National Institute for Health and Care Excellence (NICE) have reviewed the drug treatments used to treat Covid-19. Their final recommendation is that two drugs, Paxlovid and Sotrovimab, are available to treat people who test positive for the virus in the community and one drug treatment, Tocilizumab, is used for people who are admitted to hospital and require additional oxygen.
NICE say Sotrovimab can only be used in people who cannot take Paxlovid because of their health condition or the drugs they take. This will include people with late kidney disease, those with transplants or those on dialysis, meaning that Sotrovimab is likely to be the drug offered to most people with kidney disease in the community who test positive for Covid-19. Sotrovimab is given as an infusion, so a trip to a medical centre would be needed.
Kidney Care UK was very alarmed by NICE’s draft guidance, issued in November 2022, which had recommended only Paxlovid and therefore left many people with kidney disease with no treatments unless they became very ill. Many of you contacted us to share your concerns and explain how vulnerable and anxious you would feel if treatments were no longer available in the community.
We put these concerns to NICE as part of their consultation process, to make sure they were fully aware of the effect of this decision on people with kidney disease and the risk of exacerbating inequalities, particularly for those who are already at greater risk of severe illness with Covid-19.
We also highlighted key issues within NICE’s appraisal of the drug treatments that we felt failed to capture the impact of Covid-19 on people with kidney disease, for example their higher risk of severe illness and going into hospital. On your behalf, we gave verbal evidence to the two public meetings which NICE held to consider these treatments. Thank you to everyone who shared their views with us and helped NICE to understand why Sotrovimab is such an important safety net.
Enabling access to Sotrovimab, where the other treatments are not appropriate, also means that children aged 12 and over can access a treatment in the community.
Fiona Loud, Policy Director at Kidney Care UK, said: “We are relieved that NICE have listened to the concerns of those with kidney disease, raised by us and others, and have now made available a Covid-19 treatment that can be taken by them. Their draft guidance would have left thousands of kidney patients without a safe treatment to reduce their risk of severe Covid-19 as they could not take the only drug originally recommended. We highlighted to NICE the continuing higher risk of severe illness and hospitalisation among people with kidney disease who are immunosuppressed and therefore less to respond to the Covid-19 vaccines. This is what makes access to effective treatments so vital.
"We remain concerned that there is a gap in treatment for people in hospital who do not require oxygen. It is vital that government and pharmaceutical companies continue to plan for, research and develop effective Covid-19 treatment – for thousands of people the pandemic is not over.”
We also shared Kidney Care UK's views on the challenge of following NICE’s processes, which can be time consuming, when new variants of the virus are still emerging. We are pleased therefore that NICE are developing a new review process so that its recommendations on Covid-19 treatments can be updated if the evidence base changes as new variants emerge, new studies are published or the disease changes, for example if cases rapidly rise.
If no appeals are received, NICE expects to publish its final recommendations on medicines to treat Covid-19 in March 2023.
