我们试图调查使用抗病毒药物和中和单克隆抗体治疗后严重COVID-19结局的发生率,并评估社区个体治疗的相对有效性。我们进行了一项回顾性队列研究,调查住院的临床结果,重症监护室入院和死亡,2021年12月至2022年9月在苏格兰接受COVID-19抗病毒药物和单克隆抗体治疗的患者中。我们比较了各种治疗方法对严重COVID-19结局风险的影响,按当时最普遍的次谱系分层,并控制合并症和其他患者特征。在我们的研究期间,我们确定了14,365名接受COVID-19治疗的个体,其中一些人接受了多种感染的治疗。社区治疗患者(占所有治疗发作的81%)的严重COVID-19结局(住院或死亡)发生率为1.2%(n=137/11894,95%CI1.0-1.4),相比之下,因急性COVID-19(再次入院或死亡;n=40/122,95%CI25.1-41.5)在医院接受治疗的患者中,这一比例为32.8%。对于社区治疗的患者,年轻患者的严重结局(住院或死亡)风险较低,以及那些接受过三次或更多次COVID-19疫苗接种的人。在BA.2是英国最普遍的亚血统时期,与nirmaltrelvir+利托那韦相比,sotrovimab的治疗效果降低。然而,由于BA.5一直是英国最普遍的亚血统,sotrovimab和nirmaltrelvir+利托那韦的严重结局发生率均低于莫那普拉韦.接受抗病毒药物或中和单克隆抗体治疗的COVID-19患者中约有1%需要住院。在BA.5是英国流行的亚血统时期,在接受社区治疗的患者中,莫那普拉韦的严重结局发生率最高.
We sought to investigate the incidence of severe COVID-19 outcomes after treatment with antivirals and neutralising monoclonal antibodies, and estimate the comparative effectiveness of treatments in community-based individuals. We conducted a retrospective cohort study investigating clinical outcomes of hospitalisation, intensive care unit admission and death, in those treated with antivirals and monoclonal antibodies for COVID-19 in Scotland between December 2021 and September 2022. We compared the effect of various treatments on the risk of severe COVID-19 outcomes, stratified by most prevalent sub-lineage at that time, and controlling for comorbidities and other patient characteristics. We identified 14,365 individuals treated for COVID-19 during our study period, some of whom were treated for multiple infections. The incidence of severe COVID-19 outcomes (inpatient admission or death) in community-treated patients (81% of all treatment episodes) was 1.2% (n = 137/11894, 95% CI 1.0-1.4), compared to 32.8% in those treated in hospital for acute COVID-19 (re-admissions or death; n = 40/122, 95% CI 25.1-41.5). For community-treated patients, there was a lower risk of severe outcomes (inpatient admission or death) in younger patients, and in those who had received three or more COVID-19 vaccinations. During the period in which BA.2 was the most prevalent sub-lineage in the UK, sotrovimab was associated with a reduced treatment effect compared to nirmaltrelvir + ritonavir. However, since BA.5 has been the most prevalent sub-lineage in the UK, both sotrovimab and nirmaltrelvir + ritonavir were associated with similarly lower incidence of severe outcomes than molnupiravir. Around 1% of those treated for COVID-19 with antivirals or neutralising monoclonal antibodies required hospital admission. During the period in which BA.5 was the prevalent sub-lineages in the UK, molnupiravir was associated with the highest incidence of severe outcomes in community-treated patients.