NIHR Nottingham Biomedical Research Centre & University of Nottingham, Nottingham, United Kingdom.
Department of Infectious Diseases, Nottingham University Hospitals, Nottingham, United Kingdom.
PLoS One. 2023 Mar 15;18(3):e0281915. doi: 10.1371/journal.pone.0281915. eCollection 2023.
Antivirals, such as molnupiravir, and SARS-CoV-2 neutralising monoclonal antibodies (nMAbs), such as sotrovimab, reduced the risk of hospitalisation and death in clinical trials of high-risk non-hospitalised patients with Covid-19. However, the real-world benefits of these drugs are unclear.
To evaluate the characteristics and outcomes of high-risk patients referred for outpatient antiviral or nMAb treatment for symptomatic Covid-19.
The records of patients referred to a large UK Covid Medicines Delivery Unit (CMDU) over nine weeks (December 2021-February 2022) were reviewed. Data were collected on demographics, referral indications, vaccination, deprivation, treatment, complications, hospital admission, and mortality.
1820 patients were referred to the CMDU, with 604 (33.2%) suitable for further assessment. 169 patients received sotrovimab, 80 patients received molnupiravir, 70 patients declined treatment, and 266 were ineligible for treatment because of resolving symptoms. There were trends towards higher proportions of female and white patients, lower deprivation scores, and malignancy- or transplant-related indications in the groups receiving treatment compared with untreated patients. Covid-19-related hospitalisations occurred in 1.2% of the treated group and 3.0% of the untreated group indicating a potential treatment effect, however Covid-related hospitalisations were lower than reported in the original clinical trials (2.2% compared with 7-10%).
The referral pathways for outpatient treatment of Covid-19 are inefficient, and the UK system may not be serving all groups equitably. Hospitalisation with Covid-19 was rare regardless of treatment. Ongoing service evaluation is required to ensure efficient use of resources for the outpatient management of Covid-19.
在针对有住院风险的非住院新冠患者的临床试验中，莫努匹韦等抗病毒药物和索特罗维单抗等 SARS-CoV-2 中和单克隆抗体（nMAb）降低了住院和死亡风险。然而，这些药物在真实世界中的获益尚不明确。
评估因有症状新冠而被推荐接受门诊抗病毒或 nMAb 治疗的高危患者的特征和结局。
对在 9 周（2021 年 12 月至 2022 年 2 月）期间被转诊至英国新冠药物输送单位（CMDU）的患者记录进行回顾性分析。收集的数据包括人口统计学特征、转诊指征、疫苗接种情况、贫困程度、治疗、并发症、住院和死亡率。
共有 1820 例患者被转诊至 CDU，其中 604 例（33.2%）适合进一步评估。169 例患者接受了索特罗维单抗治疗，80 例患者接受了莫努匹韦治疗，70 例患者拒绝治疗，266 例因症状缓解而不适合治疗。与未接受治疗的患者相比，接受治疗的患者中女性和白人患者比例更高，贫困程度评分更低，并且有癌症或移植相关指征的患者更多。在接受治疗的患者中，有 1.2%发生了新冠相关住院，而未接受治疗的患者中这一比例为 3.0%，这表明可能存在治疗效果，然而新冠相关住院率低于原始临床试验报道（2.2%比 7-10%）。
新冠门诊治疗的转诊途径效率低下，英国系统可能没有公平地为所有人群服务。无论是否接受治疗，新冠住院都很少见。需要对服务进行持续评估，以确保门诊管理新冠的资源得到有效利用。
