The University of Southampton
University of Southampton Institutional Repository

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
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.

2312-0541
Wilkinson, Tom
8c55ebbb-e547-445c-95a1-c8bed02dd652
De Soyza, Anthony
3de67db7-3d38-4f99-b2fc-3c9a0afa5a4a
Carroll, Miles
3ab9c61d-f681-45a2-9921-f506ff1426a4
Chalmers, James D.
7796c9e2-3dce-407b-acdb-d3712e3fe9da
Crooks, Michael G.
f2d50908-e8c7-45c8-8df7-def423242d32
Griffiths, Gareth
7fd300c0-d279-4ff6-842d-aa1f2b9b864d
Shankar-Hari, Manu
6168fb5a-39fd-4713-a885-e7479d6b6775
Ho, Ling-Pei
78fd2483-d7c2-4244-8ffe-e3c8a2d27e32
Horsley, Alex
f3ba30f0-2ffe-496f-b450-ef48c119e53a
Kell, Chris
a67aee81-e464-4cf0-a28d-39a283d02ba6
Lara, Beatriz
47ce5c9a-e3f7-4fbd-9e8c-63d9e33e03c9
Mishra, Biswa
8a414b1e-3e88-4a7c-abc8-d29dc91b59c0
Moate, Rachel
8cc14acf-ecbc-4744-929e-9b635a77ea47
Page, Clive
4f26c48e-eec0-4440-89ad-d7f5d5811734
Pandya, Hitesh
fb8f9183-1e67-4310-82e8-e57f556e8c79
Raw, Jason
09da0026-2df1-447c-9995-2280835c2cbd
Reid, Fred
88bdd0b4-2236-4453-8fa2-3e3299613191
Saralaya, Dinesh
dc9fbc4a-7e6d-42ea-a42a-272a52533be0
Scott, Ian C.
0a7fc519-ec57-404c-b144-d8eb8271e23b
Siddiqui, Salman
d14ac91e-dc87-4384-acff-54ee646c05fc
Ustianowski, Andy
c897eebc-50c1-4ed1-81d7-21814798cd00
van Zuydam, Natalie
d0ccc3c7-b19c-4805-be63-70118136a53e
Woodcock, Ashley
b13cf094-8318-42ef-b8ed-2f4b8d8770f3
Singh, Dave
5a8e5ba8-f961-4422-9a21-a6ef346041e5
on behalf of the ACCORD Collaborative Group
Wilkinson, Tom
8c55ebbb-e547-445c-95a1-c8bed02dd652
De Soyza, Anthony
3de67db7-3d38-4f99-b2fc-3c9a0afa5a4a
Carroll, Miles
3ab9c61d-f681-45a2-9921-f506ff1426a4
Chalmers, James D.
7796c9e2-3dce-407b-acdb-d3712e3fe9da
Crooks, Michael G.
f2d50908-e8c7-45c8-8df7-def423242d32
Griffiths, Gareth
7fd300c0-d279-4ff6-842d-aa1f2b9b864d
Shankar-Hari, Manu
6168fb5a-39fd-4713-a885-e7479d6b6775
Ho, Ling-Pei
78fd2483-d7c2-4244-8ffe-e3c8a2d27e32
Horsley, Alex
f3ba30f0-2ffe-496f-b450-ef48c119e53a
Kell, Chris
a67aee81-e464-4cf0-a28d-39a283d02ba6
Lara, Beatriz
47ce5c9a-e3f7-4fbd-9e8c-63d9e33e03c9
Mishra, Biswa
8a414b1e-3e88-4a7c-abc8-d29dc91b59c0
Moate, Rachel
8cc14acf-ecbc-4744-929e-9b635a77ea47
Page, Clive
4f26c48e-eec0-4440-89ad-d7f5d5811734
Pandya, Hitesh
fb8f9183-1e67-4310-82e8-e57f556e8c79
Raw, Jason
09da0026-2df1-447c-9995-2280835c2cbd
Reid, Fred
88bdd0b4-2236-4453-8fa2-3e3299613191
Saralaya, Dinesh
dc9fbc4a-7e6d-42ea-a42a-272a52533be0
Scott, Ian C.
0a7fc519-ec57-404c-b144-d8eb8271e23b
Siddiqui, Salman
d14ac91e-dc87-4384-acff-54ee646c05fc
Ustianowski, Andy
c897eebc-50c1-4ed1-81d7-21814798cd00
van Zuydam, Natalie
d0ccc3c7-b19c-4805-be63-70118136a53e
Woodcock, Ashley
b13cf094-8318-42ef-b8ed-2f4b8d8770f3
Singh, Dave
5a8e5ba8-f961-4422-9a21-a6ef346041e5

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).

Record type: Article

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.

Text
00249-2023.full - Version of Record
Available under License Creative Commons Attribution.
Download (964kB)

More information

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
ORCID for Gareth Griffiths: ORCID iD orcid.org/0000-0002-9579-8021

Catalogue record

Date deposited: 12 Dec 2023 17:30
Last modified: 18 Mar 2024 03:30

Export record

Altmetrics

Contributors

Author: Tom Wilkinson
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

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×