Efficacy and safety of CD24Fc in hospitalised patients with COVID-19: a randomised, double-blind, placebo-controlled, phase 3 study

James Welker, Juan D Pulido, Andrew T Catanzaro, Carlos D Malvestutto, Zihai Li, Jonathan B Cohen, Eric D Whitman, Dana Byrne, Olivia K Giddings, Jordan E Lake, Joel V Chua, Ella Li, Jian Chen, Xiang Zhou, Kun He, Davis Gates, Amarjot Kaur, Jamie Chen, Hung-Yen Chou, Martin Devenport, Raymond Touomou, Shyamasundaran Kottilil, Yang Liu, Pan Zheng, SAC-COVID Study Team, Pan Zheng, Yang Liu, Martin Devenport, Raymond Touomou, Hung-Yen Chou, Jai Thakor, Imaan Khan, Nicole Do, Josephine Faragalla, Andrea Hook, Sarah Kern, Janira V Ramos, Jason Ward, Jamie Chen, John Higson, Meena Dam, Dawn Serkin, Pooja Karloopia, Wendy Moore, Mark Scofield, David Jeffery Childers, Jeffrey S Cantrell, Millie Corgan, Ella Li, Jian Chen, Xiang Zhou, Jing Liu, Denise Redvers-Higgins, Hua Han, Jiyun Hou, Yudi Pan, Karyn Tucker, Xiaoyan Zhang, Shyamasundaran Kottilil, Joel V Chua, Jennifer Husson, Shivakumar Narayanan, Jaqueline Bran, Ka Wing Joyce Lam, Alicia Jeffrey, Olivia K Giddings, Jennie Pexa, Mario Becerra, James Welker, Kathleen W Gray, Nicole Richmond, Chukwuemeka Nzelibe, Carlos D Malvestutto, Susan Koletar, Mahdee Sobhanie, Jan Clark, Zihai Li, Kelsi Reynolds, Karthik Chakravarthy, Kevin Weller, Mohamed Yusuf, Jennifer Severing, Kelley Barley, Juan D Pulido, Jennifer C Fulton, William Gil, M D Jeanine, Richmond R N, Sandy Jones, Kristina Clemmer, Dana Byrne, Lisa Pedroza, Emily Nicole Davidson, Amanda Logan, Katie Grant, Eric D Whitman, Jason Kessler, Robert Roland, Rosemary Stefiniw, Molly Maurer, Salome Geene, Christopher F Buck, Debra Connolly, Patrice Light, Sunanda Baviskar, Yee Won Low, Kyra Michalski, Pamela Giordano, Jennifer Chao, Michelle Williams, Amulya Makkapati, Andrew T Catanzaro, Jonathan B Cohen, Mehad Musbah, Pramila Jaladanki, Ying Yuan, Shilpa Rele, Desirae Stewart, Starlet Lewis, Ian Sankar, Nabulungi Kasumba, Kaylia Biney, Elham Hekmat, Jordan E Lake, Bindu Akkanti, Melissa J Reimer-McAtee, Marisel Negret Hernandez, James Welker, Juan D Pulido, Andrew T Catanzaro, Carlos D Malvestutto, Zihai Li, Jonathan B Cohen, Eric D Whitman, Dana Byrne, Olivia K Giddings, Jordan E Lake, Joel V Chua, Ella Li, Jian Chen, Xiang Zhou, Kun He, Davis Gates, Amarjot Kaur, Jamie Chen, Hung-Yen Chou, Martin Devenport, Raymond Touomou, Shyamasundaran Kottilil, Yang Liu, Pan Zheng, SAC-COVID Study Team, Pan Zheng, Yang Liu, Martin Devenport, Raymond Touomou, Hung-Yen Chou, Jai Thakor, Imaan Khan, Nicole Do, Josephine Faragalla, Andrea Hook, Sarah Kern, Janira V Ramos, Jason Ward, Jamie Chen, John Higson, Meena Dam, Dawn Serkin, Pooja Karloopia, Wendy Moore, Mark Scofield, David Jeffery Childers, Jeffrey S Cantrell, Millie Corgan, Ella Li, Jian Chen, Xiang Zhou, Jing Liu, Denise Redvers-Higgins, Hua Han, Jiyun Hou, Yudi Pan, Karyn Tucker, Xiaoyan Zhang, Shyamasundaran Kottilil, Joel V Chua, Jennifer Husson, Shivakumar Narayanan, Jaqueline Bran, Ka Wing Joyce Lam, Alicia Jeffrey, Olivia K Giddings, Jennie Pexa, Mario Becerra, James Welker, Kathleen W Gray, Nicole Richmond, Chukwuemeka Nzelibe, Carlos D Malvestutto, Susan Koletar, Mahdee Sobhanie, Jan Clark, Zihai Li, Kelsi Reynolds, Karthik Chakravarthy, Kevin Weller, Mohamed Yusuf, Jennifer Severing, Kelley Barley, Juan D Pulido, Jennifer C Fulton, William Gil, M D Jeanine, Richmond R N, Sandy Jones, Kristina Clemmer, Dana Byrne, Lisa Pedroza, Emily Nicole Davidson, Amanda Logan, Katie Grant, Eric D Whitman, Jason Kessler, Robert Roland, Rosemary Stefiniw, Molly Maurer, Salome Geene, Christopher F Buck, Debra Connolly, Patrice Light, Sunanda Baviskar, Yee Won Low, Kyra Michalski, Pamela Giordano, Jennifer Chao, Michelle Williams, Amulya Makkapati, Andrew T Catanzaro, Jonathan B Cohen, Mehad Musbah, Pramila Jaladanki, Ying Yuan, Shilpa Rele, Desirae Stewart, Starlet Lewis, Ian Sankar, Nabulungi Kasumba, Kaylia Biney, Elham Hekmat, Jordan E Lake, Bindu Akkanti, Melissa J Reimer-McAtee, Marisel Negret Hernandez

Abstract

Background: Non-antiviral therapeutic options are required for the treatment of hospitalised patients with COVID-19. CD24Fc is an immunomodulator with potential to reduce the exaggerated inflammatory response to tissue injuries. We aimed to evaluate the safety and efficacy of CD24Fc in hospitalised adults with COVID-19 receiving oxygen support.

Methods: We conducted a randomised, double-blind, placebo-controlled, phase 3 study at nine medical centres in the USA. Hospitalised patients (age ≥18 years) with confirmed SARS-CoV-2 infection who were receiving oxygen support and standard of care were randomly assigned (1:1) by site-stratified block randomisation to receive a single intravenous infusion of CD24Fc 480 mg or placebo. The study funder, investigators, and patients were masked to treatment group assignment. The primary endpoint was time to clinical improvement over 28 days, defined as time that elapsed between a baseline National Institute of Allergy and Infectious Diseases ordinal scale score of 2-4 and reaching a score of 5 or higher or hospital discharge. The prespecified primary interim analysis was done when 146 participants reached the time to clinical improvement endpoint. Efficacy was assessed in the intention-to-treat population. Safety was assessed in the as-treated population. This study is registered with ClinicalTrials.gov, NCT04317040.

Findings: Between April 24 and Sept 22, 2020, 243 hospitalised patients were assessed for eligibility and 234 were enrolled and randomly assigned to receive CD24Fc (n=116) or placebo (n=118). The prespecified interim analysis was done when 146 participants reached the time to clinical improvement endpoint among 197 randomised participants. In the interim analysis, the 28-day clinical improvement rate was 82% (81 of 99) for CD24Fc versus 66% (65 of 98) for placebo; median time to clinical improvement was 6·0 days (95% CI 5·0-8·0) in the CD24Fc group versus 10·0 days (7·0-15·0) in the placebo group (hazard ratio [HR] 1·61, 95% CI 1·16-2·23; log-rank p=0·0028, which crossed the prespecified efficacy boundary [α=0·0147]). 37 participants were randomly assigned after the interim analysis data cutoff date; among the 234 randomised participants, median time to clinical improvement was 6·0 days (95% CI 5·0-9·0) in the CD24Fc group versus 10·5 days (7·0-15·0) in the placebo group (HR 1·40, 95% CI 1·02-1·92; log-rank p=0·037). The proportion of participants with disease progression within 28 days was 19% (22 of 116) in the CD24Fc group versus 31% (36 of 118) in the placebo group (HR 0·56, 95% CI 0·33-0·95; unadjusted p=0·031). The incidences of adverse events and serious adverse events were similar in both groups. No treatment-related adverse events were observed.

Interpretation: CD24Fc is generally well tolerated and accelerates clinical improvement of hospitalised patients with COVID-19 who are receiving oxygen support. These data suggest that targeting inflammation in response to tissue injuries might provide a therapeutic option for patients hospitalised with COVID-19.

Funding: Merck & Co, National Cancer Institute, OncoImmune.

Conflict of interest statement

Declaration of interests JW, JDP, ATC, CDM, EDW, DB, OKG, JEL, and SK had clinical trial agreements with OncoImmune. JDP reports payment for Baptist Medical Health COVID update (CME event). EDW was on the speaker's bureau at Merck & Co (before Merck's acquisition of OncoImmune). JEL is a consultant to Merck & Co for HIV-related studies. SK reports a grant from OncoImmune, during the conduct of the study; and grants from Merck & Co, Gilead Sciences, and Arbutus Pharmaceuticals, outside of the submitted work. ZL serves as a scientific advisory board member for Alphamab, Hengenix, and Ikonisys; and receives grants from Heat Biologics, National Institutes of Health, and Pelotonia, outside of the submitted work. EL, JiC, and XZ are employees of Edetek, the clinical data management and biostats service provider for OncoImmune. DB, DG, and AK are employees of Merck Sharp & Dohme, a subsidiary of Merck & Co, and could hold stocks or stock options in Merck & Co. H-YC, MD, RT, YL, and PZ are employees of OncoImmune, and received grants from National Institutes of Health and National Cancer Institute (R44CA246991-02S1), during the conduct of the study. MD, YL, and PZ have a patent or a patent pending. All other authors declare no competing interests.

Copyright © 2022 Elsevier Ltd. All rights reserved.

Figures

Figure 1
Figure 1
Study profile
Figure 2
Figure 2
Kaplan-Meier curves for time to clinical improvement (A) Primary endpoint; time to clinical improvement among randomised participants included in the interim analysis (n=197). (B) Supportive analysis; time to clinical improvement among all randomised participants (n=234). HR=hazard ratio.
Figure 3
Figure 3
Kaplan-Meier estimates of secondary endpoints (A) Time to hospital discharge among all randomised participants (n=234). (B) Time to disease progression (defined by death, invasive mechanical ventilation, or extracorporeal membrane oxygenation) among all randomised participants (n=234). HR=hazard ratio.

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Source: PubMed

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