Outpatient treatment options to address the SARS-CoV-2 variant Omicron

ABSTRACT

Introduction

On 26 November 2021, the World Health Organization’s Technical Advisory Group on SARS-CoV-2 Virus Evolution designated PANGO lineage B.1.1.529 a variant of concern and gave it the designation Omicron. The following day, the United Kingdom reported its first two cases of Omicron, a novel variant that was thought to be more transmissible than other variants such as Delta, Beta, and Alpha.

Areas covered

Omicron has since become the dominant variant around the world, accounting for unprecedented case counts and hospitalizations. Omicron’s high rate of spread has been attributed to a variety of factors, including enhanced replication in the upper airways (bronchi) as well as immune evasion.

Expert opinion

These intrinsic factors have implications for the approach to treatment. Monoclonal antibody therapies, which were highly effective against prior SARS-CoV-2 variants, were rendered largely ineffective against Omicron, and other antiviral options remain severely limited due to supply issues. This manuscript reviews the landscape of Omicron therapeutics and looks ahead to examine how these treatments and others may be used in the future to address the expanding threat of the Omicron variant.

KEYWORDS:

• COVID-19
• bebtelovimab
• nirmatrelvir
• outpatient
• molnupiravir

Article highlights

• The approach to treating outpatients with Omicron infection relies upon a combination of antiviral and immunomodulatory therapeutics.

• There are four effective outpatient treatment options for Omicron: bebtelovimab, molnupiravir, nirmatrelvir/ritonavir, and remdesivir. Several other outpatient medications are remain under investigation.

• For maximal efficacy, treatment must be given early in the course of infection (within the first 5-7 days of symptom onset)

Declaration of Interests

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The authors have no funding to report.