Updated guidance on the choice of antiviral treatments for Covid-19 patients in the community has removed sotrovimab from first-line treatments.
Monoclonal antibody sotrovimab, which last winter was a first-line option, is now only to be used as the exception where other treatments are unsuitable, said the central alert from the Chief Medical Officer.
First-line treatment remains the combined antiviral nirmatrelvir/ritonavir (Paxlovid) with remdesivir as the second option followed by molnupiravir.
Eligible children and adolescents who are eligible for antiviral treatments because they are at high risk can be considered for treatment with remdesivir (of all ages weighing 40kg and above) or sotrovimab (for those aged 12 years and above and weighing 40kg and above) but only with the involvement of paediatric multi-disciplinary teams, the guidelines state.
Neither nirmatrelvir/ritonavir nor molnupiravir are recommended during pregnancy, the updated advice issued on the 28 November adds.
At the moment, treatments are still only available through Covid Medicine Delivery Units (CMDUs).
It follows draft recommendations from the National Institute of Health and Clinical Excellence (NICE) which only recommended nirmatrelvir/ritonavir for patients outside hospital.
A separate paper published at the same time which analysed ‘real-world’ NHS experience of the medications and concluded that sotrovimab was more effective at reducing severe illness in Covid-19 than the antiviral drug molnupiravir even with the newer variants.
Some experts had been surprised that sotrovimab had been omitted from the treatments NICE had approved for community treatment of Covid-19.
The ‘published UK-wide policy has been updated, effective with immediate effect, following consideration
of the updated COVID therapeutic guideline from the World Health Organization (WHO)’, the alert stated.
