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

{ 'indexed': {'date-parts': [[2023, 3, 16]], 'date-time': '2023-03-16T04:42:29Z', 'timestamp': 1678941749610}, 'reference-count': 16, 'publisher': 'Public Library of Science (PLoS)', 'issue': '3', 'license': [ { 'start': { 'date-parts': [[2023, 3, 15]], 'date-time': '2023-03-15T00:00:00Z', 'timestamp': 1678838400000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'http://creativecommons.org/licenses/by/4.0/'}], 'funder': [ { 'DOI': '10.13039/501100000272', 'name': 'National Institute for Health Research', 'doi-asserted-by': 'publisher', 'award': ['I.P. Hall holds a NIHR Senior Investigator award (NF-SI-0617-10096)']}, { 'DOI': '10.13039/501100000272', 'name': 'National Institute for Health Research', 'doi-asserted-by': 'publisher', 'award': ['ATG holds an NIHR-funded Academic Clinical Lecturer post (CL-2020-12-003)']}], 'content-domain': {'domain': ['www.plosone.org'], 'crossmark-restriction': False}, '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>', 'DOI': '10.1371/journal.pone.0281915', 'type': 'journal-article', 'created': {'date-parts': [[2023, 3, 15]], 'date-time': '2023-03-15T17:25:42Z', 'timestamp': 1678901142000}, 'page': 'e0281915', 'update-policy': 'http://dx.doi.org/10.1371/journal.pone.corrections_policy', 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': 'Evaluation of outpatient treatment for non-hospitalised patients with COVID-19: The experience ' 'of a regional centre in the UK', 'prefix': '10.1371', 'volume': '18', 'author': [ { 'ORCID': 'http://orcid.org/0000-0002-1488-6549', 'authenticated-orcid': True, 'given': 'Amanda T.', 'family': 'Goodwin', 'sequence': 'first', 'affiliation': []}, {'given': 'Jonathan S.', 'family': 'Thompson', 'sequence': 'additional', 'affiliation': []}, {'given': 'Ian P.', 'family': 'Hall', 'sequence': 'additional', 'affiliation': []}], 'member': '340', 'published-online': {'date-parts': [[2023, 3, 15]]}, 'reference': [ { 'key': 'pone.0281915.ref001', 'unstructured': 'World Health Organisation (WHO) Coronavirus (COVID-19) dashboard. ' 'https://covid19.who.int Accessed 1/12/22.'}, { 'key': 'pone.0281915.ref002', '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', 'year': '2022', 'journal-title': 'Infection'}, { 'key': 'pone.0281915.ref003', 'unstructured': 'NHS interim clinical commissioning policy: neutralising monoclonal ' 'antibodies or antivirals for non-hospitalised patients with COVID-19. ' 'C1603. Published 24th February 2022. ' 'https://www.england.nhs.uk/coronavirus/documents/c1603-interim-clinical-commissioning-policy-antivirals-or-neutralising-monoclonal-antibodies-for-non-hospitalised-patients-with-covid-19-version-5. ' 'Accessed 21st April 2022'}, { 'issue': '21', 'key': 'pone.0281915.ref004', 'doi-asserted-by': 'crossref', 'first-page': '1941', 'DOI': '10.1056/NEJMoa2107934', 'article-title': 'Early treatment for Covid-19 with SARS-CoV-2 Neutralizing antibody ' 'sotrovimab', 'volume': '385', 'author': 'A Gupta', 'year': '2021', 'journal-title': 'N Engl J Med'}, { 'issue': '13', 'key': 'pone.0281915.ref005', 'doi-asserted-by': 'crossref', 'first-page': '1236', 'DOI': '10.1001/jama.2022.2832', 'article-title': 'Effect of sotrovimab on hospitalisation or death among high-risk ' 'patients with mild to moderate COVID-19: a randomized clinical trial', 'volume': '327', 'author': 'A Gupta', 'year': '2022', 'journal-title': 'JAMA'}, { 'issue': '6', 'key': 'pone.0281915.ref006', 'doi-asserted-by': 'crossref', 'first-page': '509', 'DOI': '10.1056/NEJMoa2116044', 'article-title': 'Molnupiravir for oral treatment of Covid-19 in nonhospitalized patients', 'volume': '386', 'author': 'A Jayk Bernal', 'year': '2022', 'journal-title': 'N Eng J Med'}, { 'key': 'pone.0281915.ref007', 'unstructured': 'NHS England. Statistical work areas: COVID-19 therapeutics (antivirals, ' 'neutralising monoclonal antibodies, and interleukin 6 inhibitors). ' 'https://www.england.nhs.uk/statistics/statistical-work-areas/covid-therapeutics-antivirals-and-neutralising-monoclonal-antibodies/. ' 'Accessed 14th May 2022.'}, { 'key': 'pone.0281915.ref008', 'unstructured': 'UK Government. Indices of multiple deprivation maps 2015 and 2019. ' 'http://dclgapps.communities.gov.uk/imd/iod_index.html'}, { 'key': 'pone.0281915.ref009', 'unstructured': 'Ministry of Housing, Communities and Local Government. English indices ' 'of deprivation 2019 –LOSA level. ' 'https://opendatacommunities.org/resource?uri=http%3A%2F%2Fopendatacommunities.org%2Fdata%2Fsocietal-wellbeing%2Fimd2019%2Findices. ' 'Accessed April 2022'}, { 'key': 'pone.0281915.ref010', 'unstructured': 'UK Health Security Agency. SARS-CoV-2 variants of concern and variants ' 'under investigation in England: Technical briefing 37. Published 25th ' 'February 2022. ' 'https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1057359/Technical-Briefing-37-25February2022.pdf'}, { 'issue': '6', 'key': 'pone.0281915.ref011', 'doi-asserted-by': 'crossref', 'first-page': '1290', 'DOI': '10.1016/j.kint.2022.04.003', 'article-title': 'Early treatment with sotrovimab monoclonal antibody in kidney ' 'transplant recipients with Omicron infection', 'volume': '101', 'author': 'N Chavarot', 'year': '2022', 'journal-title': 'Kidney Int'}, { 'issue': '7', 'key': 'pone.0281915.ref012', 'doi-asserted-by': 'crossref', 'first-page': 'e336', 'DOI': '10.1097/TP.0000000000004136', 'article-title': 'Sotrovimab for treatment of COVID-19 in solid organ transplant ' 'recipients', 'volume': '106', 'author': 'A Dhand', 'year': '2022', 'journal-title': 'Transplantation'}, { 'key': 'pone.0281915.ref013', 'volume-title': 'Quality and inequality: digging deeper', 'author': 'S Scobie', 'year': '2020'}, { 'issue': '6', 'key': 'pone.0281915.ref014', 'doi-asserted-by': 'crossref', 'first-page': '1297', 'DOI': '10.1038/s41591-022-01792-5', 'article-title': 'Serum neutralization of SARS-CoV-2 Omicron sublineages BA.1 and BA.2 in ' 'patients receiving monoclonal antibodies', 'volume': '28', 'author': 'T Bruel', 'year': '2022', 'journal-title': 'Nat Med'}, { 'key': 'pone.0281915.ref015', 'unstructured': 'UK Health Security Agency. SARS-CoV-2 therapeutics technical briefing 3: ' 'Genomic surveillance. ' 'https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1074186/therapeutics-programme-technical-briefing-3.pdf. ' 'Accessed 13th July 2022.'}, { 'key': 'pone.0281915.ref016', 'unstructured': 'US Food and Drug Administration. ' 'https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-sotrovimab-emergency-use-authorization. ' 'Accessed 22nd April 2022'}], 'container-title': 'PLOS ONE', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://dx.plos.org/10.1371/journal.pone.0281915', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2023, 3, 15]], 'date-time': '2023-03-15T17:25:57Z', 'timestamp': 1678901157000}, 'score': 1, 'resource': {'primary': {'URL': 'https://dx.plos.org/10.1371/journal.pone.0281915'}}, 'subtitle': [], 'editor': [{'given': 'Seung-Hwa', 'family': 'Lee', 'sequence': 'first', 'affiliation': []}], 'short-title': [], 'issued': {'date-parts': [[2023, 3, 15]]}, 'references-count': 16, 'journal-issue': {'issue': '3', 'published-online': {'date-parts': [[2023, 3, 15]]}}, 'URL': 'http://dx.doi.org/10.1371/journal.pone.0281915', 'relation': {}, 'ISSN': ['1932-6203'], 'subject': ['Multidisciplinary'], 'container-title-short': 'PLoS ONE', 'published': {'date-parts': [[2023, 3, 15]]}}