A leading infectious diseases expert has urged health authorities to rethink their stance on the COVID-19 treatment sotrovimab, with new evidence suggesting it may outperform molnupiravir in preventing severe disease.

National treatment guidelines currently recommend the monoclonal antibody should only be used as a last resort because of the lack of clinical evidence backing its efficacy against the Omicron subvariants. 

But now, a UK cohort study has shown that high-risk, mostly-vaccinated adults have a “substantially lower risk” of severe COVID-19 outcomes when treated with sotrovimab compared with molnupiravir — even with the BA.2 variant.

Writing in the BMJ, the researchers say the results are consistent with UK guidance, which prioritises the use of sotrovimab in eligible patients who do not require hospitalisation.