COVID-19 treatment: tofacitinib, REGN bNAbs, convalescent plasma

Simon Collins, HIV i-Base

The following brief reports are significant for COVID-19 treatment. Please refer to the online papers for context and full details.

Tofacitinib

A randomised placebo-controlled study in 289 participants hospitalised with COVID-19 pneumonia in Brazil reported reduced risk of mortality using the JAK inhibitor tofacitinib.

“The cumulative incidence of death or respiratory failure through day 28 was 18.1% in the tofacitinib group and 29.0% in the placebo group (risk ratio, 0.63; 95% CI: 0.41 to 0.97; p=0.04). Death from any cause through day 28 occurred in 2.8% vs 5.5% of the active vs placebo groups (hazard ratio 0.49; 95% CI: 0.15 to 1.63).”

Participants receiving tofacitinib also had significantly improved outcomes on an 8-point ordinal scale. Adverse events were similar in each group (14% vs 12%).

Ref: Guimarães PO et al.  for the STOP-COVID Trial. Tofacitinib in Patients Hospitalized with Covid-19 Pneumonia. NEJM. DOI: 10.1056/NEJMoa2101643. (16 June 2021).
https://www.nejm.org/doi/full/10.1056/NEJMoa2101643

REGN dual bNAbs: casirivimab and imdevimab

The UK RECOVERY study report a mortality benefit using REGN dual bNAbs in people hospitalised with COVID-19, but only in the 30% who were seronegative at baseline.

“In the primary efficacy population of seronegative patients, 396/1633 (24%) vs 451/150 (30%) died within 28 days in the REGN-COV vs standard of care arms respectively (rate ratio 0.80; 95% CI: 0.70 to 0.91; p=0·0010).

Overall, (regardless of baseline antibody status), the results were 944/4839 (20%) vs 1026/4946 (21%) respectively (rate ratio 0.94; 95% CI: 0.86 to 1.03; p=0·17).

Ref: RECOVERY Study. Casirivimab and imdevimab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. MedRxiv. Pre-peer review. doi: 10.1101/2021.06.15.21258542. (15 June 2021).
https://www.medrxiv.org/content/10.1101/2021.06.15.21258542v1

Convalescent plasma

No impact of convalescent plasma (CP) was found on 30-day mortality in participants with mild or moderate COVID-19 using date from an observational cohort from the Veteran’s Affairs (VA).

Based on approximately 400 participants using CP and >10,000 controls, there were 40 vs 671 deaths, respectively. Mortality was 6.5% vs 6.2%, with a risk difference of 0.30% (95% CI: 2.30 to 3.60) and hazard ratio of 1.04 (95% CI: 0.64 to 1.62).

Ref: Cho K et al. Early convalescent plasma therapy and mortality among US veterans hospitalized with non-severe COVID-19: An observational analysis emulating a target trial. JID, DOIj:10.1093/infdis/jiab330. (21 June 2021).
https://doi.org/10.1093/infdis/jiab330