1. A Phase III Randomized Controlled Trial of Plitidepsin, a Marine-Derived Compound, in Hospitalized Adults With Moderate COVID-19.
- Author
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Landete P, Caliman-Sturdza OA, Lopez-Martin JA, Preotescu L, Luca MC, Kotanidou A, Villares P, Iglesias SP, Guisado-Vasco P, Saiz-Lou EM, Del Carmen Farinas-Alvarez M, de Lucas EM, Perez-Alba E, Cisneros JM, Estrada V, Hidalgo-Tenorio C, Poulakou G, Torralba M, Fortun J, Garcia-Ocana P, Lemaignen A, Marcos-Martin M, Molina M, Paredes R, Perez-Rodriguez MT, Raev D, Ryan P, Meira F, Gomez J, Torres N, Lopez-Mendoza D, Jimeno J, and Varona JF
- Subjects
- Humans, Male, Female, Middle Aged, Aged, COVID-19, SARS-CoV-2, Adult, Treatment Outcome, Hospitalization, Dexamethasone therapeutic use, Dexamethasone administration & dosage, Antiviral Agents therapeutic use, Antiviral Agents adverse effects, Antiviral Agents administration & dosage, COVID-19 Drug Treatment, Depsipeptides therapeutic use, Depsipeptides adverse effects, Depsipeptides administration & dosage, Peptides, Cyclic therapeutic use, Peptides, Cyclic adverse effects
- Abstract
Background: Plitidepsin has shown potent preclinical activity against severe acute respiratory syndrome coronavirus 2 and was generally well tolerated in a phase I trial of hospitalized patients with coronavirus disease 2019 (COVID-19). NEPTUNO, a phase III, multicenter, randomized, controlled trial, was designed to evaluate the efficacy and safety of plitidepsin in the management of moderate COVID-19 in hospitalized adult patients., Methods: Included patients had documented severe acute respiratory syndrome coronavirus 2 infection, required oxygen therapy, and had adequate organ function. The planned sample size was 609 patients. Patients were randomized 1:1:1 to at least 3 days of dexamethasone plus either plitidepsin (1.5 mg/day or 2.5 mg/day, for 3 days) or standard of care (control). The primary endpoint was the time to sustained withdrawal of supplemental oxygen. Secondary endpoints included time to sustained hospital discharge, clinical status, duration of oxygen support, percentage of patients requiring admission to the intensive care unit, and safety., Results: After randomizing 205 patients, NEPTUNO was discontinued due to a notable drop in COVID-19-related hospitalizations. Available data suggest a 2-day improvement in the median time to sustained oxygen therapy discontinuation (5 vs 7 days) favoring both plitidepsin arms (hazard ratio, 1.37; 95% confidence interval, .96-1.96; P = .08 for plitidepsin 1.5 mg vs control; hazard ratio, 1.06; 95% confidence interval, .73-1.53; P = .78 for plitidepsin 2.5 mg vs control). Plitidepsin was generally well tolerated., Conclusions: Despite the trial limitations, these results suggest that plitidepsin may have a positive benefit-risk ratio in the management of patients requiring oxygen therapy. Further studies with plitidepsin, including those in immunosuppressed patients, are warranted.Results from this phase III trial suggest that plitidepsin, a first-in-class antiviral, may have a positive benefit-risk ratio in the management of hospitalized patients requiring oxygen therapy for moderate COVID-19., Competing Interests: Potential conflicts of interest. V. E. has received economic support for educational talks and advisory boards from Gilead Sciences and PharmaMar SA. M. M-M. has received grants and fees for scientific advice not related with this work; received in the past 36 months from Boehringer Ing, Roche, Ferrer, Chiesi. P. V. has received provision of study materials, travel support travel from PharmaMar SA, and payments from PharmaMar SA and GlaxoSmithKline (GSK). P. G-V. received speaker fees from FLS Science, PharmaMar SA (Madrid, Spain), Pfizer (Spain), and GSK (Spain); consulting fees from Angelini Pharma and PharmaMar SA; served as an advisory board member for Berlin Cures GmbH and PharmaMar SA; and received meeting grants from GSK and PharmaMar SA. A. L. has received occasional training fees from Gilead, is a member of a Data Monitoring Committee for a randomized controlled trial for Biophytis Biopharma. R. P. has received grants or contracts from MSD, ViiV Healthcare; consulting fees Pfizer, Gilead, AstraZeneca, PharmaMar SA, GSK, Atea. G. P. has received fees, as member advisory panels and consultancy, from Pfizer, MSD, Menarini, and Gilead. M. M. has received fees from Boehringer as scientific advisor and payments for lectures and educational events from GSK. J. F. has received grants and payments from Gilead, Pfizer, Shionogy, Astellas, and MSD, as well as travel support. P. R. has received fees and travel support from Gilead, Merck, VIV, and Gesida. D. L-M., E-M. S-L, F. M., J. G., and N. T. are a full-time employees of PharmaMar. J. J. holds stocks of Pangaea Oncology, has a nonremunerated role in the Scientific Advisory Board, and holds stocks of Promontory Therapeutics; is a full-time employee and shareholder of PharmaMar, S.A. (Madrid, Spain), and a co-inventor of 2 patents for Plitidepsin (WO99-42125). J. A. L.-M. is a full-time employee and shareholder of PharmaMar, S.A (Madrid, Spain), and a co-inventor of a patent for plitidepsin (WO2008135793A1). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
- Published
- 2024
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