Uptake of monoclonal antibodies and anti-viral therapies for COVID-19 in Scotland

Tibble, Holly and Mueller, Tanja and Proud, Euan and Hall, Elliott and Kurdi, Amanj and Robertson, Chris and Bennie, Marion and Woolford, Lana and Sheikh, Aziz (2023) Uptake of monoclonal antibodies and anti-viral therapies for COVID-19 in Scotland. The Lancet, 401 (10371). pp. 101-102. (https://doi.org/10.1016/S0140-6736(22)02398-4)

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SARS-CoV-2 has constantly been evolving since it was first detected in 2019. Virus mutations have impacted on transmissibility, virulence, and the effectiveness of vaccines and COVID-19 therapeutics. In Scotland, treatments recently made available for use in patients with COVID-19 are Sotrovimab, a neutralising monoclonal antibody (mAB) that specifically target SARS-CoV-2 spike proteins, and the SARS-CoV-2-specific antiviral drugs nirmatrelvir/ritonavir (Paxlovid) and molnupiravir, which inhibit viral replication by inhibiting viral protease and by increasing viral RNA mutagenesis. Current guidance is that these should be offered to vulnerable patients within five to seven days of presenting with mild-to-moderate COVID-19 to prevent disease progression.[1] Choice of treatment is mainly determined based on pre-existing conditions and/or concurrent drug treatment. Other more established therapeutics are also used in an in-patient setting to improve outcomes in hospitalised patients with severe COVID-19.[2]