Two anti-inflammatory drugs prevented new coronavirus deaths

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A new study shows that two anti-inflammatory drugs did not reduce recovery time in hospitalized patients with severe COVID-19, but they were less likely to die.

The researchers compared patients who received drugs commonly prescribed to treat inflammatory diseases such as rheumatoid arthritis and psoriasis to those who received standard care alone. The results of this study may expand treatment options for patients with severe COVID-19.

In April 2020, the NIH dubbed Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV), with the ultimate goal of accelerating the development of the most promising COVID-19 treatments and vaccines. Established a public-private partnership.

As part of this partnership, a clinical trial called ACTIV-1 Immunomodulator (IM) was developed to compare multiple drugs at once. Researchers evaluated three anti-inflammatory drugs (infliximab, abatacept, and senicriviroc) added to standard care versus standard care alone in participants hospitalized with COVID-19.

Standard treatment for such patients includes the antiviral drug remdesivir and the corticosteroid dexamethasone. The study included 1,971 patients treated at 95 hospitals in the United States and Latin America. Many of these sites are supported by the Clinical and Translational Science Awards Program funded by NCATS.

Even in the early stages of the COVID-19 pandemic, the body’s aberrant and dysregulated immune response to SARS-CoV-2, the virus that causes COVID-19, can lead to pneumonia, respiratory failure, and other serious conditions. It was clear that it was often the cause of effects of illness.

“One of the fundamental questions of early COVID-19 research was whether existing anti-inflammatory drugs could be used to suppress the inflammatory process,” said Professor of Medicine and co-director of the Division of Infectious Diseases at the University of Washington. William G. Powdery, who is Medical School in St. Louis. Mr. Powderley served as the domestic principal investigator leading the ACTIV-1 trial.

“Our data suggest that two of the drugs we studied can be administered to reduce mortality in critically ill patients. We hope it will help revise our guidelines on best practices.”

The use of these immunomodulatory agents in combination with standard therapy did not result in a statistically significant difference in recovery time compared with no such agent.

But Powderley said two of the three drug treatments still have clinical significance, especially in terms of mortality, one of the study’s key secondary endpoints. . Fewer patients died when treated with standard care plus either infliximab or abatacept compared with those who received standard care and placebo. Treatment with a third agent, senicriviroc, was stopped early because data were ineffective.

Abatacept, sold under the brand name Orencia, is used to treat joint swelling, pain, and fatigue associated with rheumatoid arthritis. It is administered via an infusion and works by reducing T-cell responses.

Infliximab, known by the trade name Remicade, is used in combination with methotrexate to treat adults with rheumatoid arthritis, as well as chronic severe plaque psoriasis. In the ACTIV-1 trial, she received a single infusion of abatacept and infliximab.

Among COVID-19 patients treated with abatacept, 56 of 509 patients died by 28 days (mortality rate 11%). In the placebo group, 77 of 510 patients died during the same period (15.1% mortality). This 4.1% difference represents 21 fewer deaths for those receiving abatacept.

In patients treated with infliximab, 52 of 517 patients died by day 28 (10.1% mortality). In the placebo group, 75 of 516 patients died by day 28 (14.5% mortality). This 4.4% difference in his represents 23 fewer deaths in patients receiving infliximab than her.

The immunomodulatory agents in the study did not make a statistically significant difference in recovery time when combined with standard therapy, Powderley said, but the mortality measured in the study remains clinically important. It is believed that He said this type of research is crucial for patients hospitalized with COVID-19 because it means that potential treatment options are continually expanding.

“We have shown that there are multiple potential options for treating COVID-19,” said Powderley. “But ideally, we doctors don’t have to treat COVID-19 pneumonia. It’s the best way to prevent disease.”

This research JAMA.

The US Department of Health and Human Services, the Office of Strategic Preparedness and Response, and the Office of Biomedical Advanced Research and Development funded this study.

sauce: Washington University in St. Louis

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