Sotrovimab outperforms molnupiravir for high-risk COVID-19 patients. Angiotensin blockers show no benefit. Explore implications for at-risk populations.
Sotrovimab is effective compared with molnupiravir for patients at high risk for severe outcomes from COVID-19; however, there is no difference for angiotensin receptor blockers versus placebo for management of COVID-19, according to two studies published online Nov. 16 in The BMJ.
Bang Zheng, Ph.D., from the London School of Hygiene and Tropical Medicine, and colleagues compared the effectiveness of sotrovimab and molnupiravir for preventing severe outcomes of COVID-19 in adults at high risk for severe outcomes. A total of 3,331 and 2,689 patients were treated with sotrovimab and molnupiravir, respectively, between Dec. 16, 2021, and Feb. 10, 2022. The researchers found that sotrovimab treatment was associated with a substantially lower risk after adjustment for multiple confounding variables (hazard ratio, 0.54). In propensity score weighted Cox models and in analyses that were restricted to people who were fully vaccinated, the results were consistent (hazard ratios, 0.50 and 0.53, respectively).
Meg J. Jardine, M.B.B.S., Ph.D., from the University of Sydney, and colleagues conducted a phase 3 trial at 17 hospital sites in India and Australia involving adults who had been admitted to the hospital for management of COVID-19. Participants were randomly assigned to receive either oral angiotensin receptor blockers or placebo for 28 days (393 and 394 patients, respectively). The researchers found that the median World Health Organization Clinical Progression Scale score was 1 for both the angiotensin receptor blocker and placebo groups (adjusted odds ratio, 1.51; 95 percent credible interval, 1.02 to 2.23; probability of an odds ratio of >1 = 0.98). When a prespecified futility rule was met, the trial was stopped.
“Angiotensin receptor blockers that were predominantly administered as 40 mg/day of telmisartan were not an effective treatment to reduce disease severity at day 14,” Jardine and colleagues write.
Several authors from the Zheng study disclosed financial ties to GlaxoSmithKline, the manufacturer of sotrovimab; several authors from the Jardine study disclosed ties to various pharmaceutical companies.
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