Evaluation of outpatient treatment for non-hospitalised patients with COVID-19: The experience of a regional centre in the UK

DOI record: { "DOI": "10.1371/journal.pone.0281915", "ISSN": [ "1932-6203" ], "URL": "http://dx.doi.org/10.1371/journal.pone.0281915", "abstract": "<jats:sec id=\"sec001\">\n<jats:title>Introduction</jats:title>\n<jats:p>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.</jats:p>\n</jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Aims</jats:title>\n<jats:p>To evaluate the characteristics and outcomes of high-risk patients referred for outpatient antiviral or nMAb treatment for symptomatic Covid-19.</jats:p>\n</jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods</jats:title>\n<jats:p>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.</jats:p>\n</jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results</jats:title>\n<jats:p>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%).</jats:p>\n</jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion</jats:title>\n<jats:p>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.</jats:p>\n</jats:sec>", "author": [ { "ORCID": "http://orcid.org/0000-0002-1488-6549", "affiliation": [], "authenticated-orcid": true, "family": "Goodwin", "given": "Amanda T.", "sequence": "first" }, { "affiliation": [], "family": "Thompson", "given": "Jonathan S.", "sequence": "additional" }, { "affiliation": [], "family": "Hall", "given": "Ian P.", "sequence": "additional" } ], "container-title": "PLOS ONE", "container-title-short": "PLoS ONE", "content-domain": { "crossmark-restriction": false, "domain": [ "www.plosone.org" ] }, "created": { "date-parts": [ [ 2023, 3, 15 ] ], "date-time": "2023-03-15T17:25:42Z", "timestamp": 1678901142000 }, "deposited": { "date-parts": [ [ 2023, 3, 15 ] ], "date-time": "2023-03-15T17:25:57Z", "timestamp": 1678901157000 }, "editor": [ { "affiliation": [], "family": "Lee", "given": "Seung-Hwa", "sequence": "first" } ], "funder": [ { "DOI": "10.13039/501100000272", "award": [ "I.P. Hall holds a NIHR Senior Investigator award (NF-SI-0617-10096)" ], "doi-asserted-by": "publisher", "name": "National Institute for Health Research" }, { "DOI": "10.13039/501100000272", "award": [ "ATG holds an NIHR-funded Academic Clinical Lecturer post (CL-2020-12-003)" ], "doi-asserted-by": "publisher", "name": "National Institute for Health Research" } ], "indexed": { "date-parts": [ [ 2023, 3, 16 ] ], "date-time": "2023-03-16T04:42:29Z", "timestamp": 1678941749610 }, "is-referenced-by-count": 0, "issue": "3", "issued": { "date-parts": [ [ 2023, 3, 15 ] ] }, "journal-issue": { "issue": "3", "published-online": { "date-parts": [ [ 2023, 3, 15 ] ] } }, "language": "en", "license": [ { "URL": "http://creativecommons.org/licenses/by/4.0/", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2023, 3, 15 ] ], "date-time": "2023-03-15T00:00:00Z", "timestamp": 1678838400000 } } ], "link": [ { "URL": "https://dx.plos.org/10.1371/journal.pone.0281915", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "340", "original-title": [], "page": "e0281915", "prefix": "10.1371", "published": { "date-parts": [ [ 2023, 3, 15 ] ] }, "published-online": { "date-parts": [ [ 2023, 3, 15 ] ] }, "publisher": "Public Library of Science (PLoS)", "reference": [ { "key": "pone.0281915.ref001", "unstructured": "World Health Organisation (WHO) Coronavirus (COVID-19) dashboard. https://covid19.who.int Accessed 1/12/22." }, { "article-title": "Differential efficacy and safety of anti-SARS-CoV-2 antibody therapies for the management of COVID-19: a systematic review and network meta-analysis", "author": "J Deng", "journal-title": "Infection", "key": "pone.0281915.ref002", "year": "2022" }, { "key": "pone.0281915.ref003", "unstructured": "NHS interim clinical commissioning policy: neutralising monoclonal antibodies or antivirals for non-hospitalised patients with COVID-19. 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