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Observational Study
. 2024 Sep;89(3):106227.
doi: 10.1016/j.jinf.2024.106227. Epub 2024 Jul 15.

The safety of antivirals and neutralising monoclonal antibodies used in prehospital treatment of Covid-19

Katie Bechman  1 , Amelia Ca Green  2 , Mark D Russell  3 , Zijing Yang  3 , Bang Zheng  4 , Sam Norton  3 , Rebecca M Smith  2 , Amir Mehrkar  2 , Sebastian C J Bacon  2 , Ben Goldacre  2 , Brian MacKenna  2 , James B Galloway  3 ; OpenSAFELY Collaborative
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Free article
Observational Study

The safety of antivirals and neutralising monoclonal antibodies used in prehospital treatment of Covid-19

Katie Bechman et al. J Infect. 2024 Sep.
Free article

Abstract

Objective: This proof-of-principle pharmacovigilance study used Electronic Health Record (EHR) data to examine the safety of sotrovimab, paxlovid and molnupiravir in prehospital treatment of Covid-19.

Method: With NHS England approval, we conducted an observational cohort study using OpenSAFELY-TPP, a secure software-platform which executes analyses across EHRs for 24 million people in England. High-risk individuals with Covid-19 eligible for prehospital treatment were included. Adverse events (AEs) were categorised into events in the drug's Summary of Product Characteristics (SmPC), drug-reactions and immune-mediated. Cox models compared risk across treatments. A pre-pandemic record analysis was performed for comparative purposes.

Results: Between 2021-2023, 37,449 patients received sotrovimab, paxlovid or molnupiravir whilst 109,647 patients made up an eligible-but-untreated population. The 28-day rates of AEs were low: SmPC 0.34 per 1000 patient-years (95% CI 0.32-0.36); drug-reactions 0.01 (95% CI 0.01-0.02) and immune-mediated 0.03 (95% CI 0.03-0.04), and similar or lower than the pre-pandemic period. Compared with the eligible but untreated population, sotrovimab and paxlovid associated with a risk of SmPC AE [adjHR 1.36 (95% CI 1.15-1.62) and 1.28 (95% CI 1.05-1.55), respectively], whilst sotrovimab associated with a risk of drug-reactions [adjHR 2.95 (95% CI 1.56-5.55)] and immune-mediated events [adjHR 3.22 (95% CI 1.86-5.57)].

Conclusion: Sotrovimab, paxlovid and molnupiravir demonstrate acceptable safety profiles. Although the risk of AEs was greatest with sotrovimab, event rates were lower than comparative pre-pandemic period.

Keywords: Anti-viral; Covid-19; Pharmacovigilance.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: AG, BMK, BZ, RMS, SB, SN and ZY have no known competing financial interests. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: AM is a senior clinical researcher at the University of Oxford in the Bennett Institute, which is funded by contracts and grants obtained from the Bennett Foundation, Wellcome Trust, NIHR Oxford Biomedical Research Centre, NIHR Applied Research Collaboration Oxford and Thames Valley, Mohn-Westlake Foundation, and NHS England. AMe received 3 days of consultancy for https://inductionhealthcare.com/ (last date feb 2022) - paid direct to me. Member of RCGP health informatics group and the NHS Digital GP data Professional Advisory Group that advises on access to GP Data for Pandemic Planning and Research (GDPPR); payment direct to me for the GDPPR role. Last invoiced Dec 2022. BG has received research funding from the Laura and John Arnold Foundation, NIHR, NIHR School of Primary Care Research, NHS England, NIHR Oxford Biomedical Research Centre, the Mohn-Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, the Wellcome Trust, the Good Thinking Foundation, Health Data Research UK, the Health Foundation, the World Health Organisation, UKRI MRC, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme; he is a Non-Executive Director at NHS Digital; he also receives personal income from speaking and writing for lay audiences on the misuse of science. JBG has received honoraria from Abbvie, Amgen, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sobi, and UCB, and has research funding from Amgen, Aztra-Zeneca, Gilead, Janssen, Medicago, Novovax and Pfizer. KB has received honoraria from Galapagos, UCB and Viforpharma. MDR has received honoraria from AbbVie, Biogen, Lilly, Galapagos, Menarini, UCB, and Viforpharma.

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