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Treating COVID-19 patients with Sotrovimab

Posted on: January 19, 2022

New COVID-19 therapies are now available for the treatment of outpatients with mild to moderate illness who are at high risk for progression to hospitalization and severe disease. Island health has established an Outpatient Covid Therapeutics Clinic (OCTC) for the evaluation and treatment of patients who meet criteria for these therapies at CRH, NRGH, and RJH [Island Health establishes three outpatient clinics to treat vulnerable COVID-19 patients using Sotrovimab]. Work is being undertake to establish additional sites including CDH, WCGH and possible TGH.

Patient Eligibility

To meet criteria patients must have a positive Covid test, they must present within 7 days of symptom onset, and they need to be in one of the following high risk Tier one populations to qualify for therapy.      

1. Patients identified as Clinically Extremely Vulnerable Group 1 and Group 2 (CEV 1 and CEV 2), regardless of vaccine status or previous infection. They are considered unlikely to respond to vaccination. (Treatment may be offered despite >7 days of symptom onset based on clinical judgement)

a. Active treatment for solid tumor or hematological malignancies

b. Having received a solid organ transplant treated with immunosuppression

c. Receiving CAR-T cell therapy or hematopoietic stem cell transplant in the last 2 yrs,

d.  Having a moderate to severe primary immunodeficiency

e.  Having advanced untreated HIV or AIDS

f.  Active receipt of anti-B cell therapies (e.g. rituximab, ocrelizumab, obinutuzumab), high-dose systemic steroids (=20mg prednisone equivalent daily for at least 14 days), alkylating agents (e.g. cyclophosphamide, cisplatin), antimetabolites (e.g. methotrexate, 5-FU) or anti-TNF agents (e.g. infliximab, adalimumab).  

g.  Those with ESRD on dialysis

2. Unvaccinated or partially vaccinated individuals identified as Clinically Extremely Vulnerable Group 3 (CEV3). (less than 2 doses of vaccine or 2 doses of non-mRNA vaccine)

a. This includes a heterogeneous group of disorders including patients with severe respiratory conditions, rare blood disorders and hematologic diseases and cancers,, splenectomy, metabolic disorders, significant developmental disabilities, and milder immune suppression.

b. Pregnancy

c. Diabetes requiring insulin therapy

3. Unvaccinated or partially vaccinated individuals aged ≥70 years with one or more chronic condition/co-morbidity (e.g. obesity, non-insulin dependent diabetes, hypertension, heart failure, renal dysfunction) (Many chronic conditions or comorbidities can be considered; consult a clinician for guidance as this list is not exhaustive)

4. Unvaccinated (and previously uninfected) or partially vaccinated individuals ≥ 60 years with three or more chronic conditions/co-morbidities

5. Unvaccinated (Previously uninfected) or partially vaccinated aboriginal individuals ≥ 60 years.

Referral: Any clinician can refer a patient to the Outpatient Covid Therapeutics Clinic (OCTC) by telling the patient to call the clinic and undergo screening for eligibility. If they meet criteria they will be booked for a sotrovimab infusion or they will be prescribed Paxlovid. Ideally patients will check the website first to check for eligibility. The OCTC line is: 250-737-2030 ext 44685. For referrals please either talk to an ID doctor on call or direct the patient to the website to check their eligibility or have them call the clinic directly.

For outpatient referrals please direct the patient to the website to check their eligibility or have them call the clinic directlyFor questions regarding inpatients please consult the ID doctor on call in your geography.  See on call scheduling for availability.

Clinical Practice Guide for the Use of Sotrovimab in Patients with COVID-19

For more information on COVID-19 Therapeutic Clinics, please visit:  https://www.islandhealth.ca/learn-about-health/covid-19/outpatient-covid-19-therapeutics-clinic

A message from Dr. Eric Partlow, Infectious Diseases Consultant, Department of Medicine, Island Health

Updated memo originally sent on January 10th. Memo on Sotrovimab Therapy for Vulnerable Patients click here