(108) Impact of Treatment of COVID-19 with Sotrovimab on Post-Acute COVID-19 Syndrome: An Analysis of National COVID Cohort Collaborative (N3C) Data

Background: The sequelae of SARS-CoV-2 infection can present as various symptoms and severity beyond the acute phase of the disease, referred to as post-acute sequelae COVID-19 syndrome (PASC) or long COVID.

Objectives: To evaluate the impact of sotrovimab, a monoclonal antibody used to reduce the risk of COVID-19 progression, on the risk of developing PASC.

Methods: Retrospective cohort study (using the US N3C database) of high-risk patients ≥12 years old diagnosed with COVID-19 between 26 May 2021–26 March 2022, who were either treated with sotrovimab or received no early treatment. PASC was defined as the incidence of ≥1 of 26 PASC symptoms following a 30-day acute COVID-19 phase (starting on diagnosis date). Average treatment effect among the treated (ATT) weighting was used to balance baseline characteristics between treated and untreated cohorts and to address confounding by indication, with standardised differences employed to assess potential confounders. Doubly robust ATT-weighted Cox regression models were constructed to compare the time to event for PASC between the two cohorts. Sensitivity of the findings to a more specific PASC definition (PASC ICD-10 code or PASC clinic visit) was investigated.

Results: Sotrovimab-treated patients (N=9,504) were older (mean 60 vs. 53 years) than untreated patients (N=619,618), more likely to be White (86% vs. 75%), obese (39% vs. 25%) and smokers (19% vs. 7%), and met more high-risk criteria for sotrovimab use (mean 3 vs. 2). Except for concomitant medication or healthcare encounters during the acute phase before index date (sotrovimab treatment date or imputed date), cohorts were well-balanced after weighting (standardised difference ≤10%). The risk of developing PASC was significantly lower in the sotrovimab-treated compared to the untreated cohort (doubly robust hazard ratio [95% confidence interval] = 0.92 [0.89-0.96], p < 0.001). Results of the sensitivity analysis were similar but non-significant (doubly robust hazard ration [95% confidence interval] = 0.89 [0.74-1.07, p=0.21), possibly due to lower observed event rates.

Conclusions: Sotrovimab treatment is associated with a small but statistically significant reduced risk of developing PASC among high-risk patients with acute COVID-19 and may present an effective option for PASC prevention in this population.

Funding: GSK (Study 218554)/Vir Biotechnology, Inc. The original abstract has been previously submitted to the ECCMID 2024 congress.