Infection . DFV890: a new oral NLRP3 inhibitor-tested in an early phase 2a randomised clinical trial in patients with COVID-19 pneumonia and impaired respiratory function

[tetano]

Infection


. 2022 Sep 14.
doi: 10.1007/s15010-022-01904-w. Online ahead of print.
DFV890: a new oral NLRP3 inhibitor-tested in an early phase 2a randomised clinical trial in patients with COVID-19 pneumonia and impaired respiratory function


Ildiko Madurka ¹ , Alexander Vishnevsky ² , Joan B Soriano ³ , Stephanus J Gans ⁴ , Danilo Joel Salazar Ore ⁵ , Adrian Rendon ⁶ , Charlotte S Ulrik ⁷ , Sushma Bhatnagar ⁸ , Srikanth Krishnamurthy ⁹ , Kirsten Mc Harry ^{10 11} , Tobias Welte ¹² , Alberto A Fernandez ¹³ , Beata Mehes ¹⁴ , Karin Meiser ¹⁴ , Ewa Gatlik ¹⁴ , Ulrike Sommer ¹⁴ , Guido Junge ¹⁴ , Ederlon Rezende ¹⁵ , Study group



Collaborators, Affiliations

• PMID: 36104613
• DOI: 10.1007/s15010-022-01904-w

Abstract

Background: Coronavirus-associated acute respiratory distress syndrome (CARDS) has limited effective therapy to date. NLRP3 inflammasome activation induced by SARS-CoV-2 in COVID-19 contributes to cytokine storm.
Methods: This randomised, multinational study enrolled hospitalised patients (18-80 years) with COVID-19-associated pneumonia and impaired respiratory function. Eligible patients were randomised (1:1) via Interactive Response Technology to DFV890 + standard-of-care (SoC) or SoC alone for 14 days. Primary endpoint was APACHE II score at Day 14 or on day-of-discharge (whichever-came-first) with worst-case imputation for death. Other key assessments included clinical status, CRP levels, SARS-CoV-2 detection, other inflammatory markers, in-hospital outcomes, and safety.
Findings: Between May 27, 2020 and December 24, 2020, 143 patients (31 clinical sites, 12 countries) were randomly assigned to DFV890 + SoC (n = 71) or SoC alone (n = 72). Primary endpoint to establish clinical efficacy of DFV890 vs. SoC, based on combined APACHE II score, was not met; LSM (SE), 8·7 (1.06) vs. 8·6 (1.05); p = 0.467. More patients treated with DFV890 vs. SoC showed ≥ 1-level improvement in clinical status (84.3% vs. 73.6% at Day 14), earlier clearance of SARS-CoV-2 (76.4% vs. 57.4% at Day 7), and mechanical ventilation-free survival (85.7% vs. 80.6% through Day 28), and there were fewer fatal events in DFV890 group (8.6% vs. 11.1% through Day 28). DFV890 was well tolerated with no unexpected safety signals.
Interpretation: DFV890 did not meet statistical significance for superiority vs. SoC in primary endpoint of combined APACHE II score at Day 14. However, early SARS-CoV-2 clearance, improved clinical status and in-hospital outcomes, and fewer fatal events occurred with DFV890 vs. SoC, and it may be considered as a protective therapy for CARDS.
Trial registration: ClinicalTrials.gov, NCT04382053.

Keywords: Coronavirus-associated acute respiratory distress syndrome; DFV890; NLRP3 inhibitors; Randomised controlled trial; SARS-CoV-2.