Change in effectiveness of sotrovimab for preventing hospitalization and mortality for at-risk COVID-19 outpatients during an Omicron BA.1 and BA.1.1-predominant phase

• Published in: International journal of infectious diseases 2023-03, Vol.128, p.310-317
• Main Authors: Aggarwal, Neil R., Beaty, Laurel E., Bennett, Tellen D., Carlson, Nichole E., Mayer, David A., Molina, Kyle C., Peers, Jennifer L., Russell, Seth, Wynia, Matthew K., Ginde, Adit A.
• Format: Article
• Language: English
• Subjects: Adult; COVID-19; Hospitalization; Humans; Monoclonal antibody; Outpatients; Real-world evidence; SARS-CoV-2
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2022.10.002

•Adult outpatients infected with Omicron BA.1 or BA.1.1 were administered sotrovimab.•Sotrovimab did not reduce hospitalization compared to all untreated patients.•Sotrovimab may reduce hospitalization rates in the highest-risk outpatient subgroups.•Sotrovimab treatment benefit during Delta was markedly attenuated in Omicron BA.1. Sotrovimab effectively prevented progression to severe disease and mortality following infection with pre-Omicron SARS-CoV-2 variants. We sought to determine whether sotrovimab is similarly effective against SARS-CoV-2 Omicron variant infection. Observational cohort study of non-hospitalized adult patients with SARS-CoV-2 infection from December 26, 2021, to March 10, 2022, using electronic health records from a statewide health system. We propensity-matched patients not receiving authorized treatment for each patient treated with sotrovimab. The primary outcome was 28-day hospitalization; secondary outcomes included mortality. We also propensity-matched sotrovimab-treated patients from the Omicron and Delta phases. Logistic regression was used to determine sotrovimab effectiveness during Omicron and between variant phases. Of 30,247 SARS-CoV-2 Omicron variant infected outpatients, we matched 1542 receiving sotrovimab to 3663 not receiving treatment. Sotrovimab treatment was not associated with reduced odds of 28-day hospitalization (2.5% vs 3.2%; adjusted odds ratio [OR] 0.82, 95% CI 0.55, 1.19) or mortality (0.1% vs 0.2%; adjusted OR 0.62, 95% CI 0.07, 2.78). Between phases, the observed treatment OR was higher during Omicron than during Delta (OR 0.85 vs 0.39, respectively; interaction P-value = 0.053). Real-world evidence demonstrated that sotrovimab was not associated with reduced 28-day hospitalization or mortality among COVID-19 outpatients during the Omicron BA.1 phase.