Impact of treatment of COVID-19 with sotrovimab on post-acute sequelae of COVID-19 (PASC): an analysis of National COVID Cohort Collaborative (N3C) data

DOI record: { "DOI": "10.1007/s15010-025-02505-z", "ISSN": [ "0300-8126", "1439-0973" ], "URL": "http://dx.doi.org/10.1007/s15010-025-02505-z", "abstract": "<jats:title>Abstract</jats:title>\n <jats:sec>\n <jats:title>Purpose</jats:title>\n <jats:p>To assess the impact of early sotrovimab treatment versus no treatment on the risk of developing post-acute sequelae of COVID-19 (PASC; long COVID) in patients (age ≥ 12 years) with COVID-19 at high risk for progression to severe disease.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Methods</jats:title>\n <jats:p>Retrospective cohort study using the US National COVID Cohort Collaborative (N3C) data. Phase 1 identified and assessed multiple definitions of PASC; Phase 2 evaluated the effectiveness of sotrovimab for reducing the risk of PASC, utilizing definitions from Phase 1. Average treatment effect in the treated (ATT)-weighted Cox proportional hazards regression models were used to compare time to event for PASC between high-risk patients who received sotrovimab treatment between May 26, 2021 and April 5, 2022, and high-risk patients with COVID-19 diagnosed between May 26, 2021 and March 26, 2022 who did not receive any treatment for COVID-19 during the acute phase or any pre-exposure prophylaxis against SARS-CoV-2.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Results</jats:title>\n <jats:p>A total of 9,504 sotrovimab-treated and 619,668 untreated patients were included in the main analysis. Most baseline characteristics were balanced between the two cohorts after ATT weighting. The doubly robust ATT-weighted hazard ratio (95% confidence interval) was 0.92 (0.89–0.96) (<jats:italic>p</jats:italic> &lt; 0.001), indicating that sotrovimab use was associated with a significantly lower risk of PASC. Results remained consistent in sensitivity analyses.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Conclusion</jats:title>\n <jats:p>In patients at high risk for severe COVID-19, the benefits of early sotrovimab treatment may extend beyond the acute phase of COVID-19 and contribute to the prevention of PASC symptoms.</jats:p>\n </jats:sec>", "alternative-id": [ "2505" ], "assertion": [ { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Received", "name": "received", "order": 1, "value": "24 July 2024" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Accepted", "name": "accepted", "order": 2, "value": "1 March 2025" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "First Online", "name": "first_online", "order": 3, "value": "22 March 2025" }, { "group": { "label": "Declarations", "name": "EthicsHeading" }, "name": "Ethics", "order": 1 }, { "group": { "label": "Conflict of interest", "name": "EthicsHeading" }, "name": "Ethics", "order": 2, "value": "MD, JH, HB, CS, MVD, and IAG are employed by and hold financial equities in GSK. RC, TG, MSD, DL, SK, and MDS are employees of Analysis Group; Analysis Group received funding from GSK to conduct the study. Disclaimer: This article was prepared while SK was an employee of Analysis Group. The opinions expressed in this article are her own and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government." }, { "group": { "label": "Ethical approval and consent to participate", "name": "EthicsHeading" }, "name": "Ethics", "order": 3, "value": "This study complies with all applicable laws regarding subject privacy. No direct subject contact or primary collection of individual human subject data occurred. Study results were in tabular form and aggregate analyses that omit subject identification, therefore informed consent, ethics committee or Institutional Review Board (IRB) approval was not required. However, use of the N3C Limited Dataset requires IRB review. A request for a waiver of authorization was obtained from WCG IRB." }, { "group": { "label": "Consent to publication", "name": "EthicsHeading" }, "name": "Ethics", "order": 4, "value": "All named authors meet the International Committee of Medical Journal Editors criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published." } ], "author": [ { "ORCID": "https://orcid.org/0000-0002-8994-2816", "affiliation": [], "authenticated-orcid": false, "family": "Drysdale", "given": "Myriam", "sequence": "first" }, { "affiliation": [], "family": "Chang", "given": "Rose", "sequence": "additional" }, { "affiliation": [], "family": "Guo", "given": "Tracy", "sequence": "additional" }, { "affiliation": [], "family": "Duh", "given": "Mei Sheng", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0003-4744-8067", "affiliation": [], "authenticated-orcid": false, "family": "Han", "given": "Jennifer", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0002-4924-4810", "affiliation": [], "authenticated-orcid": false, "family": "Birch", "given": "Helen", "sequence": "additional" }, { "affiliation": [], "family": "Sharpe", "given": "Catherine", "sequence": "additional" }, { "affiliation": [], "family": "Liu", "given": "Daisy", "sequence": "additional" }, { "affiliation": [], "family": "Kalia", "given": "Sarah", "sequence": "additional" }, { "affiliation": [], "family": "Van Dyke", "given": "Melissa", "sequence": "additional" }, { "affiliation": [], "family": "DerSarkissian", "given": "Maral", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0002-2265-9506", "affiliation": [], "authenticated-orcid": false, "family": "Gillespie", "given": "Iain A.", "sequence": "additional" } ], "container-title": "Infection", "container-title-short": "Infection", "content-domain": { "crossmark-restriction": false, "domain": [ "link.springer.com" ] }, "created": { "date-parts": [ [ 2025, 3, 23 ] ], "date-time": "2025-03-23T07:52:01Z", "timestamp": 1742716321000 }, "deposited": { "date-parts": [ [ 2025, 3, 23 ] ], "date-time": "2025-03-23T07:52:05Z", "timestamp": 1742716325000 }, "indexed": { "date-parts": [ [ 2025, 3, 24 ] ], "date-time": "2025-03-24T04:07:07Z", "timestamp": 1742789227695, "version": "3.40.2" }, "is-referenced-by-count": 0, "issued": { "date-parts": [ [ 2025, 3, 22 ] ] }, "language": "en", "license": [ { "URL": "https://creativecommons.org/licenses/by/4.0", "content-version": "tdm", "delay-in-days": 0, "start": { "date-parts": [ [ 2025, 3, 22 ] ], "date-time": "2025-03-22T00:00:00Z", "timestamp": 1742601600000 } }, { "URL": "https://creativecommons.org/licenses/by/4.0", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2025, 3, 22 ] ], "date-time": "2025-03-22T00:00:00Z", "timestamp": 1742601600000 } } ], "link": [ { "URL": "https://link.springer.com/content/pdf/10.1007/s15010-025-02505-z.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://link.springer.com/article/10.1007/s15010-025-02505-z/fulltext.html", "content-type": "text/html", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://link.springer.com/content/pdf/10.1007/s15010-025-02505-z.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "297", "original-title": [], "prefix": "10.1007", "published": { "date-parts": [ [ 2025, 3, 22 ] ] }, "published-online": { "date-parts": [ [ 2025, 3, 22 ] ] }, "publisher": "Springer Science and Business Media LLC", "reference": [ { "DOI": "10.15585/mmwr.mm7121e1", "author": "L Bull-Otterson", "doi-asserted-by": "publisher", "first-page": "713", "journal-title": "MMWR Morb Mortal Wkly Rep", "key": "2505_CR1", "unstructured": "Bull-Otterson L, Baca S, Saydah S, Boehmer TK, Adjei S, Gray S, et al. 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