Coverage and uptake of antivirals and neutralising monoclonal antibodies for the treatment of non-hospitalised patients with COVID-19
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. This report is updated approximately weekly as new data arrives and 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 at the OpenSAFELY antibody-and-antiviral-deployment repository. The accompanying manuscript is available on MedRXiV and will shortly be submitted for peer review.
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 16th 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, linked above. Brief methods can be found at the end of the this report.
Between 11-Dec-2021 and 01-Apr-2022, a total of 79,050 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 79,050 potentially eligible patients, (16%) were classified into more than one high risk cohort (high risk cohort count range 1 - 6). The number of patients potentially eligible in each high risk cohort is described in Figure 1 and Table 1 below.
Of the 79,050 potentially eligible patients, 12,200 (15%) received treatment from a CMDU (Table 1, Figure 2);
- Paxlovid: 2,070;
- Sotrovimab: 6,600;
- Remdesivir: 10;
- Molnupiravir: 3,470;
- Casirivimab: 50.