Published: 2026-03-03 01:29
The National Institute for Health and Care Excellence (NICE) has issued an update to its key guidance on treatments for COVID-19, Technology Appraisal 878 (TA878), reflecting shifts in the availability and clinical landscape of therapeutic options. The latest revision specifically removes sotrovimab from its recommendations while continuing to endorse nirmatrelvir plus ritonavir (Paxlovid) and tocilizumab (RoActemra) for eligible patients at risk of severe disease.
Sotrovimab’s Departure from Guidance
A significant change within the updated guidance is the removal of sotrovimab (marketed as Xevudy) as a recommended treatment for COVID-19. This decision stems directly from the manufacturer’s announcement to discontinue the production, supply, distribution, and marketing of sotrovimab in the UK.
Sotrovimab, a monoclonal antibody, was previously included in the guidance for individuals at high risk of progressing to severe COVID-19. Its withdrawal from the market, rather than a reassessment of its clinical effectiveness by NICE, necessitates its removal from the national recommendations, ensuring that guidance reflects currently available treatments.
Continued Role for Nirmatrelvir Plus Ritonavir (Paxlovid)
Nirmatrelvir plus ritonavir, commonly known by its brand name Paxlovid, maintains its position within the NICE recommendations for treating COVID-19. This antiviral combination is a key oral therapeutic option for non-hospitalised adults who are at a high risk of developing severe illness.
The guidance highlights its utility in preventing disease progression, reducing the need for hospitalisation, and mitigating mortality in specific patient populations. These typically include individuals who are immunocompromised or have other significant risk factors for severe outcomes, provided the treatment can be initiated within a defined timeframe from symptom onset.
Healthcare professionals are advised to continue following established clinical criteria for patient selection, which typically involve assessing the individual’s risk factors, vaccination status, and the timing relative to symptom onset, to ensure appropriate and effective use of the antiviral.
Tocilizumab and its Biosimilars Retained
Tocilizumab, an immunosuppressive drug marketed as RoActemra, also remains a recommended treatment option under NICE TA878. This monoclonal antibody, which targets the interleukin-6 (IL-6) receptor, is primarily indicated for hospitalised adults with severe COVID-19 who require oxygen supplementation and exhibit evidence of systemic inflammation.
The guidance explicitly extends its recommendations to include biosimilar products of tocilizumab that have received a marketing authorisation for the same indication. This inclusion supports broader access and cost-effectiveness within the NHS by promoting competition among pharmaceutical products.
Tocilizumab’s role is critical in modulating the inflammatory response associated with severe COVID-19, thereby improving clinical outcomes in carefully selected patients within a hospital setting. The guidance acknowledges a simple discount patient access scheme for tocilizumab, details of which are available to NHS organisations.
Understanding the Context of NICE Guidance
NICE technology appraisals provide evidence-based recommendations on the clinical and cost-effectiveness of new and existing health technologies for the NHS in England. TA878, titled “Nirmatrelvir plus ritonavir and tocilizumab for treating COVID-19,” serves as a crucial reference for clinicians managing patients with COVID-19 at higher risk.
It is important for healthcare professionals to recognise that while NICE guidance provides a robust framework, national decisions regarding the use of these treatments can sometimes be influenced by broader public health considerations. The guidance itself notes that the government, the NHS, or the UK Health Security Agency may opt to use these treatments in ways that deviate from the specific recommendations under exceptional circumstances. Such scenarios could include:
- Widespread incidence of COVID-19 variants to which the general population has limited natural or vaccine immunity.
- Local or national high rates of hospitalisation attributed to COVID-19.
This flexibility ensures that the healthcare system can adapt its response to evolving epidemiological situations and the emergence of new viral threats.
Evolving Treatment Landscape
The update underscores the dynamic nature of COVID-19 management, where treatment strategies must continuously adapt to new scientific evidence, viral variants, and product availability. While TA878 focuses on these specific agents, NICE has also issued guidance on other treatments for COVID-19, including molnupiravir and remdesivir, reflecting a multifaceted approach to combating the virus.
Healthcare professionals are encouraged to stay abreast of the latest versions of NICE guidance, as these documents are reviewed regularly. The current guidance states it will be reviewed again if new evidence emerges that is likely to alter the existing recommendations, ensuring that practice remains informed by the most current data.
The shift in recommendations, driven by the discontinuation of sotrovimab, highlights the importance of an adaptable and responsive national guidance framework. By maintaining recommendations for Paxlovid and tocilizumab, NICE continues to support clinicians in providing evidence-based care to those most vulnerable to severe COVID-19 outcomes.
Source: nice
Contains public sector information licensed under the Open Government Licence v3.0. Clinical summary provided for healthcare professionals; not for patient self-diagnosis.
