Some COVID-19 treatments have been prioritised for higher risk individuals who are more vulnerable to both COVID-19 infection and to worse symptoms should they test positive. This includes those who take immunosuppression medications to treat conditions such as scleroderma. These treatments are designed to reduce a person’s risk of becoming seriously ill once if they contract COVID-19.

What Treatments are Available?

Neutralising Monoclonal Antibodies (nMABs)

nMABs are synthetic monoclonal antibodies that act like human antibodies in the immune system. They bind to the COVID-19 spike protein, preventing it from entering cells in the body and replicating. nMABs include Sotrovimab (Xevudy) and Ronapreve, which are usually given as a drip into your arm at a hospital or local care centre.

Antivirals

There are several antivirals available, which include PF-07321332 (nirmatelvir) plus ritonavir, marketed as Paxlovid, and Molnupiravir. They work via various mechanisms which typically disrupt viral replication, reducing the severity of a persons infection and therefore the symptoms they experience. Molnupiravir can be taken at home as an oral tablet however others are administered as a drip. 

1. How can I access nMAB or antiviral treatments?

Those at the highest risk are automatically eligible, and should by now have all received a letter or email about this, along with a PCR test to keep at home should you develop COVID-19 symptoms.

Regardless of whether you have received the aforementioned letter, in the event of registering a positive lateral flow test or PCR test, a local COVID-19 Medicine Delivery Unit (CMDU) will contact you directly should you be eligible. If you have not heard from the CMDU within 24 hours and believe that you are eligible for any of these treatments, then it is suggested that you ring your GP or 111 for an urgent referral to a CMDU. Your GP cannot prescribe any antiviral or nMAB treatment, however they can refer you to a CMDU.

2. Who is eligible for treatment with nMABs or antivirals?

• Must be aged 12+
• Must have a positive PCR test or LFT
• Must have symptoms of COVID-19 (over 20 symptoms are listed which include feverish, chills, sore throat, cough, shortness of breath, headache, loss of taste or smell, and tight chest.)
• The onset of symptoms must have occurred within the last 7 days
• Must be a member of the ‘highest’ risk group

The group relevant to our community - Patients with immune-mediated inflammatory disorders (IMID):

• IMID treated with rituximab or other B cell depleting therapy in the last 12 months
• IMID with active/unstable disease on corticosteroids, cyclophosphamide, tacrolimus, cyclosporin or mycophenolate.
• IMID with stable disease on either corticosteroids, cyclophosphamide, tacrolimus, cyclosporin or mycophenolate.
• IMID patients with active/unstable disease including those on biological monotherapy and on combination biologicals with thiopurine or methotrexate
• IMID with stable disease on either corticosteroids, cyclophosphamide, tacrolimus, cyclosporin or mycophenolate.
• IMID patients with active/unstable disease including those on biological monotherapy and on combination biologicals with thiopurine or methotrexate

3. Can I access nMABs or antivirals if I am not in the ‘highest risk’ group?

Oral antivirals are being made available to a wider group of at-risk patients via the national study PANORAMIC. More information on the trial is available here.

Patients can join the PANORAMIC study if they are:

• Aged 50 and over, or aged between 18 to 49 years with underlying health conditions that make them clinically more vulnerable (see PANORAMIC); and
• Have been unwell with COVID-19 for less than five days.
• Have a recorded positive PCR test within the past seven days

Access to this study will usually take place via GP referral, however if you believe you are eligible you can also sign up online.