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Real-world effectiveness of molnupiravir, nirmatrelvir-ritonavir, and sotrovimab on preventing hospital admission among higher-risk patients with COVID-19 in Wales: A retrospective cohort study

Andrew Evans, Cathy Qi, Jubril Omololu Adebayo, Jonathan Underwood, James Coulson, Rowena Bailey, Ronan Lyons, Adrian Edwards, Alison Cooper, Gareth John, Ashley Akbari, Cathy Qi, Lolu Adebayo, Rowena Bailey, Ronan Lyons Orcid Logo, Ashley Akbari Orcid Logo

Journal of Infection, Volume: 86, Issue: 4, Pages: 352 - 360

Swansea University Authors: Cathy Qi, Lolu Adebayo, Rowena Bailey, Ronan Lyons Orcid Logo, Ashley Akbari Orcid Logo

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DOI (Published version): 10.1016/j.jinf.2023.02.012

Abstract

Objective: To compare the effectiveness of molnupiravir, nirmatrelvir-ritonavir, and sotrovimab with no treatment in preventing hospital admission or death in higher-risk patients infected with SARS-CoV-2 in the community. Design: Retrospective cohort study of non-hospitalized adult patients with CO...

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Published in: Journal of Infection
ISSN: 0163-4453
Published: Elsevier BV 2023
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URI: https://cronfa.swan.ac.uk/Record/cronfa62684
first_indexed 2023-02-20T14:02:40Z
last_indexed 2024-11-14T12:21:25Z
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Design: Retrospective cohort study of non-hospitalized adult patients with COVID-19 using the Secure Anonymised Information Linkage (SAIL) Databank. Setting: A real-world cohort study was conducted within the SAIL Databank (a secure trusted research environment containing anonymised, individual, population-scale electronic health record (EHR) data) for the population of Wales, UK. Participants: Adult patients with COVID-19 in the community, at higher risk of hospitalization and death, testing positive for SARS-CoV-2 between 16th December 2021 and 22nd April 2022. Interventions: Molnupiravir, nirmatrelvir-ritonavir, and sotrovimab given in the community by local health boards and the National Antiviral Service in Wales. Main outcome measures: All-cause admission to hospital or death within 28 days of a positive test for SARS-CoV-2. Statistical analysis: Cox proportional hazard model with treatment status (treated/untreated) as a time-dependent covariate and adjusted for age, sex, number of comorbidities, Welsh Index of Multiple Deprivation, and vaccination status. Secondary subgroup analyses were by treatment type, number of comorbidities, and before and on or after 20th February 2022, when omicron BA.1 and omicron BA.2 were the dominant subvariants in Wales. Results: Between 16th December 2021 and 22nd April 2022, 7013 higher-risk patients were eligible for inclusion in the study. Of these, 2040 received treatment with molnupiravir (359, 17.6%), nirmatrelvir-ritonavir (602, 29.5%), or sotrovimab (1079, 52.9%). Patients in the treatment group were younger (mean age 53 vs 57 years), had fewer comorbidities, and a higher proportion had received four or more doses of the COVID-19 vaccine (36.3% vs 17.6%). Within 28 days of a positive test, 628 (9.0%) patients were admitted to hospital or died (84 treated and 544 untreated). The primary analysis indicated a lower risk of hospitalization or death at any point within 28 days in treated participants compared to those not receiving treatment. The adjusted hazard rate was 35% (95% CI: 18&#x2013;49%) lower in treated than untreated participants. There was no indication of the superiority of one treatment over another and no evidence of a reduction in risk of hospitalization or death within 28 days for patients with no or only one comorbidity. In patients treated with sotrovimab, the event rates before and on or after 20th February 2022 were similar (5.0% vs 4.9%) with no significant difference in the hazard ratios for sotrovimab between the time periods. Conclusions: In higher-risk adult patients in the community with COVID-19, those who received treatment with molnupiravir, nirmatrelvir-ritonavir, or sotrovimab were at lower risk of hospitalization or death than those not receiving treatment.</abstract><type>Journal Article</type><journal>Journal of Infection</journal><volume>86</volume><journalNumber>4</journalNumber><paginationStart>352</paginationStart><paginationEnd>360</paginationEnd><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0163-4453</issnPrint><issnElectronic/><keywords>Covid-19, Health protection, Public Health</keywords><publishedDay>1</publishedDay><publishedMonth>4</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-04-01</publishedDate><doi>10.1016/j.jinf.2023.02.012</doi><url>http://dx.doi.org/10.1016/j.jinf.2023.02.012</url><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>This work was supported by the Con-COV team funded by the Medical Research Council (grant number: MR/V028367/1. This work was supported by Health Data Research UK, which receives its funding from HDR UK Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. This work was supported by the ADR Wales programme of work. The ADR Wales programme of work is aligned to the priority themes as identified in the Welsh Government's national strategy: Prosperity for All. ADR Wales brings together data science experts at Swansea University Medical School, staff from the Wales Institute of Social and Economic Research, Data and Methods (WISERD) at Cardiff University and specialist teams within the Welsh Government to develop new evidence which supports Prosperity for All by using the SAIL Databank at Swansea University, to link and analyse anonymised data. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation) funded ADR UK (grant ES/S007393/1).</funders><projectreference/><lastEdited>2023-09-04T18:06:04.9455725</lastEdited><Created>2023-02-17T19:29:48.0123556</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Andrew</firstname><surname>Evans</surname><order>1</order></author><author><firstname>Cathy</firstname><surname>Qi</surname><order>2</order></author><author><firstname>Jubril Omololu</firstname><surname>Adebayo</surname><order>3</order></author><author><firstname>Jonathan</firstname><surname>Underwood</surname><order>4</order></author><author><firstname>James</firstname><surname>Coulson</surname><order>5</order></author><author><firstname>Rowena</firstname><surname>Bailey</surname><order>6</order></author><author><firstname>Ronan</firstname><surname>Lyons</surname><order>7</order></author><author><firstname>Adrian</firstname><surname>Edwards</surname><order>8</order></author><author><firstname>Alison</firstname><surname>Cooper</surname><order>9</order></author><author><firstname>Gareth</firstname><surname>John</surname><order>10</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><order>11</order></author><author><firstname>Cathy</firstname><surname>Qi</surname><order>12</order></author><author><firstname>Lolu</firstname><surname>Adebayo</surname><order>13</order></author><author><firstname>Rowena</firstname><surname>Bailey</surname><order>14</order></author><author><firstname>Ronan</firstname><surname>Lyons</surname><orcid>0000-0001-5225-000X</orcid><order>15</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>16</order></author></authors><documents/><OutputDurs/></rfc1807>
spelling 2023-09-04T18:06:04.9455725 v2 62684 2023-02-17 Real-world effectiveness of molnupiravir, nirmatrelvir-ritonavir, and sotrovimab on preventing hospital admission among higher-risk patients with COVID-19 in Wales: A retrospective cohort study ca7ac3158e7a78d832f55d14017ffbe7 Cathy Qi Cathy Qi true false 95c90b519e214400b8be5d39a2cc455a Lolu Adebayo Lolu Adebayo true false 455e2c1e6193448f6269b9e72acaf865 Rowena Bailey Rowena Bailey true false 83efcf2a9dfcf8b55586999d3d152ac6 0000-0001-5225-000X Ronan Lyons Ronan Lyons true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 2023-02-17 MEDS Objective: To compare the effectiveness of molnupiravir, nirmatrelvir-ritonavir, and sotrovimab with no treatment in preventing hospital admission or death in higher-risk patients infected with SARS-CoV-2 in the community. Design: Retrospective cohort study of non-hospitalized adult patients with COVID-19 using the Secure Anonymised Information Linkage (SAIL) Databank. Setting: A real-world cohort study was conducted within the SAIL Databank (a secure trusted research environment containing anonymised, individual, population-scale electronic health record (EHR) data) for the population of Wales, UK. Participants: Adult patients with COVID-19 in the community, at higher risk of hospitalization and death, testing positive for SARS-CoV-2 between 16th December 2021 and 22nd April 2022. Interventions: Molnupiravir, nirmatrelvir-ritonavir, and sotrovimab given in the community by local health boards and the National Antiviral Service in Wales. Main outcome measures: All-cause admission to hospital or death within 28 days of a positive test for SARS-CoV-2. Statistical analysis: Cox proportional hazard model with treatment status (treated/untreated) as a time-dependent covariate and adjusted for age, sex, number of comorbidities, Welsh Index of Multiple Deprivation, and vaccination status. Secondary subgroup analyses were by treatment type, number of comorbidities, and before and on or after 20th February 2022, when omicron BA.1 and omicron BA.2 were the dominant subvariants in Wales. Results: Between 16th December 2021 and 22nd April 2022, 7013 higher-risk patients were eligible for inclusion in the study. Of these, 2040 received treatment with molnupiravir (359, 17.6%), nirmatrelvir-ritonavir (602, 29.5%), or sotrovimab (1079, 52.9%). Patients in the treatment group were younger (mean age 53 vs 57 years), had fewer comorbidities, and a higher proportion had received four or more doses of the COVID-19 vaccine (36.3% vs 17.6%). Within 28 days of a positive test, 628 (9.0%) patients were admitted to hospital or died (84 treated and 544 untreated). The primary analysis indicated a lower risk of hospitalization or death at any point within 28 days in treated participants compared to those not receiving treatment. The adjusted hazard rate was 35% (95% CI: 18–49%) lower in treated than untreated participants. There was no indication of the superiority of one treatment over another and no evidence of a reduction in risk of hospitalization or death within 28 days for patients with no or only one comorbidity. In patients treated with sotrovimab, the event rates before and on or after 20th February 2022 were similar (5.0% vs 4.9%) with no significant difference in the hazard ratios for sotrovimab between the time periods. Conclusions: In higher-risk adult patients in the community with COVID-19, those who received treatment with molnupiravir, nirmatrelvir-ritonavir, or sotrovimab were at lower risk of hospitalization or death than those not receiving treatment. Journal Article Journal of Infection 86 4 352 360 Elsevier BV 0163-4453 Covid-19, Health protection, Public Health 1 4 2023 2023-04-01 10.1016/j.jinf.2023.02.012 http://dx.doi.org/10.1016/j.jinf.2023.02.012 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee This work was supported by the Con-COV team funded by the Medical Research Council (grant number: MR/V028367/1. This work was supported by Health Data Research UK, which receives its funding from HDR UK Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. This work was supported by the ADR Wales programme of work. The ADR Wales programme of work is aligned to the priority themes as identified in the Welsh Government's national strategy: Prosperity for All. ADR Wales brings together data science experts at Swansea University Medical School, staff from the Wales Institute of Social and Economic Research, Data and Methods (WISERD) at Cardiff University and specialist teams within the Welsh Government to develop new evidence which supports Prosperity for All by using the SAIL Databank at Swansea University, to link and analyse anonymised data. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation) funded ADR UK (grant ES/S007393/1). 2023-09-04T18:06:04.9455725 2023-02-17T19:29:48.0123556 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Andrew Evans 1 Cathy Qi 2 Jubril Omololu Adebayo 3 Jonathan Underwood 4 James Coulson 5 Rowena Bailey 6 Ronan Lyons 7 Adrian Edwards 8 Alison Cooper 9 Gareth John 10 Ashley Akbari 11 Cathy Qi 12 Lolu Adebayo 13 Rowena Bailey 14 Ronan Lyons 0000-0001-5225-000X 15 Ashley Akbari 0000-0003-0814-0801 16
title Real-world effectiveness of molnupiravir, nirmatrelvir-ritonavir, and sotrovimab on preventing hospital admission among higher-risk patients with COVID-19 in Wales: A retrospective cohort study
spellingShingle Real-world effectiveness of molnupiravir, nirmatrelvir-ritonavir, and sotrovimab on preventing hospital admission among higher-risk patients with COVID-19 in Wales: A retrospective cohort study
Cathy Qi
Lolu Adebayo
Rowena Bailey
Ronan Lyons
Ashley Akbari
title_short Real-world effectiveness of molnupiravir, nirmatrelvir-ritonavir, and sotrovimab on preventing hospital admission among higher-risk patients with COVID-19 in Wales: A retrospective cohort study
title_full Real-world effectiveness of molnupiravir, nirmatrelvir-ritonavir, and sotrovimab on preventing hospital admission among higher-risk patients with COVID-19 in Wales: A retrospective cohort study
title_fullStr Real-world effectiveness of molnupiravir, nirmatrelvir-ritonavir, and sotrovimab on preventing hospital admission among higher-risk patients with COVID-19 in Wales: A retrospective cohort study
title_full_unstemmed Real-world effectiveness of molnupiravir, nirmatrelvir-ritonavir, and sotrovimab on preventing hospital admission among higher-risk patients with COVID-19 in Wales: A retrospective cohort study
title_sort Real-world effectiveness of molnupiravir, nirmatrelvir-ritonavir, and sotrovimab on preventing hospital admission among higher-risk patients with COVID-19 in Wales: A retrospective cohort study
author_id_str_mv ca7ac3158e7a78d832f55d14017ffbe7
95c90b519e214400b8be5d39a2cc455a
455e2c1e6193448f6269b9e72acaf865
83efcf2a9dfcf8b55586999d3d152ac6
aa1b025ec0243f708bb5eb0a93d6fb52
author_id_fullname_str_mv ca7ac3158e7a78d832f55d14017ffbe7_***_Cathy Qi
95c90b519e214400b8be5d39a2cc455a_***_Lolu Adebayo
455e2c1e6193448f6269b9e72acaf865_***_Rowena Bailey
83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
author Cathy Qi
Lolu Adebayo
Rowena Bailey
Ronan Lyons
Ashley Akbari
author2 Andrew Evans
Cathy Qi
Jubril Omololu Adebayo
Jonathan Underwood
James Coulson
Rowena Bailey
Ronan Lyons
Adrian Edwards
Alison Cooper
Gareth John
Ashley Akbari
Cathy Qi
Lolu Adebayo
Rowena Bailey
Ronan Lyons
Ashley Akbari
format Journal article
container_title Journal of Infection
container_volume 86
container_issue 4
container_start_page 352
publishDate 2023
institution Swansea University
issn 0163-4453
doi_str_mv 10.1016/j.jinf.2023.02.012
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
url http://dx.doi.org/10.1016/j.jinf.2023.02.012
document_store_str 0
active_str 0
description Objective: To compare the effectiveness of molnupiravir, nirmatrelvir-ritonavir, and sotrovimab with no treatment in preventing hospital admission or death in higher-risk patients infected with SARS-CoV-2 in the community. Design: Retrospective cohort study of non-hospitalized adult patients with COVID-19 using the Secure Anonymised Information Linkage (SAIL) Databank. Setting: A real-world cohort study was conducted within the SAIL Databank (a secure trusted research environment containing anonymised, individual, population-scale electronic health record (EHR) data) for the population of Wales, UK. Participants: Adult patients with COVID-19 in the community, at higher risk of hospitalization and death, testing positive for SARS-CoV-2 between 16th December 2021 and 22nd April 2022. Interventions: Molnupiravir, nirmatrelvir-ritonavir, and sotrovimab given in the community by local health boards and the National Antiviral Service in Wales. Main outcome measures: All-cause admission to hospital or death within 28 days of a positive test for SARS-CoV-2. Statistical analysis: Cox proportional hazard model with treatment status (treated/untreated) as a time-dependent covariate and adjusted for age, sex, number of comorbidities, Welsh Index of Multiple Deprivation, and vaccination status. Secondary subgroup analyses were by treatment type, number of comorbidities, and before and on or after 20th February 2022, when omicron BA.1 and omicron BA.2 were the dominant subvariants in Wales. Results: Between 16th December 2021 and 22nd April 2022, 7013 higher-risk patients were eligible for inclusion in the study. Of these, 2040 received treatment with molnupiravir (359, 17.6%), nirmatrelvir-ritonavir (602, 29.5%), or sotrovimab (1079, 52.9%). Patients in the treatment group were younger (mean age 53 vs 57 years), had fewer comorbidities, and a higher proportion had received four or more doses of the COVID-19 vaccine (36.3% vs 17.6%). Within 28 days of a positive test, 628 (9.0%) patients were admitted to hospital or died (84 treated and 544 untreated). The primary analysis indicated a lower risk of hospitalization or death at any point within 28 days in treated participants compared to those not receiving treatment. The adjusted hazard rate was 35% (95% CI: 18–49%) lower in treated than untreated participants. There was no indication of the superiority of one treatment over another and no evidence of a reduction in risk of hospitalization or death within 28 days for patients with no or only one comorbidity. In patients treated with sotrovimab, the event rates before and on or after 20th February 2022 were similar (5.0% vs 4.9%) with no significant difference in the hazard ratios for sotrovimab between the time periods. Conclusions: In higher-risk adult patients in the community with COVID-19, those who received treatment with molnupiravir, nirmatrelvir-ritonavir, or sotrovimab were at lower risk of hospitalization or death than those not receiving treatment.
published_date 2023-04-01T20:19:54Z
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