The purpose of this guidance is to outline the model by which sotrovimab will be used in NSW. This model will be updated as required and based on:
Local access to sotrovimab will be through usual Drug and Therapeutic Committee processes.
The model is based on recommendations from the National Clinical Evidence Taskforce guidelines2 and evidence from the COMET-ICE study3.
This evidence was considered by an expert group of NSW clinicians to inform the development of this model. This included infectious diseases, hospital in the home, aged care, respiratory, medication safety, drug and therapeutics and oncology.
Additional advice regarding administration settings was subsequently developed by the same clinical working group and included representatives from metropolitan and rural local health districts.
The model was reviewed by the Expert Advisory Group of the NSW COVID-19 Clinical Council.
As per the National Taskforce Guidelines, sotrovimab is appropriate for use in non-pregnant adults and pregnant women in their second or third timester:
The following additional risk factors should also be considered:
Clinical judgement should be used when assessing the severity of specific risk factors. This may include other significant chronic health conditions including but not limited to cardiac failure, chronic lung disease, immunosuppression and active malignancy.
Access for patients should be considered in the context of the outbreak in NSW. As such, it is the recommendation of the clinical working group that the following cohorts are prioritised. Patients identified as part of the following groups also need to meet the clinical criteria above.
It may be prudent to plan access for patients in the above groups who have been exposed but have not yet developed symptoms.
Specifications for administration of sotrovimab are outlined in the
NSW Therapeutic Advisory Group (TAG) Drug Guideline for sotrovimab 4
Specific notes for the community and rural setting:
Many patients with COVID-19 are receiving care in the community as outlined in the guidance
Caring for adults with COVID-19 in the community.
The use of sotrovimab requires reporting and monitoring of outcomes
for more information, contact NSW TAG or see the
The access and supply of sotrovimab is managed by HealthShare and is aligned to the processes for other COVID-19 medications.
Operationalisation of models of care for use of medications for treatment of COVID-19 should be determined in consultation with local clinicians and the local Drug and Therapeutics Committee.
The clinical working group has recommended that sotrovimab is not delivered in hospital in the home or community care settings. This aligns to advice released by the Society of Hospital Pharmacists of Australia on administration of the medicine
5,4 and reflects the approach of other Australian jurisdictions.
This is in recognition that sotrovimab is a new treatment requiring monitoring during and after infusion. It is also informed by the rate and severity of the infusion reactions during the trial.
It is acknowledged that some local health districts may adopt a HITH approach for the administration of sotrovimab locally where they can address the considerations below and feel it meets the needs of their local community.
As staff need to be on site for at least two hours, local health districts will need to manage processes for extended COVID-19 exposure.
Staff need to have competency in monitoring for infusion reactions, managing adverse events and resuscitation skills in the event of anaphylaxis.
Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning
15 October 2021