1 , Rose Higgins  1 , Linda Nab  1 , Viyaasan Mahalingasivam  2 , Rebecca M Smith  1 , Amir Mehrkar  1 , Peter Inglesby  1 , Henry Drysdale  1 , Nicholas J DeVito  1 , Richard Croker  1 , Christopher T Rentsch  2 , Krishnan Bhaskaran  2 , John Tazare  2 , Bang Zheng  2 , Colm D Andrews  1 , Sebastian C J Bacon  1 , Simon Davy  1 , Iain Dillingham  1 , David Evans  1 , Louis Fisher  1 , George Hickman  1 , Lisa E M Hopcroft  1 , William J Hulme  1 , Jon Massey  1 , Orla MacDonald  3 , Jessica Morley  1 , Caroline E Morton  1 , Robin Y Park  1 , Alex J Walker  1 , Tom Ward  1 , Milan Wiedemann  1 , Christopher Bates  4 , Jonathan Cockburn  4 , John Parry  4 , Frank Hester  4 , Sam Harper  4 , Ian J Douglas  2 , Stephen J W Evans  2 , Ben Goldacre  1 , Laurie A Tomlinson  2 , Brian MacKenna  1
Affiliations

Trends, variation, and clinical characteristics of recipients of antiviral drugs and neutralising monoclonal antibodies for covid-19 in community settings: retrospective, descriptive cohort study of 23.4 million people in OpenSAFELY

Amelia C A Green et al. BMJ Med. .

Abstract

Objective: To ascertain patient eligibility status and describe coverage of antiviral drugs and neutralising monoclonal antibodies (nMAB) as treatment for covid-19 in community settings in England.

Design: Retrospective, descriptive cohort study, approved by NHS England.

Setting: Routine clinical data from 23.4 million people linked to data on covid-19 infection and treatment, within the OpenSAFELY-TPP database.

Participants: Outpatients with covid-19 at high risk of severe outcomes.

Interventions: Nirmatrelvir/ritonavir (paxlovid), sotrovimab, molnupiravir, casirivimab/imdevimab, or remdesivir, used in the community by covid-19 medicine delivery units.

Results: 93 870 outpatients with covid-19 were identified between 11 December 2021 and 28 April 2022 to be at high risk of severe outcomes and therefore potentially eligible for antiviral or nMAB treatment (or both). Of these patients, 19 040 (20%) received treatment (sotrovimab, 9660 (51%); molnupiravir, 4620 (24%); paxlovid, 4680 (25%); casirivimab/imdevimab, 50 (<1%); and remdesivir, 30 (<1%)). The proportion of patients treated increased from 9% (190/2220) in the first week of treatment availability to 29% (460/1600) in the latest week. The proportion treated varied by high risk group, being lowest in those with liver disease (16%; 95% confidence interval 15% to 17%); by treatment type, with sotrovimab favoured over molnupiravir and paxlovid in all but three high risk groups (Down's syndrome (35%; 30% to 39%), rare neurological conditions (45%; 43% to 47%), and immune deficiencies (48%; 47% to 50%)); by age, ranging from ≥80 years (13%; 12% to 14%) to 50-59 years (23%; 22% to 23%); by ethnic group, ranging from black (11%; 10% to 12%) to white (21%; 21% to 21%); by NHS region, ranging from 13% (12% to 14%) in Yorkshire and the Humber to 25% (24% to 25%) in the East of England); and by deprivation level, ranging from 15% (14% to 15%) in the most deprived areas to 23% (23% to 24%) in the least deprived areas. Groups that also had lower coverage included unvaccinated patients (7%; 6% to 9%), those with dementia (6%; 5% to 7%), and care home residents (6%; 6% to 7%).

Conclusions: Using the OpenSAFELY platform, we were able to identify patients with covid-19 at high risk of severe outcomes who were potentially eligible to receive treatment and assess the coverage of these new treatments among these patients. In the context of a rapid deployment of a new service, the NHS analytical code used to determine eligibility could have been over-inclusive and some of the eligibility criteria not fully captured in healthcare data. However targeted activity might be needed to resolve apparent lower treatment coverage observed among certain groups, in particular (at present): different NHS regions, ethnic groups, people aged ≥80 years, those living in socioeconomically deprived areas, and care home residents.

Keywords: COVID-19; community health services; public health; therapeutics.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from the Wellcome Trust, MRC, NIHR, and Health Data Research UK for the submitted work. BG has received research funding from the Laura and John Arnold Foundation, NHS NIHR, NIHR School of Primary Care Research, NIHR Oxford Biomedical Research Centre, Mohn-Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, Wellcome Trust, Good Thinking Foundation, Health Data Research UK, Health Foundation, World Health Organization, UK Research and Innovation, Asthma UK, British Lung Foundation, and Longitudinal Health and Wellbeing strand of the National Core Studies programme; he also receives personal income from speaking and writing for lay audiences on the misuse of science. IJD has received unrestricted research grants and holds shares in GlaxoSmithKline (GSK). JT is employed by the London School of Hygiene and Tropical Medicine (LSHTM) on a fellowship sponsored by an unrestricted GSK grant. NJD received research funding related to the COVID-19 pandemic from the Federal Ministry of Education and Research (BMBF, Germany).

Figures

Figure 1
Figure 1
Cumulative total number of potentially eligible patients receiving antiviral drugs or neutralising monoclonal antibodies for covid-19 treatment since 11 December 2021, stratified by high risk group. Patients were considered eligible on the date of their positive SARS-CoV-2 test. Patients could appear in more than one high risk group, and the overall number in each group is likely to be an overestimation owing to the inclusion of SARS-CoV-2 infection confirmed by either lateral flow or polymerase chain reaction (PCR) test (where only infections confirmed by PCR should have been treated, according to guidance in effect before 10 February 2022), and potentially including patients with no symptoms
Figure 2
Figure 2
Cumulative total number of patients in OpenSAFELY-TPP who received antiviral drugs or neutralising monoclonal antibodies for covid-19 treatment since 16 December 2021, stratified by treatment type and high risk groups. Shorter lines for paxlovid and casirivimab/imdevimab reflect availability and guidance. A total of 330 treated patients were excluded because their date of treatment was after 28 April 2022; patients could appear in more than one high risk group
See this image and copyright information in PMC

References

    1. Agarwal A, Rochwerg B, Lamontagne F, et al. . A living WHO guideline on drugs for covid-19. BMJ 2020;370:m3379. 10.1136/bmj.m3379 - DOI - PubMed
    1. COVID-19 Treatment Guidelines . Hospitalized adults: therapeutic management. Available: https://www.covid19treatmentguidelines.nih.gov/management/clinical-manag... [Accessed 23 Feb 2022].
    1. NICE . Recommendations: COVID-19 rapid guideline: managing COVID-19: guidance. Available: https://www.nice.org.uk/guidance/ng191/chapter/Recommendations [Accessed 23 Feb 2022].
    1. Department of Health and Social Care . Government launches COVID-19 antivirals Taskforce to roll out innovative home treatments this autumn, 2021. Available: https://www.gov.uk/government/news/government-launches-covid-19-antivira... [Accessed 23 Feb 2022].
    1. Department of Health and Social Care . UK’s most vulnerable people to receive life-saving COVID-19 treatments in the community, 2021. Available: https://www.gov.uk/government/news/uks-most-vulnerable-people-to-receive... [Accessed 23 Feb 2022].