tetano
Editor, Senior Moderator
Clin Kidney J
. 2023 Aug 29;16(11):2048-2058.
doi: 10.1093/ckj/sfad184. eCollection 2023 Nov. Comparative effectiveness of sotrovimab and molnupiravir for preventing severe COVID-19 outcomes in patients on kidney replacement therapy: observational study using the OpenSAFELY-UKRR and SRR databases
Bang Zheng[SUP] 1 [/SUP], Jacqueline Campbell[SUP] 2 [/SUP], Edward J Carr[SUP] 3 [/SUP], John Tazare[SUP] 1 [/SUP], Linda Nab[SUP] 4 [/SUP], Viyaasan Mahalingasivam[SUP] 1 [/SUP], Amir Mehrkar[SUP] 4 [/SUP], Shalini Santhakumaran[SUP] 5 [/SUP], Retha Steenkamp[SUP] 5 [/SUP], Fiona Loud[SUP] 6 [/SUP], Susan Lyon[SUP] 7 [/SUP], Miranda Scanlon[SUP] 8 [/SUP], William J Hulme[SUP] 4 [/SUP], Amelia C A Green[SUP] 4 [/SUP], Helen J Curtis[SUP] 4 [/SUP], Louis Fisher[SUP] 4 [/SUP], Edward Parker[SUP] 1 [/SUP], Ben Goldacre[SUP] 4 [/SUP], Ian Douglas[SUP] 1 [/SUP], Stephen Evans[SUP] 1 [/SUP], Brian MacKenna[SUP] 4 [/SUP], Samira Bell[SUP] 2 9 [/SUP], Laurie A Tomlinson[SUP] 1 [/SUP], Dorothea Nitsch[SUP] 1 5 [/SUP]; OpenSAFELY Collaborative and LH&W NCS (or CONVALESCENCE) Collaborative
Affiliations
Background: Due to limited inclusion of patients on kidney replacement therapy (KRT) in clinical trials, the effectiveness of coronavirus disease 2019 (COVID-19) therapies in this population remains unclear. We sought to address this by comparing the effectiveness of sotrovimab against molnupiravir, two commonly used treatments for non-hospitalised KRT patients with COVID-19 in the UK.
Methods: With the approval of National Health Service England, we used routine clinical data from 24 million patients in England within the OpenSAFELY-TPP platform linked to the UK Renal Registry (UKRR) to identify patients on KRT. A Cox proportional hazards model was used to estimate hazard ratios (HRs) of sotrovimab versus molnupiravir with regards to COVID-19-related hospitalisations or deaths in the subsequent 28 days. We also conducted a complementary analysis using data from the Scottish Renal Registry (SRR).
Results: Among the 2367 kidney patients treated with sotrovimab (n = 1852) or molnupiravir (n = 515) between 16 December 2021 and 1 August 2022 in England, 38 cases (1.6%) of COVID-19-related hospitalisations/deaths were observed. Sotrovimab was associated with substantially lower outcome risk than molnupiravir {adjusted HR 0.35 [95% confidence interval (CI) 0.17-0.71]; P = .004}, with results remaining robust in multiple sensitivity analyses. In the SRR cohort, sotrovimab showed a trend toward lower outcome risk than molnupiravir [HR 0.39 (95% CI 0.13-1.21); P = .106]. In both datasets, sotrovimab had no evidence of an association with other hospitalisation/death compared with molnupiravir (HRs ranged from 0.73 to 1.29; P > .05).
Conclusions: In routine care of non-hospitalised patients with COVID-19 on KRT, sotrovimab was associated with a lower risk of severe COVID-19 outcomes compared with molnupiravir during Omicron waves.
Keywords: COVID-19; cohort studies; comparative effectiveness research; renal replacement therapy.
. 2023 Aug 29;16(11):2048-2058.
doi: 10.1093/ckj/sfad184. eCollection 2023 Nov. Comparative effectiveness of sotrovimab and molnupiravir for preventing severe COVID-19 outcomes in patients on kidney replacement therapy: observational study using the OpenSAFELY-UKRR and SRR databases
Bang Zheng[SUP] 1 [/SUP], Jacqueline Campbell[SUP] 2 [/SUP], Edward J Carr[SUP] 3 [/SUP], John Tazare[SUP] 1 [/SUP], Linda Nab[SUP] 4 [/SUP], Viyaasan Mahalingasivam[SUP] 1 [/SUP], Amir Mehrkar[SUP] 4 [/SUP], Shalini Santhakumaran[SUP] 5 [/SUP], Retha Steenkamp[SUP] 5 [/SUP], Fiona Loud[SUP] 6 [/SUP], Susan Lyon[SUP] 7 [/SUP], Miranda Scanlon[SUP] 8 [/SUP], William J Hulme[SUP] 4 [/SUP], Amelia C A Green[SUP] 4 [/SUP], Helen J Curtis[SUP] 4 [/SUP], Louis Fisher[SUP] 4 [/SUP], Edward Parker[SUP] 1 [/SUP], Ben Goldacre[SUP] 4 [/SUP], Ian Douglas[SUP] 1 [/SUP], Stephen Evans[SUP] 1 [/SUP], Brian MacKenna[SUP] 4 [/SUP], Samira Bell[SUP] 2 9 [/SUP], Laurie A Tomlinson[SUP] 1 [/SUP], Dorothea Nitsch[SUP] 1 5 [/SUP]; OpenSAFELY Collaborative and LH&W NCS (or CONVALESCENCE) Collaborative
Affiliations
- PMID: 37915915
- PMCID: PMC10616487
- DOI: 10.1093/ckj/sfad184
Background: Due to limited inclusion of patients on kidney replacement therapy (KRT) in clinical trials, the effectiveness of coronavirus disease 2019 (COVID-19) therapies in this population remains unclear. We sought to address this by comparing the effectiveness of sotrovimab against molnupiravir, two commonly used treatments for non-hospitalised KRT patients with COVID-19 in the UK.
Methods: With the approval of National Health Service England, we used routine clinical data from 24 million patients in England within the OpenSAFELY-TPP platform linked to the UK Renal Registry (UKRR) to identify patients on KRT. A Cox proportional hazards model was used to estimate hazard ratios (HRs) of sotrovimab versus molnupiravir with regards to COVID-19-related hospitalisations or deaths in the subsequent 28 days. We also conducted a complementary analysis using data from the Scottish Renal Registry (SRR).
Results: Among the 2367 kidney patients treated with sotrovimab (n = 1852) or molnupiravir (n = 515) between 16 December 2021 and 1 August 2022 in England, 38 cases (1.6%) of COVID-19-related hospitalisations/deaths were observed. Sotrovimab was associated with substantially lower outcome risk than molnupiravir {adjusted HR 0.35 [95% confidence interval (CI) 0.17-0.71]; P = .004}, with results remaining robust in multiple sensitivity analyses. In the SRR cohort, sotrovimab showed a trend toward lower outcome risk than molnupiravir [HR 0.39 (95% CI 0.13-1.21); P = .106]. In both datasets, sotrovimab had no evidence of an association with other hospitalisation/death compared with molnupiravir (HRs ranged from 0.73 to 1.29; P > .05).
Conclusions: In routine care of non-hospitalised patients with COVID-19 on KRT, sotrovimab was associated with a lower risk of severe COVID-19 outcomes compared with molnupiravir during Omicron waves.
Keywords: COVID-19; cohort studies; comparative effectiveness research; renal replacement therapy.