A randomised phase 2a study to investigate the effects of blocking interleukin-33 with tozorakimab in patients hospitalised with COVID-19: ACCORD-2
A randomised phase 2a study to investigate the effects of blocking interleukin-33 with tozorakimab in patients hospitalised with COVID-19: ACCORD-2
Background: increased serum interleukin (IL)-33 predicts poor outcomes in patients hospitalised with coronavirus disease 2019 (COVID-19). We examined the efficacy and safety of tozorakimab, a monoclonal antibody that neutralises IL-33, in improving outcomes in ACCORD-2 (EudraCT: 2020-001736-95).
Methods: ACCORD-2 was an open-label, phase 2a study in adults hospitalised with COVID-19. Patients were randomised 1:1 to tozorakimab 300 mg plus standard of care (SoC) or SoC alone. The primary end-point was time to clinical response (sustained clinical improvement of ≥2 points on the World Health Organization ordinal scale, discharge from hospital or fit for discharge) by day 29. Other end-points included death or respiratory failure, mortality and intensive care unit admission by day 29, and safety. Serum IL-33/soluble stimulated-2 (sST2) complex levels were measured by high-sensitivity immunoassay.
Results: efficacy analyses included 97 patients (tozorakimab+SoC, n=53; SoC, n=44). Median time to clinical response did not differ between the tozorakimab and SoC arms (8.0 and 9.5 days, respectively; HR 0.96, 80% CI 0.70-1.31; one-sided p=0.33). Tozorakimab was well tolerated and the OR for risk of death or respiratory failure with treatment versus SoC was 0.55 (80% CI 0.27-1.12; p=0.26), while the OR was 0.31 (80% CI 0.09-1.06) in patents with high baseline serum IL-33/sST2 complex levels.
Conclusions: overall, ACCORD-2 results suggest that tozorakimab could be a novel therapy for patients hospitalised with COVID-19, warranting further investigation in confirmatory phase 3 studies.
Wilkinson, Tom
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De Soyza, Anthony
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Carroll, Miles
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Chalmers, James D.
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Crooks, Michael G.
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Griffiths, Gareth
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Shankar-Hari, Manu
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Ho, Ling-Pei
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Horsley, Alex
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Kell, Chris
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Lara, Beatriz
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Mishra, Biswa
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Moate, Rachel
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Page, Clive
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Pandya, Hitesh
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Raw, Jason
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Reid, Fred
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Saralaya, Dinesh
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Scott, Ian C.
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Siddiqui, Salman
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Ustianowski, Andy
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van Zuydam, Natalie
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Woodcock, Ashley
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Singh, Dave
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on behalf of the ACCORD Collaborative Group
Wilkinson, Tom
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De Soyza, Anthony
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Carroll, Miles
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Chalmers, James D.
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Crooks, Michael G.
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Griffiths, Gareth
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Shankar-Hari, Manu
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Ho, Ling-Pei
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Horsley, Alex
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Kell, Chris
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Lara, Beatriz
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Mishra, Biswa
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Moate, Rachel
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Page, Clive
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Pandya, Hitesh
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Raw, Jason
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Reid, Fred
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Saralaya, Dinesh
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Scott, Ian C.
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Siddiqui, Salman
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Ustianowski, Andy
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van Zuydam, Natalie
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Woodcock, Ashley
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Singh, Dave
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Wilkinson, Tom, De Soyza, Anthony, Carroll, Miles, Chalmers, James D., Crooks, Michael G., Griffiths, Gareth, Shankar-Hari, Manu, Ho, Ling-Pei, Horsley, Alex, Kell, Chris, Lara, Beatriz, Mishra, Biswa, Moate, Rachel, Page, Clive, Pandya, Hitesh, Raw, Jason, Reid, Fred, Saralaya, Dinesh, Scott, Ian C., Siddiqui, Salman, Ustianowski, Andy, van Zuydam, Natalie, Woodcock, Ashley and Singh, Dave
,
on behalf of the ACCORD Collaborative Group
(2023)
A randomised phase 2a study to investigate the effects of blocking interleukin-33 with tozorakimab in patients hospitalised with COVID-19: ACCORD-2.
ERJ Open Research, 9 (5), [00249-2023].
(doi:10.1183/23120541.00249-2023).
Abstract
Background: increased serum interleukin (IL)-33 predicts poor outcomes in patients hospitalised with coronavirus disease 2019 (COVID-19). We examined the efficacy and safety of tozorakimab, a monoclonal antibody that neutralises IL-33, in improving outcomes in ACCORD-2 (EudraCT: 2020-001736-95).
Methods: ACCORD-2 was an open-label, phase 2a study in adults hospitalised with COVID-19. Patients were randomised 1:1 to tozorakimab 300 mg plus standard of care (SoC) or SoC alone. The primary end-point was time to clinical response (sustained clinical improvement of ≥2 points on the World Health Organization ordinal scale, discharge from hospital or fit for discharge) by day 29. Other end-points included death or respiratory failure, mortality and intensive care unit admission by day 29, and safety. Serum IL-33/soluble stimulated-2 (sST2) complex levels were measured by high-sensitivity immunoassay.
Results: efficacy analyses included 97 patients (tozorakimab+SoC, n=53; SoC, n=44). Median time to clinical response did not differ between the tozorakimab and SoC arms (8.0 and 9.5 days, respectively; HR 0.96, 80% CI 0.70-1.31; one-sided p=0.33). Tozorakimab was well tolerated and the OR for risk of death or respiratory failure with treatment versus SoC was 0.55 (80% CI 0.27-1.12; p=0.26), while the OR was 0.31 (80% CI 0.09-1.06) in patents with high baseline serum IL-33/sST2 complex levels.
Conclusions: overall, ACCORD-2 results suggest that tozorakimab could be a novel therapy for patients hospitalised with COVID-19, warranting further investigation in confirmatory phase 3 studies.
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00249-2023.full
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Accepted/In Press date: 25 July 2023
e-pub ahead of print date: 2 October 2023
Additional Information:
Funding Information:
The study protocol was reviewed and approved by the UK Medicines and Healthcare Products Regulatory Agency (EudraCT: 2020-001736-95; registered 28 April 2020). Ethical approval was received from the relevant Health Research Authority and Research Ethics Committee. An independent data monitoring committee assessed safety throughout the study. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki, Council for International Organizations of Medical Sciences International Ethical Guidelines, International Council for Harmonisation (ICH) Good Clinical Practice Guidelines, and applicable local laws and regulations. The ACCORD-2 study was sponsored by University Hospital Southampton NHS Foundation Trust, and was funded by UK Research and Innovation.
Funding Information:
Acknowledgements: Medical writing support was provided by Charlie Foster and Sinéad Flannery (PharmaGenesis London, London, UK), with funding from AstraZeneca. The authors thank Helen Killick (AstraZeneca, Cambridge, UK) for scientific and operational support. The authors also thank Martin Wiselka (University Hospitals of Leicester NHS Trust, Leicester, UK), Stephen Ryder (Nottingham University Hospitals NHS Trust, Nottingham, UK ), Niranjan Setty (Basildon & Thurrock University Hospitals NHS Foundation Trust, Basildon, UK) and Nuria Martinez-Alier (Evelina London Children’s Hospital, Guy’s and St Thomas Hospital NHS Foundation Trust, London, UK), and the participants, investigators and all staff involved in the study. The authors acknowledge the support of the Medicines Evaluation Unit, Manchester, IQVIA, National Institute for Health and Care Research (NIHR) Respiratory Translational Research Collaboration, NIHR Southampton, Biomedical Research Centre and the NIHR Clinical Research Facilities in Manchester.
Publisher Copyright:
© The authors 2023.
Identifiers
Local EPrints ID: 485590
URI: http://eprints.soton.ac.uk/id/eprint/485590
ISSN: 2312-0541
PURE UUID: f487c6e5-3eca-4029-bd60-fa48734f838a
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Date deposited: 12 Dec 2023 17:30
Last modified: 18 Mar 2024 03:30
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Contributors
Author:
Anthony De Soyza
Author:
Miles Carroll
Author:
James D. Chalmers
Author:
Michael G. Crooks
Author:
Manu Shankar-Hari
Author:
Ling-Pei Ho
Author:
Alex Horsley
Author:
Chris Kell
Author:
Beatriz Lara
Author:
Biswa Mishra
Author:
Rachel Moate
Author:
Clive Page
Author:
Hitesh Pandya
Author:
Jason Raw
Author:
Fred Reid
Author:
Dinesh Saralaya
Author:
Ian C. Scott
Author:
Salman Siddiqui
Author:
Andy Ustianowski
Author:
Natalie van Zuydam
Author:
Ashley Woodcock
Author:
Dave Singh
Corporate Author: on behalf of the ACCORD Collaborative Group
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