Purpose: To assess the impact of early sotrovimab treatment versus no treatment on the risk of developing post-acute sequelae of COVID-19 (PASC; long COVID) in patients (age ≥ 12 years) with COVID-19 at high risk for progression to severe disease.
Methods: Retrospective cohort study using the US National COVID Cohort Collaborative (N3C) data. Phase 1 identified and assessed multiple definitions of PASC; Phase 2 evaluated the effectiveness of sotrovimab for reducing the risk of PASC, utilizing definitions from Phase 1. Average treatment effect in the treated (ATT)-weighted Cox proportional hazards regression models were used to compare time to event for PASC between high-risk patients who received sotrovimab treatment between May 26, 2021 and April 5, 2022, and high-risk patients with COVID-19 diagnosed between May 26, 2021 and March 26, 2022 who did not receive any treatment for COVID-19 during the acute phase or any pre-exposure prophylaxis against SARS-CoV-2.
Results: A total of 9,504 sotrovimab-treated and 619,668 untreated patients were included in the main analysis. Most baseline characteristics were balanced between the two cohorts after ATT weighting. The doubly robust ATT-weighted hazard ratio (95% confidence interval) was 0.92 (0.89-0.96) (p < 0.001), indicating that sotrovimab use was associated with a significantly lower risk of PASC. Results remained consistent in sensitivity analyses.
Conclusion: In patients at high risk for severe COVID-19, the benefits of early sotrovimab treatment may extend beyond the acute phase of COVID-19 and contribute to the prevention of PASC symptoms.
Keywords: COVID-19; Post-acute sequelae of COVID-19; Sotrovimab.
© 2025. The Author(s).