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BackgroundCOVID-19 has driven innovation leading to emergency use authorization of treatments that address its urgent healthcare needs. However, physicians, payers and healthcare systems are challenged to select among these novel treatments for both effectiveness and value. Reliance on change in relative, rather than absolute, risk often makes discrimination of treatment effects between medications impractical, with potentially misleading conclusions. Number Needed to Treat (NNT), the reciprocal of the Absolute Risk Reduction, can be a valuable alternative in assessing benefit:risk. The objective of the current analysis was to calculate NNT for reported endpoints of COVID-19 treatments.MethodsClinical information was captured from published literature and pre-prints from investigations of COVID-19 treatments. NNTs were calculated for reported endpoints. Outpatient treatments to reduce viral load included neutralizing antibody ‘cocktails’ REGN-COV21 and bamlanivimab/etesevimab.2 Inpatient treatments included the anti-viral: remdesivir 3,4;and immune modulators: baricitinib5, and lenzilumab.6ResultsREGN-COV2 reduced the number of medically attended visits with NNT of 33.3. The NNT for hospitalization or death was 20 for bamlanivimab/etesevimab. NNTs for 28-day mortality with inpatient treatment were 37 for baricitinib, 26.3 for remdesivir alone, and 22.7 for lenzilumab. Additional analyses of lenzilumab resulted in NNT of 14.7 when combined with remdesivir and corticosteroids, 15.4 when combined with remdesivir, and 13.9 in patients with baseline CRP

BackgroundThe hyperinflammatory cytokine storm (CS) of COVID-19 is mediated by GM-CSF leading to release of downstream inflammatory chemokines, cytokines, and markers of systemic inflammation (C-reactive protein, CRP). The LIVE-AIR study demonstrated that lenzilumab, an anti-GM-CSF monoclonal antibody in patients hospitalized with COVID-19, safely improved the likelihood of achieving the primary endpoint, survival without ventilation (SWOV) by 1.54-fold (HR: 1.54;95%CI: 1.02–2.32, p=0.0403) compared with placebo. An exploratory analysis in patients with CRP 18 years, and ≤94% oxygen saturation on room air and/or requiring supplemental oxygen, but not invasive mechanical ventilation (IMV), were randomized to receive lenzilumab (600 mg, n=261) or placebo (n=259) via three intravenous infusions administered 8 hours apart. Participants were followed through Day 28 following treatment.ResultsOverall, baseline demographics were comparable between treatment groups: male, 64.7%;mean age, 60.5 years;mean BMI, 32.5 kg/m2;median CRP, 79 mg/L;CRP was 137 mg/L, HR: 1.17). The incidence of IMV, ECMO, or death was reduced (OR: 0.31;95%CI: 0.15–0.63, p=0.002) and mortality was improved by 2.22-fold (OR: 2.22;95%CI: 1.07–4.67, p=0.034). In these participants, lenzilumab decreased CRP as early as Day 2 following treatment, compared with placebo which was further decreased by 38% on Day 28 compared with placebo (24.4±3.4 mg/L vs 39.1±4.9 mg/L).ConclusionLenzilumab significantly improved SWOV in hospitalized, hypoxic participants with COVID-19 pneumonia with the greatest benefits in SWOV and survival in patients with CRP