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Safety and efficacy of inhaled IBIO123 for mild-to-moderate COVID-19: a randomised, double-blind, dose-ascending, placebo-controlled, phase 1/2 trial - The Lancet

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  • Safety and efficacy of inhaled IBIO123 for mild-to-moderate COVID-19: a randomised, double-blind, dose-ascending, placebo-controlled, phase 1/2 trial - The Lancet

    Published: August 21, 2023

    DOI: https://doi.org/10.1016/S1473-3099(23)00393-6

    Bruno Maranda, MD *, Sébastien M Labbé, PhD *, Magali Lurquin, BSc, Pascal Brabant, RN, Alexandre Fugère, MSc, Jean-François Larrivée, BSc, et al. Show all authors

    Summary

    Background
    COVID-19 severity is associated with its respiratory manifestations. Neutralising antibodies against SARS-CoV-2 administered systemically have shown clinical e cacy. However, immediate and direct delivery of neutralising antibodies via inhalation might provide additional respiratory clinical bene ts. IBIO123 is a cocktail of three, fully human, neutralising monoclonal antibodies against SARS-CoV-2. We aimed to assess the safety and e cacy of inhaled IBIO123 in individuals with mild-to-moderate COVID-19.

    Methods
    This double-blind, dose-ascending, placebo-controlled, rst-in-human, phase 1/2 trial recruited symptomatic and non-hospitalised participants with COVID-19 in South Africa and Brazil across 11 centres. Eligible participants were adult outpatients (aged ≥18 years; men and non-pregnant women) infected with COVID-19 ( rst PCR-con rmed within 72 h) and with mild-to-moderate symptoms, the onset of which had to be within 10 days of randomisation. Using permuted blocks of four, strati ed by site, we randomly assigned participants (1:3) to receive single-dose placebo or IBIO123 (1 mg, 5 mg, or 10 mg) in phase 1, and single-dose placebo or IBIO123 (10 mg) in phase 2, in addition to local standard of care. Participants underwent serological testing to identify antibodies against SARS- CoV-2. Participants, investigators, and the study team were masked to treatment assignment. In phase 1, the primary outcome was the safety assessment in the safety population (ie, all participants who received an intervention). In phase 2, the primary outcome was the mean absolute change from baseline to day 5 in SARS-CoV-2 viral load measured by nasopharyngeal swabs analysed using a mixed model for repeated measures in the full analysis set (FAS; ie, participants with one analysable viral load value at baseline and at least one analysable viral load value at day 3 or day 5). Secondary clinical outcomes included safety from baseline to day 29, assessed by evaluating adverse events; the e ect of IBIO123 on baseline COVID-19 symptoms resolution until day 8, with symptoms systemically evaluated by the investigators; and disease progression as measured by the COVID-19 WHO Clinical Progression Scale. For clinical endpoints in phase 2, we used a modi ed FAS (ie, participants who had at least one analysable viral load value over the course of the study, con rming that they were infected with SARS-CoV-2). This trial is now completed and is registered with ClinicalTrials.gov, NCT05298813.

    Findings
    Between Dec 4, 2021, and May 23, 2022, 24 participants were enrolled in phase 1. Between July 20, 2022, and Jan 4, 2023, 138 participants were enrolled in phase 2 and ve were excluded because they did not meet the inclusion criteria. Participants were randomly assigned to receive IBIO123 (n=18) or placebo (n=6) in phase 1, and randomly assigned to receive IBIO123 (n=104) or placebo (n=34) in phase 2. In phase 2, the study was stopped before reaching the planned accrual because of a decline in COVID-19 incidence. In phase 1, no safety issues were observed. In phase 2, the di erence in mean absolute change from baseline viral load to day 5 between participants in the IBIO123 group and participants in the placebo group was –0·29 log10 copies per mL (95% CI −1·32 to 0·75; p=0·45) in the FAS population and –0·49 log10 copies per mL (−1·56 to 0·58; p=0·20) in seropositive participants. In the modi ed FAS, 81 (69%) of 118 participants were at high risk of severe disease progression. The number of participants with resolution of respiratory symptoms at day 8 was 33 (41%) of 81 in the IBIO123 group versus ve (17%) of 29 in the placebo group (p=0·024) in the modi ed FAS population and 19 (35%) of 55 versus two (10%) of 21 among participants at high risk (p=0·034). One participant died and one participant was hospitalised in the placebo group, whereas no deaths or hospitalisations were reported in the IBIO123 group. 39 (38%) of 104 participants in the IBIO123 group had adverse events, compared with 13 (38%) of 34 in the placebo group.

    Interpretation
    Inhalation of IBIO123 was safe. Despite the lack of signi cant reduction of viral load at day 5, treatment with IBIO123 resulted in a higher proportion of participants with complete resolution of respiratory symptoms at day 8. This study supports further clinical research on inhaled monoclonal antibodies in COVID-19 and respiratory diseases in general.


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