Real-World Effectiveness of Sotrovimab and Remdesivir for Early Treatment of High-Risk Hospitalized COVID-19 Patients

Background: Early treatment of high-risk COVID-19 patients may prevent disease progression. However, there is limited data to support treatment of hospitalized or fully-vaccinated patients with mild-to-moderate disease. In this retrospective cohort study, we studied the effect of early use of sotrovimab and remdesivir in high-risk hospitalized COVID-19 patients.Methods: We included PCR-confirmed COVID-19 patients admitted to the National Centre for Infectious Diseases who presented within the first five days of illness, and who were not requiring oxygen or ICU care at presentation. Sotrovimab- and remdesivir-treated groups were compared with control (no early treatment). A multiple propensity score-adjusted multivariable regression analysis was conducted with a composite primary endpoint of in-hospital deterioration (oxygen requirement, ICU admission, or mortality). Findings: Of 1118 patients, 841 in the control group, 106 in the sotrovimab group and 169 in the remdesivir group. The median age was 63 years (IQR 46-74 years) and 505 (45·2%) were female. In unvaccinated patients, both remdesivir and sotrovimab treatment were protective (adjusted odds ratio [aOR] 0·19, 95% CI 0·064–0·60 and 0·18 [95% CI 0·066–0·47]) respectively. Contrarily, among the vaccinated patients there was no significant treatment effect with early remdesivir treatment (aOR 2·51, 95% CI 0·83–7·57, p=0·10).Intrepretation: Remdesivir and sotrovimab treatment, given early in the disease course to unvaccinated high-risk patients, was effective in reducing the risk of in-hospital deterioration and severe disease. This effect was not seen in fully-vaccinated patients, which may be due to a small sample size or residual confounding.Funding Information: This study was funded by the Singapore National Medical Research Council 284 (COVID19RF-008).Declaration of Interests: BEY reported personal fees from Astra-Zeneca, Novacyte, Sanofi and Gilead outside the submitted work. All other authors declared no competing interests.Ethics Approval Statement: The institutional ethics committee approved a waiver of informed consent for retrospective data collection (National Healthcare Group Domain Specific Review Board reference number 2020/01122).