New antibody and antiviral treatments for people with Covid 19 who are at higher risk of becoming seriously ill.

The NHS is offering new antibody and antiviral treatments to people with coronavirus (COVID-19) who are at highest risk of becoming seriously ill.

2 types of COVID-19 treatment are available:

• sotrovimab (Xevudy)
• molnupiravir (Lagevrio)

These treatments can help some people manage their COVID-19 symptoms and reduce the risk of becoming seriously ill.

MOLNUPIRAVIR

Molnupiravir is an antiviral ORAL medicine.

SOTROVIMAB

Sotrovimab is a biological medicine. It is also known as a neutralising monoclonal antibody (nMAb). It is only available to patients who are at the highest risk from Covid-19 or SHIELDED.

A list of those considered to be at the highest risk is given below.

• Down’s syndrome and other genetic conditions that might reasonably be expected to reduce immune competence
• Sickle cell disease
• Solid cancers, or patients who have received radiotherapy within the last six months or chemotherapy within the last 12 months.
• Certain patients with a haematologic malignancy – eg, those within 12 months of a stem cell transplant, who have active graft vs host disease or who are within 3-6 months of various therapies.
• Renal disease including those with a transplant (or a failed transplant within the last 12 months), all those with CKD 4 or 5 and those who have had B cell depleting therapy in the past 12 months or are otherwise immunosuppressed.
• Liver disease including cirrhosis, transplant and immunosuppression due to therapy for liver disease.
• Immune mediated inflammatory disorders, including immunosuppression due to medication
• Primary immune deficiencies
• HIV or AIDS where the viral load is high or the CD4 count is <350 cells/mm³ (or > cells/mm³ that with additional risk factors)
• Recipients of solid organ transplants not covered in other categories
• Neurological conditions – multiple sclerosis, motor neurone disease, myasthenia gravis and Huntington’s disease.

Where an nMAB is contraindicated, not recommended or the administration of a nMAB is not possible, patients may be treated with a five-day course of molnupiravir, provided the onset of symptoms is in the last 5 days.

It is given intravenously, within 5 days of symptom onset.

One trial found a single dose of sotrovimab reduced the risk of hospitalisation and death by 85% when given to high risk unvaccinated hospitalised patients with Covid 19.

https://www.nejm.org/doi/full/10.1056/NEJMoa2107934