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Moullan N, Asiago J, Stecco K, Hadi S, Albizem M, Tieu H, Hock B, Fenwick C, Lin K, Lengsfeld T, Poffenbarger L, Liu D, Trono D, Pantaleo G, Venkayya R, Bhuyan P. A First-in-Human Randomized Study to Assess the Safety, Tolerability, Pharmacokinetics, and Neutralization Profile of Two Investigational Long-Acting Anti-SARS-CoV-2 Monoclonal Antibodies. Infect Dis Ther 2024; 13:173-187. [PMID: 38221576 PMCID: PMC10828317 DOI: 10.1007/s40121-023-00908-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
INTRODUCTION COVID-19 remains a significant risk for the immunocompromised given their lower responsiveness to vaccination or infection. Therefore, passive immunity through long-acting monoclonal antibodies (mAbs) offers a needed approach for pre-exposure prophylaxis (PrEP). Our study evaluated safety, anti-SARS-CoV-2 neutralizing activity, nasal penetration, and pharmacokinetics (PK) of two half-life-extended investigational mAbs, AER001 and AER002, providing the first demonstration of upper airway penetration of mAbs with the LS-modification. METHODS This randomized, double-blind, placebo-controlled phase I study enrolled healthy adults (n = 80) who received two long-acting COVID mAbs (AER001 and AER002), AER002 alone, or placebo. The dose ranged from 100 mg (mg) to 1200 mg per mAb component. The primary objective was to describe the safety and tolerability following intravenous (IV) administration. Secondary objectives were to describe PK, anti-drug antibodies (ADA), neutralization activity levels, and safety evaluation through 6 months of follow-up. RESULTS The majority (97.6%) of the reported adverse events (AE) post administration were of grade 1 severity. There were no serious adverse events (SAE) or ADAs. AER001 and AER002 successfully achieved an extended half-life of 105 days and 97.5 days, respectively. Participants receiving AER001 and AER002 (300 mg each) or AER002 (300 mg) alone showed 15- and 26-fold higher neutralization levels against D614G and omicron BA.1 than the placebo group 24 h post-administration. Single 300 or 1200 mg IV dose of AER001 and AER002 resulted in nasal mucosa transudation of approximately 2.5% and 2.7%, respectively. CONCLUSION AER001 and AER002 showed an acceptable safety profile and extended half-life. High serum neutralization activity was observed against D614G and Omicron BA.1 compared to the placebo group. These data support that LS-modified mAbs can achieve durability, safety, potency, and upper airway tissue penetration and will guide the development of the next generation of mAbs for COVID-19 prevention and treatment. TRIAL REGISTRATION EudraCT Number 2022-001709-35 (COV-2022-001).
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Affiliation(s)
| | | | | | | | | | | | - Björn Hock
- Lavaux Biotech Consulting, Yens, Switzerland
| | | | - Kai Lin
- Aerium Therapeutics, Boston, MA, USA
| | | | | | - David Liu
- Aerium Therapeutics, Boston, MA, USA
| | - Didier Trono
- School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Giuseppe Pantaleo
- Service of Immunology and Allergy, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Swiss Vaccine Research Institute, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Herman GA, O'Brien MP, Forleo-Neto E, Sarkar N, Isa F, Hou P, Chan KC, Bar KJ, Barnabas RV, Barouch DH, Cohen MS, Hurt CB, Burwen DR, Marovich MA, Musser BJ, Davis JD, Turner KC, Mahmood A, Hooper AT, Hamilton JD, Parrino J, Subramaniam D, Baum A, Kyratsous CA, DiCioccio AT, Stahl N, Braunstein N, Yancopoulos GD, Weinreich DM, Chani A, Adepoju A, Mahmood A, Mortagy A, Dupljak A, Baum A, Brown A, Froment A, Hooper A, Margiotta A, Bombardier A, Islam A, Smith A, Dhillon A, McMillian A, Breazna A, Aslam A, Carpentino B, Kowal B, Siliverstein B, Horel B, Zhu B, Musser B, Bush B, Head B, Snow B, Zhu B, Debray C, Phillips C, Simiele C, Lee C, Nienstedt C, Trbovic C, Chan C(KC, Elliott C, Fish C, Ni C, Polidori C, Enciso C, Caira C, Powell C, Kyratsous CA, Baum C, McDonald C, Leigh C, Pan C, Wolken D, Manganello D, Liu D, Stein D, Weinreich DM, Hassan D, Gulabani D, Fix D, Leonard D, Sarda D, Bonhomme D, Kennedy D, Darcy D, Barron D, Hughes D, Rofail D, Kaur D, Ramesh D, Bianco D, Cohen D, Forleo-Neto E, Jean-Baptiste E, Bukhari E, Doyle E, Bucknam E, Labriola-Tomkins E, Nanna E, Huffman O'Keefe E, Gasparino E, Fung E, Isa F, To FY, Herman G, Yancopoulos GD, Bellingham G, Sumner G, Moggan G, Power G, Zeng H, Mariveles H, Gonzalez H, Kang H, Noor H, Minns I, Heirman I, Peszek I, Donohue J, Rusconi J, Austin J, Parrino J, Yo J, McDonnell J, Hamilton JD, Boarder J, Wei J, Yu J, Malia J, Tucciarone J, Tyler-Gale J, Davis JD, Strein J, Cohen J, Meyer J, Ursino J, Im J, Tramaglini J, Wolken J, Potter K, Scacalossi K, Naidu K, Browning K, Rutkowski K, Yau K, Woloshin K, Lewis-Amezcua K, Turner K, Dornheim K, Chiu K, Mohan K, McGuire K, Macci K, Ringleben K, Mohammadi K, Foster K, Knighton L, Lipsich L, Darling L, Boersma L, Cowen L, Hersh L, Jackson L, Purcell L, Sherpinsky L, Lai L, Faria L, Geissler L, Boppert L, Fiske L, Dickens M, Mancini M, Leigh MC, O'Brien MP, Batchelder M, Klinger M, Partridge M, Tarabocchia M, Wong M, Rodriguez M, Albizem M, O'Byrne M, Braunstein N, Sarkar N, Stahl N, Deitz N, Memblatt N, Shah N, Kumar N, Herrera O, Adedoyin O, Yellin O, Snodgrass P, Floody P, D'Ambrosio P, Gao P(X, Hou P, Hearld P, Li Q, Kitchenoff R, Ali R, Iyer R, Chava R, Alaj R, Pedraza R, Hamlin R, Hosain R, Gorawala R, White R, Yu R, Fogarty R, Dass SB, Bollini S, Ganguly S, DeCicco S, Patel S, Cassimaty S, Somersan-Karakaya S, McCarthy S, Henkel S, Ali S, Geila Shapiro S, Kim S, Nossoughi S, Bisulco S, Elkin S, Long S, Sivapalasingam S, Irvin S, Wilt S, Min T, Constant T, Devins T, DiCioccio T, Norton T, Bernardo T, Chuang TC, Wei V(J, Nuce V, Battini V, Caldwell W, Gao X, Chen X, Tian Y, Khan Y, Zhao Y, Kim Y, Dye B, Hurt CB, Burwen DR, Barouch DH, Burns D, Brown E, Bar KJ, Marovich M, Clement M, Cohen MS, Sista N, Barnabas RV, Zwerski S. Efficacy and safety of a single dose of casirivimab and imdevimab for the prevention of COVID-19 over an 8-month period: a randomised, double-blind, placebo-controlled trial. Lancet Infect Dis 2022; 22:1444-1454. [PMID: 35803290 PMCID: PMC9255947 DOI: 10.1016/s1473-3099(22)00416-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is an unmet need for COVID-19 prevention in patient populations who have not mounted or are not expected to mount an adequate immune response to complete COVID-19 vaccination. We previously reported that a single subcutaneous 1200 mg dose of the monoclonal antibody combination casirivimab and imdevimab (CAS + IMD) prevented symptomatic SARS-CoV-2 infections by 81·4% in generally healthy household contacts of SARS-CoV-2-infected individuals over a 1-month efficacy assessment period. Here we present additional results, including the 7-month follow-up period (months 2-8), providing additional insights about the potential for efficacy in pre-exposure prophylaxis settings. METHODS This was a randomised, double-blind, placebo-controlled trial done in the USA, Romania, and Moldova in 2020-2021, before the emergence of omicron (B.1.1.529) and omicron-lineage variants. Uninfected and unvaccinated household contacts of infected individuals, judged by the investigator to be in good health, were randomly assigned (1:1) to receive 1200 mg CAS + IMD or placebo by subcutaneous injection according to a central randomisation scheme provided by an interactive web response system; randomisation was stratified per site by the test results of a local diagnostic assay for SARS-CoV-2 and age group at baseline. COVID-19 vaccines were prohibited before randomisation, but participants were allowed to receive COVID-19 vaccination during the follow-up period. Participants who developed COVID-19 symptoms during the follow-up period underwent RT-PCR testing. Prespecified endpoints included the proportion of previously uninfected and baseline-seronegative participants (seronegative-modified full analysis set) who had RT-PCR-confirmed COVID-19 in the follow-up period (post-hoc for the timepoints of months 2-5 and 6-8 only) and underwent seroconversion (ie, became seropositive, considered a proxy for any SARS-CoV-2 infections [symptomatic and asymptomatic]; prespecified up to day 57, post-hoc for all timepoints thereafter). We also assessed the incidence of treatment-emergent adverse events. This study is registered with ClinicalTrials.gov, NCT04452318. FINDINGS From July 13, 2020, to Oct 4, 2021, 2317 participants who were RT-PCR-negative for SARS-CoV-2 were randomly assigned, of whom 1683 (841 assigned to CAS + IMD and 842 assigned to placebo) were seronegative at baseline. During the entirety of the 8-month study, CAS + IMD reduced the risk of COVID-19 by 81·2% (nominal p<0·0001) versus placebo (prespecified analysis). During the 7-month follow-up period, protection was greatest during months 2-5, with a 100% relative risk reduction in COVID-19 (nominal p<0·0001; post-hoc analysis). Efficacy waned during months 6-8 (post-hoc analysis). Seroconversion occurred in 38 (4·5%) of 841 participants in the CAS + IMD group and in 181 (21·5%) of 842 in the placebo group during the 8-month study (79·0% relative risk reduction vs placebo; nominal p<0·0001). Six participants in the placebo group were hospitalised due to COVID-19 versus none who received CAS + IMD. Serious treatment-emergent adverse events (including COVID-19) were reported in 24 (1·7%) of 1439 participants receiving CAS + IMD and in 23 (1·6%) of 1428 receiving placebo. Five deaths were reported, none of which were due to COVID-19 or related to the study drugs. INTERPRETATION CAS + IMD is not authorised in any US region as of Jan 24, 2022, because data show that CAS + IMD is not active against omicron-lineage variants. In this study, done before the emergence of omicron-lineage variants, a single subcutaneous 1200 mg dose of CAS + IMD protected against COVID-19 for up to 5 months of community exposure to susceptible strains of SARS-CoV-2 in the pre-exposure prophylaxis setting, in addition to the post-exposure prophylaxis setting that was previously shown. FUNDING Regeneron Pharmaceuticals, F Hoffmann-La Roche, US National Institute of Allergy and Infectious Diseases, US National Institutes of Health.
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McMurray JJ, Anand IS, Diaz R, Maggioni AP, O'Connor C, Pfeffer MA, Solomon SD, Tendera M, van Veldhuisen DJ, Albizem M, Cheng S, Scarlata D, Swedberg K, Young JB. Baseline characteristics of patients in the Reduction of Events with Darbepoetin alfa in Heart Failure trial (RED-HF). Eur J Heart Fail 2013; 15:334-41. [PMID: 23329651 PMCID: PMC3576902 DOI: 10.1093/eurjhf/hfs204] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 11/07/2012] [Indexed: 12/12/2022] Open
Abstract
AIMS This report describes the baseline characteristics of patients in the Reduction of Events with Darbepoetin alfa in Heart Failure trial (RED-HF) which is testing the hypothesis that anaemia correction with darbepoetin alfa will reduce the composite endpoint of death from any cause or hospital admission for worsening heart failure, and improve other outcomes. METHODS AND RESULTS Key demographic, clinical, and laboratory findings, along with baseline treatment, are reported and compared with those of patients in other recent clinical trials in heart failure. Compared with other recent trials, RED-HF enrolled more elderly [mean age 70 (SD 11.4) years], female (41%), and black (9%) patients. RED-HF patients more often had diabetes (46%) and renal impairment (72% had an estimated glomerular filtration rate < 60 mL/min/1.73 m2). Patients in RED-HF had heart failure of longer duration [5.3 (5.4) years], worse NYHA class (35% II, 63% III, and 2% IV), and more signs of congestion. Mean EF was 30% (6.8%). RED-HF patients were well treated at randomization, and pharmacological therapy at baseline was broadly similar to that of other recent trials, taking account of study-specific inclusion/exclusion criteria. Median (interquartile range) haemoglobin at baseline was 112 (106-117) g/L. CONCLUSION The anaemic patients enrolled in RED-HF were older, moderately to markedly symptomatic, and had extensive co-morbidity.
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Affiliation(s)
- John J.V. McMurray
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA, UK
| | - Inder S. Anand
- University of Minnesota Medical School and VA Medical Center, Minneapolis, MN, USA
| | - Rafael Diaz
- Estudios Clinicos Latinoamerica, Rosario, Argentina
| | | | | | | | | | - Michal Tendera
- Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | | | | | | | | | - Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - James B. Young
- Department of Medicine, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA
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