Overview

This OpenSAFELY report has been rapidly developed to support monitoring the ongoing roll-out of antivirals and neutralising monoclonal antibodies (nMABs) for the treatment of COVID-19, based on the population of 23.4m people registered with practices that use TPP SystmOne software. Since January 2022, this report has been updated approximately bi-monthly, as new data arrives, and will continue to be updated as needed. Consequently, there are likely to be some small changes made between the some versions.

Note that currently the clinician-assigned risk group for patients receiving Paxlovid or Remdesivir is not available. While we’re able to assign high risk groups to about 70% of these patients by implementing the NHS Digital logic, the other 30% are most likely identified via non-digital routes. For now, where results are broken down by high risk cohort and no high risk cohort is able to assigned, these patients are excluded.

The code and data for this report can be found in the OpenSAFELY antibody-and-antiviral-deployment repository. The accompanying manuscript is published in BMJ Medicine doi:10.1136/bmjmed-2022-000276.

Update: The release date of this report can be found at the top. Our report is updated regularly. If you rely on a more recent update for your own reporting or analysis please contact team@opensafely.org to let us know.

Introduction

While vaccines remain the best strategy to prevent COVID-19, recent evidence suggests neutralising monoclonal antibodies (nMABs) or antivirals could potentially benefit certain vulnerable populations before or after exposure to SARS-CoV-2, such as the unvaccinated or recently vaccinated high-risk patients. On 11th December 2021, new COVID-19 Medicine Delivery Units (CMDUs) were launched across England, offering antiviral medicines and neutralising monoclonal antibodies (nMABs) as treatment to patients with COVID-19 at high risk of severe outcomes in outpatient clinics or their own home.

With the recent roll-out of nMABs and antivirals, there is an urgent need assess the coverage of these new treatments amongst these patients, such as factors of relevance in determining nMAB and antiviral treatment and the impact of nMAB and antiviral treatment in the community and hospital settings.

Using the OpenSAFELY platform we have developed and delivered a rapid, near real-time data-monitoring framework for the roll-out of antivirals and nMABs in England that can deliver detailed coverage reports in fine-grained clinical and demographic risk groups, using publicly auditable methods, using linked but pseudonymised patient-level NHS data in a highly secure Trusted Research Environment.

Full methods in code form can be found in the accompanying antibody-and-antiviral-deployment repository and are also described in our paper doi:10.1136/bmjmed-2022-000276. Brief methods can be found at the end of the this report.

Results

Overall coverage of COVID-19 treatment

Between 11-Dec-2021 and 19-Jan-2023, a total of 155,530 non-hospitalised patients registered at a TPP practice in England were identified as potentially being eligible for receiving an antiviral or nMAB for treating COVID-19. Of the 155,530 potentially eligible patients, (17%) were classified into more than one high risk cohort (high risk cohort count range 1 - 7). The number of patients potentially eligible in each high risk cohort is described in Figure 1 and Table 1 below.

Of the 155,530 potentially eligible patients, 39,870 (26%) received treatment from a CMDU (Table 1, Figure 2);

• Paxlovid: 14,350;
• Sotrovimab: 16,760;
• Remdesivir: 100;
• Molnupiravir: 8,620;
• Casirivimab: 50.

Figure 1 Cumulative total of potentially eligible patients for receiving an antiviral or nMABs for treating COVID-19 since 11th December 2021, stratified by high risk cohort. Patients are considered eligible on the date of their positive SARS-CoV-2 test. Note, patients can appear in more than one high risk group, and the overall number in each group is likely to be an overestimation due to including SARS-CoV-2 infection confirmed by either lateral flow or PCR test (where only PCR-confirmed infections should have been treated according to guidance in effect prior to 10th February 2022), and potentially including non-symptomatic patients.

Figure 2 Cumulative total of patients who received an antiviral or nMAB for treating COVID-19 since 11th December 2021, stratified by (a) treatment type and (b) high risk cohorts. Shorter lines for Paxlovid and casirivimab reflect availability and guidance. Note, treated patients can appear in more than one high risk group.