Background: Due to limited inclusion of patients on kidney replacement therapy (KRT) in clinical trials, the effectiveness of COVID-19 therapies in this population remains unclear. We sought to address this by comparing the effectiveness of sotrovimab against molnupiravir, two commonly used treatments for non-hospitalised KRT patients with COVID-19 in the UK.

Methods: With the approval of NHS England we used routine clinical data from 24 million patients in England within the OpenSAFELY-TPP platform linked to the UK Renal Registry (UKRR) to identify patients on KRT. Cox proportional hazards model was used to estimate hazard ratios of sotrovimab vs. molnupiravir with regards to COVID-19 related hospitalisation or deaths in the subsequent 28 days. We also conducted a complementary analysis using data from the Scottish Renal Registry (SRR).

Results: Among the 2367 kidney patients treated with sotrovimab (n=1852) or molnupiravir (n=515) between December 16, 2021 and August 1, 2022 in England, 38 cases (1.6%) of COVID-19 related hospitalisations/deaths were observed. Sotrovimab was associated with substantially lower outcome risk than molnupiravir (adjusted hazard ratio, HR=0.35, 95% CI: 0.17-0.71; P=0.004), with results remaining robust in multiple sensitivity analyses. In the SRR cohort, sotrovimab showed a trend toward lower outcome risk than molnupiravir (HR=0.39, 95% CI: 0.13-1.21; P=0.106). In both datasets, sotrovimab had no evidence of association with other hospitalisation/death compared with molnupiravir (HRs ranging from 0.73-1.29; P>0.05).

Conclusions: In routine care of non-hospitalised patients with COVID-19 on KRT, sotrovimab was associated with lower risk of severe COVID-19 outcomes compared with molnupiravir during Omicron waves.


This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite as

Zheng, B., Campbell, J., Carr, E., Tazare, J., Nab, L., Mahalingasivam, V., Mehrkar, A., Santhakumaran, S., Steenkamp, R., Loud, F., Lyon, S., Scanlon, M., Hulme, W., Green, A., Curtis, H., Fisher, L., Parker, E., Goldacre, B., Douglas, I., Evans, S., Mackenna, B., Bell, S., Tomlinson, L., Nitsch, D., The OpenSAFELY Collaborative & LH&W NCS (or CONVALESCENCE) Collaborative 2023, 'Comparative effectiveness of sotrovimab and molnupiravir for preventing severe COVID-19 outcomes in patients on kidney replacement therapy: observational study using OpenSAFELY-UKRR and SRR databases', Clinical Kidney Journal, article no: sfad184. https://doi.org/10.1093/ckj/sfad184

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Last updated: 03 May 2024
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