A Neutralizing Monoclonal Antibody for Hospitalized Patients with Covid-19
Authors: Jens D Lundgren, Birgit Grund, Christina E Barkauskas, Thomas L Holland, Robert L Gottlieb, Uriel Sandkovsky, Samuel M Brown, Kirk U Knowlton, Wesley H Self, D Clark Files, Mamta K Jain, Thomas Benfield, Michael E Bowdish, Bradley G Leshnower, Jason V Baker, Jens-Ulrik Jensen, Edward M Gardner, Adit A Ginde, Estelle S Harris, Isik S Johansen, Norman Markowitz, Michael A Matthay, Lars Østergaard, Christina C Chang, Victoria J Davey, Anna Goodman, Elizabeth S Higgs, Daniel D Murray, Thomas A Murray, Roger Paredes, Mahesh K B Parmar, Andrew N Phillips, Cavan Reilly, Shweta Sharma, Robin L Dewar, Marc Teitelbaum, Deborah Wentworth, Huyen Cao, Paul Klekotka, Abdel G Babiker, Annetine C Gelijns, Virginia L Kan, Mark N Polizzotto, B Taylor Thompson, H Clifford Lane, James D Neaton
Journal: New England Journal of Medicine (2020)

BackgroundLY-CoV555, a neutralizing monoclonal antibody, has been associated with a decrease in viral load and the frequency of hospitalizations or emergency department visits among outpatients with coronavirus disease 2019 (Covid-19). Data are needed on the effect of this antibody in patients who are hospitalized with Covid-19.MethodsIn this platform trial of therapeutic agents, we randomly assigned hospitalized patients who had Covid-19 without end-organ failure in a 1:1 ratio to receive either LY-CoV555 or matching placebo. In addition, all the patients received high-quality supportive care as background therapy, including the antiviral drug remdesivir and, when indicated, supplemental oxygen and glucocorticoids. LY-CoV555 (at a dose of 7000 mg) or placebo was administered as a single intravenous infusion over a 1-hour period. The primary outcome was a sustained recovery during a 90-day period, as assessed in a time-to-event analysis. An interim futility assessment was performed on the basis of a seven-category ordinal scale for pulmonary function on day 5.ResultsOn October 26, 2020, the data and safety monitoring board recommended stopping enrollment for futility after 314 patients (163 in the LY-CoV555 group and 151 in the placebo group) had undergone randomization and infusion. The median interval since the onset of symptoms was 7 days (interquartile range, 5 to 9). At day 5, a total of 81 patients (50%) in the LY-CoV555 group and 81 (54%) in the placebo group were in one of the two most favorable categories of the pulmonary outcome. Across the seven categories, the odds ratio of being in a more favorable category in the LY-CoV555 group than in the placebo group was 0.85 (95% confidence interval [CI], 0.56 to 1.29; P=0.45). The percentage of patients with the primary safety outcome (a composite of death, serious adverse events, or clinical grade 3 or 4 adverse events through day 5) was similar in the LY-CoV555 group and the placebo group (19% and 14%, respectively; odds ratio, 1.56; 95% CI, 0.78 to 3.10; P=0.20). The rate ratio for a sustained recovery was 1.06 (95% CI, 0.77 to 1.47).ConclusionsMonoclonal antibody LY-CoV555, when coadministered with remdesivir, did not demonstrate efficacy among hospitalized patients who had Covid-19 without end-organ failure. (Funded by Operation Warp Speed and others; TICO ClinicalTrials.gov number, NCT04501978.) Visual Abstract Neutralizing Monoclonal Antibody for Hospitalized Patients with Covid-19