Impact of treatment of COVID-19 with sotrovimab on post-acute sequelae of COVID-19 PASC…, 2025, Drysdale+

[SNT Gatchaman]

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
Drysdale, Myriam; Chang, Rose; Guo, Tracy; Duh, Mei Sheng; Han, Jennifer; Birch, Helen; Sharpe, Catherine; Liu, Daisy; Kalia, Sarah; Van Dyke, Melissa; DerSarkissian, Maral; Gillespie, Iain A.

PURPOSE
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.

METHODS
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.

RESULTS
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) (p < 0.001), indicating that sotrovimab use was associated with a significantly lower risk of PASC. Results remained consistent in sensitivity analyses.

CONCLUSION
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.

Link | PDF (Infection) [Open Access]

 

[Hutan]

Definition 3 of PASC:

Demonstration of PASC (occurrence of at least one of the 26 symptoms defined by Bull-Otterson [1] and identified using ICD-10-CM codes) at least 30 days after the first ICD-10 diagnosis code for COVID-19 (U07.1) or a positive PCR or antigen test for COVID-19 in the observation period;

This is the definition used for the main analysis. The definitions that were examined mostly differed by the time of assessment (e.g. 30 days, 60 days, 90 days)

Given the PASC definition and that cohort had a high risk of progression to severe disease, the treatment probably isn't of much relevance to post-Covid-19 ME/CFS.

In the main initial (unadjusted) analysis, sotrovimab use was associated with an increased risk of PASC (HR 1.42 [95% CI 1.38–1.46], p < 0.001; Table 4). However, when doubly robust ATT weighting was applied to control for measured confounding, sotrovimab use was associated with a lower risk of PASC (HR 0.92 [0.89–0.96], p < 0.001).

We need researchers to understand that PASC is an umbrella term, too broad for use in most research.