Rule logic

The data tables below summarises the logic and data used to each of the cohorts listed in the NHS England Interim Clinical Commissioning Policy: Neutralising monoclonal antibodies or antivirals for non-hospitalised patients with COVID-19 following the changes made by simple additions.

Down’s syndrome and other genetic disorders

Description	Data used	Ruleset
All individuals with Down’s syndrome	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating a diagnosis of Down's Syndrome.
Other chromosomal disorders known to affect immune competence (decision to treat to be at the discretion of the treating clinician).	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating a chromosomal condition that effects immune competence.

Solid cancer

Description	Data used	Ruleset
Metastatic or locally advanced inoperable cancer	HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating metastatic disease.
Lung cancer (at any stage)	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating lung cancer.
People receiving any chemotherapy (including antibody-drug conjugates), PI3K inhibitors or radiotherapy within 12 months	GPES,GDPPR, HES, SACT, RTDS	All people whose age equals 12 years minus therapeutic window minus 1 day or above with a clinical code in their medical records indicating chemotherapy, PI3K inhibitors or radiotherapy treatment within the last 12 months.
People who have had cancer resected within 3 months and who received no adjuvant chemotherapy or radiotherapy		Non-Digital Pathway
People who have had cancer resected within 3 to 12 months and receiving no adjuvant chemotherapy or radiotherapy are expected to be at less risk (and thus less priority) but still at increased risk compared with the non-cancer populations		Non-Digital Pathway

Haematological diseases and recipients of haematological stem cell transplant (HSCT)

Description	Data used	Ruleset
Allogeneic HSCT recipients in the last 12 months or active graft versus host disease (GVHD) regardless of time from transplant (including HSCT for non-malignant diseases)	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating GVHD.
Autologous HSCT recipients in the last 12 months (including HSCT for non-malignant diseases)	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above with a clinical code in their medical records indicating HSCT within the last 12 months.
Active graft versus host disease (GVHD) regardless of time from transplant	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who has ever had a clinical code in their medical records indicating HSCT.
Individuals with haematological malignancies who have received CAR-T cell therapy in the last 24 months	GPES, GDPPR	All people whose age equals 12 years minus therapeutic window minus 1 day or above with a clinical code in their medical records indicating CART-T cell therapy within the last 24 months.
Individuals with haematological malignancies receiving systemic anti-cancer treatment (SACT) within the last 12 months, or radiotherapy in the last 12 months	GPES, GDPPR, SACT, RTDS	All people whose age equals 12 years minus therapeutic window minus 1 day or above with a clinical code in their medical records indicating systemic anti-cancer treatment (SACT) or Radiotherapy within the last 12 months.

All people who do not fit the criteria above, and are diagnosed with:

Description	Data used	Ruleset
Myeloma (excluding monoclonal gammopathy of undetermined significance (MGUS))	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating myeloma.
AL amyloidosis	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating AL amyloidosis.
Chronic B-cell lymphoproliferative disorders (chronic lymphocytic leukaemia, follicular lymphoma)	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating B-cell lymphoproliferative disorders including all B-Cell lymphomas and lymphomas where clinical coding is ambiguous to the nature of the lymphoma.
Myelodysplastic syndrome (MDS)	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating myelodysplastic syndrome (MDS).
Chronic myelomonocytic leukaemia (CMML)	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating chronic myelomonocytic leukaemia (CMML).
Myelofibrosis	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating myelofibrosis.
All people with sickle cell disease	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating sickle cell anaemia.
Individuals with non-malignant haematological disorders (for example, aplastic anaemia or paroxysmal nocturnal haemoglobinuria) receiving B-cell depleting systemic treatment (for example, anti-CD20, anti-thymocyte globulin (ATG) and alemtuzumab) within the last 12 months	GPES, GDPPR	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have had a clinical code in their medical records indicating a B-cell depleting therapy treatment within the last 12 months.
People with thalassaemia or rare inherited anaemia with severe cardiac iron overload (T2 * less than 10ms on magnetic resonance imaging) or severe to moderate iron overload (T2 * greater than or equal to 10ms on magnetic resonance imaging) plus an additional co-morbidity of concern (for example, diabetes, chronic liver disease or severe hepatic iron load on MRI)		Non-digital pathway

Renal disease

Description	Data used	Ruleset
Renal transplant recipients (including those with failed transplants within the past 12 months)	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating a renal transplant.
Received B cell depleting therapy within the past 12 months (including alemtuzumab, rituximab (anti-CD20), anti-thymocyte globulin)	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have had a clinical code in their medical records indicating a B-cell depleting therapy treatment within the last 12 months.
An additional substantial risk factor which would in isolation make them eligible for monoclonals or oral antivirals		Non-digital pathway
Not been vaccinated prior to transplantation		Non-digital pathway
Non-transplant renal patients who have received a comparable level of immunosuppression. Please refer to the section on ‘Immune-mediated inflammatory diseases’ below for a list of qualifying immunosuppressive therapies	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have had a clinical code in their medical records indicating a prescription of one of the specified immunosuppressive therapies within the last 12 months.
Patients with chronic kidney disease (CKD) stage 4 or 5 (an eGFR less than 30ml per min per 1.73m2) without immunosuppression	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating CKD4, CKD5 or community dialysis.

Liver disease

Description	Data used	Ruleset
People with cirrhosis Child-Pugh class A,B and C, whether receiving immune suppressive therapy or not. Those with decompensated liver disease (Child-Pugh B and C) are at greatest risk	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating cirrhosis.
Patients with a liver transplant.	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating a liver transplant.
People with liver disease on immune suppressive therapy (including people with and without cirrhosis) – please refer to the section on ‘Immune-mediated inflammatory diseases’ below for a list of qualifying immunosuppressive therapies	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating a liver transplant.

Solid organ transplant recipients

Description	Data used	Ruleset
Solid organ transplant recipients not in any of the above categories.	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating a solid organ transplant.

Immune-mediated inflammatory disorders (IMID)

Description	Data used	Ruleset
People who have received a B-cell depleting therapy (anti-CD20 drug for example rituximab, ocrelizumab, ofatumab, obinutuzumab) in the last 12 months	GPES, GDPPR	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have had a clinical code in their medical records indicating a B-cell depleting therapy treatment within the last 12 months.
People who have been treated with cyclophosphamide (IV or oral) in the 6 months prior to positive PCR	GPES, GDPPR, SACT	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have had a clinical code in their medical records indicating cyclophosphamide treatment within the last 6 months.
People who are on biologics or small molecule JAK-inhibitors (except anti-CD20 depleting monoclonal antibodies) or who have received these therapies within the last 6 months	GPES, GDPPR	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have had a clinical code in their medical records indicating biologics and JAK-inhibitor therapy within the last 6 months.
People who are on corticosteroids (equivalent to greater than 10mg per day of prednisolone) for at least the 28 days prior to positive PCR	GPES, GDPPR	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have had a clinical code in their medical records indicating that they have been prescribed 4 courses of systemic corticosteroid on separate days within 6 months.
People who are on current treatment with mycophenolate mofetil, oral tacrolimus, azathioprine/mercaptopurine (for major organ involvement such as kidney, liver and/or interstitial lung disease), methotrexate (for interstitial lung disease) and/or ciclosporin	GPES, GDPPR, SACT	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have had a clinical code in their medical records indicating mycophenolate mofetil, oral tacrolimus, azathioprine, mercaptopurine, methotrexate or ciclosporin therapy within the last 6 months.
People who exhibit uncontrolled or clinically active disease (that is required recent increase in dose or initiation of new immunosuppressive drug or IM steroid injection or course of oral steroids within the 3 months prior to positive PCR)		Non-digital pathway

Immune deficiencies

Description	Data used	Ruleset
Common variable immunodeficiency (CVID)	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating common variable immunodeficiency (CVID).
Undefined primary antibody deficiency on immunoglobulin (or eligible for Ig)	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating undefined primary antibody deficiency on immunoglobulin (or eligible for Ig).
Hyper-IgM syndromes	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating hyper-IgM syndromes.
Good’s syndrome (thymoma plus B-cell deficiency)	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating Good’s syndrome (thymoma plus B-cell deficiency).
Severe combined immunodeficiency (SCID)	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating severe combined immunodeficiency (SCID).
Autoimmune polyglandular syndromes or autoimmune Poly endocrinopathy, candidiasis, ectodermal dystrophy (APECED syndrome)	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating autoimmune polyglandular syndromes or autoimmune Poly endocrinopathy, candidiasis, ectodermal dystrophy (APECED syndrome).
Primary immunodeficiency associated with impaired type 1 interferon signalling	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating primary immunodeficiency associated with impaired type 1 interferon signalling.
X-linked agammaglobulinemia (and other primary agammaglobulinemia's)	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating x-linked agammaglobulinemia (and other primary agammaglobulinemia's)
Any person with secondary immunodeficiency receiving immunoglobulin replacement therapy		Non-digital pathway

HIV/AIDS

Description	Data used	Ruleset
People with high levels of immune suppression, have uncontrolled or untreated HIV (high viral load) or present acutely with an AIDS defining diagnosis	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating HIV or AIDS.
People on treatment for HIV with CD4 less than 350 cells per mm3 and stable on HIV treatment or CD4 greater than 350 cells per mm3 and additional risk factors (for example, age, diabetes, obesity, cardiovascular, liver or renal disease, homeless, alcoholic dependency)	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating HIV or AIDS.

Rare neurological conditions

Description	Data used	Ruleset
Multiple sclerosis	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating multiple sclerosis.
Motor neurone disease	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating motor neurone disease.
Myasthenia gravis	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating myasthenia gravis.
Huntington’s disease	GPES, GDPPR, HES	All people whose age equals 12 years minus therapeutic window minus 1 day or above who have ever had a clinical code in their medical records indicating Huntington's disease.

Last edited: 29 June 2023 8:08 am