1. Tixagevimab-cilgavimab for treatment of patients hospitalised with COVID-19: a randomised, double-blind, phase 3 trial
- Author
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Thomas L. Holland, Adit A. Ginde, Roger Paredes, Thomas A. Murray, Nicole Engen, Greg Grandits, Andrew Vekstein, Noel Ivey, Ahmad Mourad, Uriel Sandkovsky, Robert L. Gottlieb, Mezgebe Berhe, Mamta K. Jain, Rubria Marines-Price, Barbine Tchamba Agbor Agbor, Lourdes Mateu, Sergio España-Cueto, Gemma Lladós, Eleftherios Mylonakis, Ralph Rogers, Fadi Shehadeh, Michael R. Filbin, Kathryn A. Hibbert, Kami Kim, Thanh Tran, Peter E. Morris, Evan P. Cassity, Barbara Trautner, Lavannya M. Pandit, Kirk U. Knowlton, Lindsay Leither, Michael A. Matthay, Angela J. Rogers, Wonder Drake, Beatrice Jones, Garyfallia Poulakou, Konstantinos N. Syrigos, Eduardo Fernández-Cruz, Marisa Di Natale, Eyad Almasri, Leire Balerdi-Sarasola, Sanjay R. Bhagani, Katherine L. Boyle, Jonathan D. Casey, Peter Chen, David J. Douin, D. Clark Files, Huldrych F. Günthard, R. Duncan Hite, Robert C. Hyzy, Akram Khan, Moses Kibirige, Robert Kidega, Ivan Kimuli, Francis Kiweewa, Jens-Ulrik Jensen, Bradley G. Leshnower, Joseph K. Lutaakome, Prasad Manian, Vidya Menon, Jose Luis Morales-Rull, D. Shane O'Mahony, J. Scott Overcash, Srikant Ramachandruni, Jay S. Steingrub, Hassan S. Taha, Michael Waters, Barnaby E. Young, Andrew N. Phillips, Daniel D. Murray, Tomas O. Jensen, Maria L. Padilla, David Sahner, Katy Shaw-Saliba, Robin L. Dewar, Marc Teitelbaum, Ven Natarajan, M. Tauseef Rehman, Sarah Pett, Fleur Hudson, Giota Touloumi, Samuel M. Brown, Wesley H. Self, Christina C. Chang, Adriana Sánchez, Amy C. Weintrob, Timothy Hatlen, Birgit Grund, Shweta Sharma, Cavan S. Reilly, Pedro Garbes, Mark T. Esser, Alison Templeton, Abdel G. Babiker, Victoria J. Davey, Annetine C. Gelijns, Elizabeth S. Higgs, Virginia Kan, Gail Matthews, B. Taylor Thompson, James D. Neaton, H. Clifford Lane, and Jens D. Lundgren
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,Treatment Outcome ,Double-Blind Method ,Antibodies, Monoclonal ,Humans ,COVID-19/drug therapy ,Antibodies, Neutralizing ,COVID-19 Drug Treatment - Abstract
BACKGROUND: Tixagevimab-cilgavimab is a neutralising monoclonal antibody combination hypothesised to improve outcomes for patients hospitalised with COVID-19. We aimed to compare tixagevimab-cilgavimab versus placebo, in patients receiving remdesivir and other standard care.METHODS: In a randomised, double-blind, phase 3, placebo-controlled trial, adults with symptoms for up to 12 days and hospitalised for COVID-19 at 81 sites in the USA, Europe, Uganda, and Singapore were randomly assigned in a 1:1 ratio to receive intravenous tixagevimab 300 mg-cilgavimab 300 mg or placebo, in addition to remdesivir and other standard care. Patients were excluded if they had acute organ failure including receipt of invasive mechanical ventilation, extracorporeal membrane oxygenation, vasopressor therapy, mechanical circulatory support, or new renal replacement therapy. The study drug was prepared by an unmasked pharmacist; study participants, site study staff, investigators, and clinical providers were masked to study assignment. The primary outcome was time to sustained recovery up to day 90, defined as 14 consecutive days at home after hospital discharge, with co-primary analyses for the full cohort and for participants who were neutralising antibody-negative at baseline. Efficacy and safety analyses were done in the modified intention-to-treat population, defined as participants who received a complete or partial infusion of tixagevimab-cilgavimab or placebo. This study is registered with ClinicalTrials.gov, NCT04501978 and the participant follow-up is ongoing.FINDINGS: From Feb 10 to Sept 30, 2021, 1455 patients were randomly assigned and 1417 in the primary modified intention-to-treat population were infused with tixagevimab-cilgavimab (n=710) or placebo (n=707). The estimated cumulative incidence of sustained recovery was 89% for tixagevimab-cilgavimab and 86% for placebo group participants at day 90 in the full cohort (recovery rate ratio [RRR] 1·08 [95% CI 0·97-1·20]; p=0·21). Results were similar in the seronegative subgroup (RRR 1·14 [0·97-1·34]; p=0·13). Mortality was lower in the tixagevimab-cilgavimab group (61 [9%]) versus placebo group (86 [12%]; hazard ratio [HR] 0·70 [95% CI 0·50-0·97]; p=0·032). The composite safety outcome occurred in 178 (25%) tixagevimab-cilgavimab and 212 (30%) placebo group participants (HR 0·83 [0·68-1·01]; p=0·059). Serious adverse events occurred in 34 (5%) participants in the tixagevimab-cilgavimab group and 38 (5%) in the placebo group.INTERPRETATION: Among patients hospitalised with COVID-19 receiving remdesivir and other standard care, tixagevimab-cilgavimab did not improve the primary outcome of time to sustained recovery but was safe and mortality was lower.FUNDING: US National Institutes of Health (NIH) and Operation Warp Speed.
- Published
- 2022