Real-world effectiveness of sotrovimab and remdesivir for early treatment of high-risk hospitalized COVID-19 patients: a propensity score adjusted retrospective cohort study
Early treatment of high-risk COVID-19 patients may prevent disease progression. However, there are 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 re...
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sg-ntu-dr.10356-1721562023-11-27T05:08:27Z Real-world effectiveness of sotrovimab and remdesivir for early treatment of high-risk hospitalized COVID-19 patients: a propensity score adjusted retrospective cohort study Koh, Lin Pin Chua, Siang Li Vasoo, Shawn Toh, Matthias Paul Han Sim Cutter, Jeremy Nicholas Nah, Puay Hoon Leo, Yee Sin Tay, Jun Xin Young, Barnaby Edward Lye, David C. Ong, Sean W. X. Lee Kong Chian School of Medicine (LKCMedicine) National Centre for Infectious Diseases, Singapore Tan Tock Seng Hospital Saw Swee Hock School of Public Health, NUS Yong Loo Lin School of Medicine, NUS Science::Medicine COVID‐19 Early‐Treatment Early treatment of high-risk COVID-19 patients may prevent disease progression. However, there are 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. We included PCR-confirmed COVID-19 patients admitted to the National Centre for Infectious Diseases who presented within the first 5 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). Of 1118 patients, 841 were 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). 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. National Medical Research Council (NMRC) This study was funded by the Singapore National Medical Research Council (COVID19RF‐008). 2023-11-27T05:08:27Z 2023-11-27T05:08:27Z 2023 Journal Article Koh, L. P., Chua, S. L., Vasoo, S., Toh, M. P. H. S., Cutter, J. N., Nah, P. H., Leo, Y. S., Tay, J. X., Young, B. E., Lye, D. C. & Ong, S. W. X. (2023). Real-world effectiveness of sotrovimab and remdesivir for early treatment of high-risk hospitalized COVID-19 patients: a propensity score adjusted retrospective cohort study. Journal of Medical Virology, 95(2), e28460-. https://dx.doi.org/10.1002/jmv.28460 0146-6615 https://hdl.handle.net/10356/172156 10.1002/jmv.28460 36602046 2-s2.0-85148657144 2 95 e28460 en COVID19RF-008 Journal of Medical Virology © 2023 Wiley Periodicals LLC. All rights reserved. |
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Science::Medicine COVID‐19 Early‐Treatment Koh, Lin Pin Chua, Siang Li Vasoo, Shawn Toh, Matthias Paul Han Sim Cutter, Jeremy Nicholas Nah, Puay Hoon Leo, Yee Sin Tay, Jun Xin Young, Barnaby Edward Lye, David C. Ong, Sean W. X. Real-world effectiveness of sotrovimab and remdesivir for early treatment of high-risk hospitalized COVID-19 patients: a propensity score adjusted retrospective cohort study |
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Early treatment of high-risk COVID-19 patients may prevent disease progression. However, there are 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. We included PCR-confirmed COVID-19 patients admitted to the National Centre for Infectious Diseases who presented within the first 5 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). Of 1118 patients, 841 were 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). 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. |
author2 |
Lee Kong Chian School of Medicine (LKCMedicine) |
author_facet |
Lee Kong Chian School of Medicine (LKCMedicine) Koh, Lin Pin Chua, Siang Li Vasoo, Shawn Toh, Matthias Paul Han Sim Cutter, Jeremy Nicholas Nah, Puay Hoon Leo, Yee Sin Tay, Jun Xin Young, Barnaby Edward Lye, David C. Ong, Sean W. X. |
format |
Article |
author |
Koh, Lin Pin Chua, Siang Li Vasoo, Shawn Toh, Matthias Paul Han Sim Cutter, Jeremy Nicholas Nah, Puay Hoon Leo, Yee Sin Tay, Jun Xin Young, Barnaby Edward Lye, David C. Ong, Sean W. X. |
author_sort |
Koh, Lin Pin |
title |
Real-world effectiveness of sotrovimab and remdesivir for early treatment of high-risk hospitalized COVID-19 patients: a propensity score adjusted retrospective cohort study |
title_short |
Real-world effectiveness of sotrovimab and remdesivir for early treatment of high-risk hospitalized COVID-19 patients: a propensity score adjusted retrospective cohort study |
title_full |
Real-world effectiveness of sotrovimab and remdesivir for early treatment of high-risk hospitalized COVID-19 patients: a propensity score adjusted retrospective cohort study |
title_fullStr |
Real-world effectiveness of sotrovimab and remdesivir for early treatment of high-risk hospitalized COVID-19 patients: a propensity score adjusted retrospective cohort study |
title_full_unstemmed |
Real-world effectiveness of sotrovimab and remdesivir for early treatment of high-risk hospitalized COVID-19 patients: a propensity score adjusted retrospective cohort study |
title_sort |
real-world effectiveness of sotrovimab and remdesivir for early treatment of high-risk hospitalized covid-19 patients: a propensity score adjusted retrospective cohort study |
publishDate |
2023 |
url |
https://hdl.handle.net/10356/172156 |
_version_ |
1783955646975049728 |