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Hobbs FDR, Montgomery H, Padilla F, Simón-Campos JA, Arbetter D, Seegobin S, Kiazand A, Streicher K, Martinez-Alier N, Cohen TS, Esser MT. Safety, Efficacy and Pharmacokinetics of AZD7442 (Tixagevimab/Cilgavimab) for Treatment of Mild-to-Moderate COVID-19: 15-Month Final Analysis of the TACKLE Trial. Infect Dis Ther 2024; 13:521-533. [PMID: 38403865 DOI: 10.1007/s40121-024-00931-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION In the phase 3 TACKLE study, outpatient treatment with AZD7442 (tixagevimab/cilgavimab) was well tolerated and significantly reduced progression to severe disease or death through day 29 in adults with mild-to-moderate coronavirus disease 2019 (COVID-19) at the primary analysis. Here, we report data from the final analysis of the TACKLE study, performed after approximately 15 months' follow-up. METHODS Eligible participants were randomized 1:1 and dosed within 7 days of symptom onset with 600 mg intramuscular AZD7442 (n = 456; 300 mg tixagevimab/300 mg cilgavimab) or placebo (n = 454). RESULTS Severe COVID-19 or death through day 29 occurred in 4.4% and 8.8% of participants who received AZD7442 or placebo, a relative risk reduction (RRR) of 50.4% [95% confidence interval (CI) 14.4, 71.3; p = 0.0096]; among participants dosed within 5 days of symptom onset, the RRR was 66.9% (95% CI 31.1, 84.1; p = 0.002). Death from any cause or hospitalization for COVID-19 complications or sequelae through day 169 occurred in 5.0% of participants receiving AZD7442 versus 9.7% receiving placebo, an RRR of 49.2% (95% CI 14.7, 69.8; p = 0.009). Adverse events occurred in 55.5% and 55.9% of participants who received AZD7442 or placebo, respectively, and were mostly mild or moderate in severity. Serious adverse events occurred in 10.2% and 14.4% of participants who received AZD7442 or placebo, respectively, and deaths occurred in 1.8% of participants in both groups. Serum concentration-time profiles recorded over 457 days were similar for AZD7442, tixagevimab, and cilgavimab, and were consistent with the extended half-life reported for AZD7442 (approx. 90 days). CONCLUSIONS AZD7442 reduced the risk of progression to severe COVID-19, hospitalization, and death, was well tolerated through 15 months, and exhibited predictable pharmacokinetics in outpatients with mild-to-moderate COVID-19. These data support the long-term safety of using long-acting monoclonal antibodies to treat COVID-19. TRIAL REGISTRATION Clinicaltrials.gov, NCT04723394. ( https://clinicaltrials.gov/study/NCT04723394 .
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Affiliation(s)
- F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Applied Research Collaboration (ARC) Oxford Thames Valley, Oxford, UK
| | - Hugh Montgomery
- Department of Medicine, University College London, London, UK
| | - Francisco Padilla
- Centro de Investigación en Cardiología y Metabolismo, Guadalajara, Jalisco, Mexico
| | - Jesus Abraham Simón-Campos
- Köhler and Milstein Research/Méchnikov Project, Universidad Autonoma de Yucatan, Mérida, Yucatán, Mexico
| | - Douglas Arbetter
- Vaccines and Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Boston, MA, USA
| | - Seth Seegobin
- Vaccines and Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Alexandre Kiazand
- Patient Safety, Chief Medical Office, R&D and Vaccines and Immune Therapies, AstraZeneca, Gaithersburg, MD, USA
| | - Katie Streicher
- Vaccines and Immune Therapies, BioPharmaceuticals R&D, Astrazeneca, 1 Medimmune Way, Gaithersburg, MD, 20878, USA
| | - Nuria Martinez-Alier
- Vaccines and Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Taylor S Cohen
- Vaccines and Immune Therapies, BioPharmaceuticals R&D, Astrazeneca, 1 Medimmune Way, Gaithersburg, MD, 20878, USA
| | - Mark T Esser
- Vaccines and Immune Therapies, BioPharmaceuticals R&D, Astrazeneca, 1 Medimmune Way, Gaithersburg, MD, 20878, USA.
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Gidari A, Sabbatini S, Bastianelli S, Pierucci S, Busti C, Svizzeretto E, Tommasi A, Pallotto C, Schiaroli E, Francisci D. Tixagevimab/Cilgavimab: Still a Valid Prophylaxis against COVID-19 New Variants? Viruses 2024; 16:354. [PMID: 38543720 PMCID: PMC10975286 DOI: 10.3390/v16030354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND this study aims to evaluate the efficacy of tixagevimab/cilgavimab (Evusheld™) against various SARS-CoV-2 variants, including newer Omicron sublineages, in an immunocompromised cohort and in vitro. STUDY DESIGN Conducted in Italy, this research involves immunocompromised patients who received Evusheld. It evaluates serum neutralization activity against different SARS-CoV-2 strains (20A.EU1, BA.5, BQ.1, XBB.1.5, XBB.1.16, and EG.5) before (T0), after 14 (T1), and after 30 (T2) days from the tixagevimab/cilgavimab injection. Furthermore, the in vitro activity of Evusheld against SARS-CoV-2 VOCs was evaluated. RESULTS The cohort was composed of 72 immunocompromised patients. The serum neutralizing activity of tixagevimab/cilgavimab-treated patients was notably lower against newer variants such as BQ.1, XBB.1.5, XBB.1.16, and EG.5. Then, the in vitro study detailed specific EC50 values to quantify the activity of tixagevimab/cilgavimab against various SARS-CoV-2 VOCs. Newer variants like BQ.1 and XBB.1.5 exhibited notably lower neutralization, underscoring the challenges in effectively countering the evolving virus. Interestingly, tixagevimab/cilgavimab maintained reduced but still valid activity against EG.5 with an EC50 of 189 ng/mL and Cmax/EC90 of 110.7. CONCLUSIONS Tixagevimab/cilgavimab efficacy wanes against novel subvariants. This underscores the critical need for ongoing adaptation and vigilance in prophylactic strategies to effectively counter the dynamic and unpredictable nature of the COVID-19 pandemic.
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Affiliation(s)
- Anna Gidari
- Department of Medicine and Surgery, Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, 06132 Perugia, Italy; (S.B.); (S.P.); (C.B.); (E.S.); (A.T.); (C.P.); (E.S.); (D.F.)
| | - Samuele Sabbatini
- Department of Medicine and Surgery, Medical Microbiology Section, University of Perugia, 06123 Perugia, Italy;
| | - Sabrina Bastianelli
- Department of Medicine and Surgery, Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, 06132 Perugia, Italy; (S.B.); (S.P.); (C.B.); (E.S.); (A.T.); (C.P.); (E.S.); (D.F.)
| | - Sara Pierucci
- Department of Medicine and Surgery, Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, 06132 Perugia, Italy; (S.B.); (S.P.); (C.B.); (E.S.); (A.T.); (C.P.); (E.S.); (D.F.)
| | - Chiara Busti
- Department of Medicine and Surgery, Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, 06132 Perugia, Italy; (S.B.); (S.P.); (C.B.); (E.S.); (A.T.); (C.P.); (E.S.); (D.F.)
| | - Elisabetta Svizzeretto
- Department of Medicine and Surgery, Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, 06132 Perugia, Italy; (S.B.); (S.P.); (C.B.); (E.S.); (A.T.); (C.P.); (E.S.); (D.F.)
| | - Andrea Tommasi
- Department of Medicine and Surgery, Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, 06132 Perugia, Italy; (S.B.); (S.P.); (C.B.); (E.S.); (A.T.); (C.P.); (E.S.); (D.F.)
| | - Carlo Pallotto
- Department of Medicine and Surgery, Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, 06132 Perugia, Italy; (S.B.); (S.P.); (C.B.); (E.S.); (A.T.); (C.P.); (E.S.); (D.F.)
| | - Elisabetta Schiaroli
- Department of Medicine and Surgery, Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, 06132 Perugia, Italy; (S.B.); (S.P.); (C.B.); (E.S.); (A.T.); (C.P.); (E.S.); (D.F.)
| | - Daniela Francisci
- Department of Medicine and Surgery, Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, 06132 Perugia, Italy; (S.B.); (S.P.); (C.B.); (E.S.); (A.T.); (C.P.); (E.S.); (D.F.)
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