Evidence-based recommendations on nirmatrelvir plus ritonavir (Paxlovid), sotrovimab (Xevudy) and tocilizumab (RoActemra) for treating COVID-19.

The recommendations also apply to tocilizumab biosimilar products that have a marketing authorisation allowing the use of the biosimilar for the same indication.

The government, the NHS or the UK Health Security Agency may choose to use these treatments in a different way from that recommended in this guidance in exceptional circumstances such as:

  • the widespread incidence of variants of COVID-19 to which the general population has no natural or vaccine immunity
  • local or national high rates of hospitalisation with COVID-19.

In March 2024:

  • after a partial review of this guidance, we updated the recommendation on nirmatrelvir plus ritonavir to include additional groups eligible for treatment
  • we removed the recommendation on casirivimab plus imdevimab because the conditional marketing authorisation for casirivimab plus imdevimab was withdrawn.

Commercial arrangements

There are simple discount patient access schemes for sotrovimab and tocilizumab. NHS organisations can get details on the Commercial Access and Pricing (CAP) Portal. Non-NHS organisations can contact the following for details:

Guidance development process

How we develop NICE technology appraisal guidance

This guidance updates recommendations on neutralising monoclonal antibodies, nirmatrelvir plus ritonavir, sarilumab, sotrovimab and tocilizumab in NICE’s rapid guideline on managing COVID-19.

Your responsibility

The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.