Yael Kilstein, Marisa Iacono, Alberto Cremona, Martín Dobarro, Héctor Lucas Luciardi, Ana Pereiro, Santiago Perez Lloret, Pablo Cruz, Sandra Lambert, Luciana Muñoz, Pedro Cahn, Laura Barcelona, Gustavo Lopardo, Omar Sued, Ricardo Teijeiro, Vanesa Zylberman, Lorena Abusamra, Maria Fernanda Alzogaray, Diego Caruso, Mariana Colonna, Darío Scublinsky, Marcelo Martín Casas, Vanina Stanek, Fernando Alberto Goldbaum, Rubén Solari, Javier Farina, Gabriela Vidiella, Anselmo Bertetti, Bernardo de Miguel, Waldo H. Belloso, Linus Spatz, Susana Millán, Esteban Nannini, Favio Crudo, Gabriel Lebersztein, Santiago Sanguineti, and INM005 Study Group
Fil: Lopardo, Gustavo. Hospital Municipal Dr. Bernardo Houssay; Argentina Fil: Lopardo, Gustavo. Fundación del Centro de Estudios Infectológicos; Argentina Fil: Belloso, Waldo H. Hospital Italiano de Buenos Aires. Department of Research; Argentina Fil: Nannini, Esteban. Sanatorio Británico. Departamento de Enfermedades Infecciosas; Argentina Fil: Nannini, Esteban. Consejo Nacional de Investigaciones Científicas y Tecnicas; Argentina Fil: Colonna, Mariana. Inmunova S.A; Argentina Fil: Sanguineti, Santiago. Inmunova S.A; Argentina Fil: Zylberman, Vanesa. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Zylberman, Vanesa. Inmunova S.A; Argentina Fil: Munoz, Luciana. Inmunova S.A; Argentina Fil: Dobarro, Martín. Sanatorio Sagrado Corazón; Argentina Fil: Lebersztein, Gabriel. Sanatorio Sagrado Corazón; Argentina Fil: Farina, Javier. Hospital de Alta Complejidad Cuenca Alta Néstor Kirchner; Argentina Fil: Vidiella, Gabriela. Sanatorio Agote; Argentina Fil: Bertetti, Anselmo. Sanatorio Güemes; Argentina Fil: Crudo, Favio. Hospital Municipal Emilio Zerboni; Argentina Fil: Crudo, Favio. Universidad Nacional de San Antonio de Areco; Argentina Fil: Alzogaray, María Fernanda. Instituto Medico Platense; Argentina Fil: Barcelona, Laura. Hospital Municipal Dr. Bernardo Houssay; Argentina Fil: Teijeiro, Ricardo. Hospital General de Agudos Dr. Ignacio Pirovano; Argentina Fil: Lambert, Sandra. Hospital de Alta Complejidad El Cruce Néstor Kirchner; Argentina Fil: Scublinsky, Darío. Clínica Zabala; Argentina Fil: Iacono, Marisa. Hospital Provincial Neuquén Dr. Castro Rendón; Argentina Fil: Stanek, Vanina. Hospital Italiano de Buenos Aires. Servicio de Medicina Interna. Sección de Infectología; Argentina Fil: Solari, Ruben. Hospital de Infecciosas Francisco Javier Muñiz; Argentina Fil: Cruz, Pablo. Centro Gallego de Buenos Aires; Argentina Fil: Casas, Marcelo Martín. Clínica Adventista Belgrano; Argentina Fil: Abusamra, Lorena. Hospital Municipal Dr. Diego Thompson; Argentina Fil: Luciardi, Hector Lucas. Hospital Centro de Salud Zenón J. Santillán; Argentina Fil: Cremona, Alberto. Hospital Italiano La Plata; Argentina Fil: Caruso, Diego. Hospital Español; Argentina Fil: Miguel, Bernardo de. mAbxience; España Fil: Millan, Susana. mAbxience; España Fil: Kilstein, Yael. Hospital Municipal Dr. Bernardo Houssay; Argentina Fil: Kilstein, Yael. Hospital Italiano de Buenos Aires. Department of Research; Argentina Fil: Pereiro, Ana. Hospital Municipal Dr. Bernardo Houssay; Argentina Fil: Pereiro, Ana. Sanatorio Británico. Departamento de Enfermedades Infecciosas; Argentina Fil: Sued, Omar. Hospital Municipal Dr. Bernardo Houssay; Argentina Fil: Sued, Omar. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Cahn, Pedro. Hospital Municipal Dr. Bernardo Houssay; Argentina Fil: Cahn, Pedro. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Spatz, Linus. Inmunova S.A.; Argentina Fil: Goldbaum, Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones Bioquímicas de Buenos Aires; Argentina Fil: Goldbaum, Fernando. Inmunova S.A.; Argentina Fil: Goldbaum, Fernando. Fundación Instituto Leloir; Argentina Fil: Goldbaum, Fernando. Universidad Nacional de San Martín Campus Miguelete. Centro de Rediseño e Ingeniería en Proteínas; Argentina Fil: Pérez Lloret, Santiago. Consejo Nacional de Investigaciones Científicas y Tecnicas; Argentina Fil: Pérez Lloret, Santiago. Pontificia Universidad Católica Argentina. Facultad de Ciencias Médicas. Departamento de Docencia e Investigación; Argentina Fil: Pérez Lloret, Santiago. Universidad Abierta Interamericana. Centro de Altos Estudios en Ciencias Humanas y de la Salud; Argentina Abstract: Background: passive immunotherapy is a therapeutic alternative for patients with COVID-19. Equine polyclonal antibodies (EpAbs) could represent a source of scalable neutralizing antibodies against SARS-CoV-2. Methods: we conducted a double-blind, randomized, placebo-controlled trial to assess efficacy and safety of EpAbs (INM005) in hospitalized adult patients with moderate and severe COVID-19 pneumonia in 19 hospitals of Argentina. Primary endpoint was improvement in at least two categories in WHO ordinal clinical scale at day 28 or hospital discharge (ClinicalTrials.gov number NCT04494984). Findings: between August 1st and October 26th, 2020, a total of 245 patients were enrolled. Enrolled patients were assigned to receive two blinded doses of INM005 (n = 118) or placebo (n = 123). Median age was 54 years old, 65 1% were male and 61% had moderate disease at baseline. Median time from symptoms onset to study treatment was 6 days (interquartile range 5 to 8). No statistically significant difference was noted between study groups on primary endpoint (risk difference [95% IC]: 5 28% [-3 95; 14 50]; p = 0 15). Rate of improvement in at least two categories was statistically significantly higher for INM005 at days 14 and 21 of follow-up. Time to improvement in two ordinal categories or hospital discharge was 14 2 (§ 0 7) days in the INM005 group and 16 3 (§ 0 7) days in the placebo group, hazard ratio 1 31 (95% CI 1 0 to 1 74). Subgroup analyses showed a beneficial effect of INM005 over severe patients and in those with negative baseline antibodies. Overall mortality was 6 9% the INM005 group and 11 4% in the placebo group (risk difference [95% IC]: 0 57 [0 24 to 1 37]). Adverse events of special interest were mild or moderate; no anaphylaxis was reported. Interpretation: Albeit not having reached the primary endpoint, we found clinical improvement of hospitalized patients with SARS-CoV-2 pneumonia, particularly those with severe disease.