Remarks

• See Section 6.1 for help to identify patients at highest risk of being hospitalized.
• Several therapeutic options are available: see decision support tool that displays benefits and harms of nirmatrelvir-ritonavir, molnupiravir, remdesivir and the monoclonal antibodies, including sotrovimab and casirivimab-imdevimab.
• The GDG concluded that nirmatrelvir-ritonavir may represent a superior choice because it may have greater efficacy in preventing hospitalization than the alternatives, has fewer concerns with respect to harms than does molnupiravir; and is easier to administer than intravenous remdesivir and the antibodies.
• The Omicron BA.2 variant may substantially reduce clinical efficacy of sotrovimab; the GDG is currently assessing this issue.
• Patients with severe or critical COVID-19: based on current evidence, the benefit of sotrovimab in seronegative patients with severe or critical COVID-19 (see casirivimab-imdevimab recommendation in Section 6.8) remains unclear. This means that careful clinical judgment needs to be applied if casirivimab-imdevimab is unavailable and sotrovimab is considered.

Practical Info Route, dosage and duration: Additional considerations are available in a summary of practical issues. Here follows a brief summary of key points.

• The authorized dose for sotrovimab is one single intravenous infusion of 500 mg over 30 minutes, administered as soon as possible after a positive viral test for SARS-CoV-2 and within 10 days of symptom onset.
• Sotrovimab is available as a concentrated solution, and must be diluted prior to administration.
• Patients should be clinically monitored patients during the infusion, and observed for at least 1 hour after the infusion is completed.