Bamlanivimab plus Etesevimab in Mild or Moderate Covid-19.

Abstract

BACKGROUND:

Patients with underlying medical conditions are at increased risk for severe coronavirus disease 2019 (Covid-19). Whereas vaccine-derived immunity develops over time, neutralizing monoclonal-antibody treatment provides immediate, passive immunity and may limit disease progression and complications.

METHODS:

In this phase 3 trial, we randomly assigned, in a 1:1 ratio, a cohort of ambulatory patients with mild or moderate Covid-19 who were at high risk for progression to severe disease to receive a single intravenous infusion of either a neutralizing monoclonal-antibody combination agent (2800 mg of bamlanivimab and 2800 mg of etesevimab, administered together) or placebo within 3 days after a laboratory diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The primary outcome was the overall clinical status of the patients, defined as Covid-19-related hospitalization or death from any cause by day 29.

RESULTS:

A total of 1035 patients underwent randomization and received an infusion of bamlanivimab-etesevimab or placebo. The mean (±SD) age of the patients was 53.8±16.8 years, and 52.0% were adolescent girls or women. By day 29, a total of 11 of 518 patients (2.1%) in the bamlanivimab-etesevimab group had a Covid-19-related hospitalization or death from any cause, as compared with 36 of 517 patients (7.0%) in the placebo group (absolute risk difference, -4.8 percentage points; 95% confidence interval [CI], -7.4 to -2.3; relative risk difference, 70%; P<0.001). No deaths occurred in the bamlanivimab-etesevimab group; in the placebo group, 10 deaths occurred, 9 of which were designated by the trial investigators as Covid-19-related. At day 7, a greater reduction from baseline in the log viral load was observed among patients who received bamlanivimab plus etesevimab than among those who received placebo (difference from placebo in the change from baseline, -1.20; 95% CI, -1.46 to -0.94; P<0.001).

CONCLUSIONS:

Among high-risk ambulatory patients, bamlanivimab plus etesevimab led to a lower incidence of Covid-19-related hospitalization and death than did placebo and accelerated the decline in the SARS-CoV-2 viral load. (Funded by Eli Lilly; BLAZE-1 ClinicalTrials.gov number, NCT04427501.).

• Authors: Michael Dougan, Ajay Nirula, Masoud Azizad, Bharat Mocherla, Robert L Gottlieb, Peter Chen, Corey Hebert, Russell Perry, Joseph Boscia, Barry Heller, Jason Morris, Chad Crystal, Awawu Igbinadolor, Gregory Huhn, Jose Cardona, Imad Shawa, Princy Kumar, Andrew C Adams, Jacob Van Naarden, Kenneth L Custer, Michael Durante, Gerard Oakley, Andrew E Schade, Timothy R Holzer, Philip J Ebert, Richard E Higgs, Nicole L Kallewaard, Janelle Sabo, Dipak R Patel, Matan C Dabora, Paul Klekotka, Lei Shen, Daniel M Skovronsky, BLAZE-1 Investigators
• Journal: The New England journal of medicine (N Engl J Med) Vol. 385 Issue 15 Pg. 1382-1392 (10 07 2021) ISSN: 1533-4406 [Electronic] United States
• PMID: 34260849 (Publication Type: Clinical Trial, Phase III, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 Massachusetts Medical Society.

Chemical References

• Antibodies, Monoclonal, Humanized
• bamlanivimab
• etesevimab

Topics

• Adolescent
• Adult
• Aged
• Antibodies, Monoclonal, Humanized (adverse effects, therapeutic use)
• COVID-19 (ethnology, virology)
• Child
• Double-Blind Method
• Drug Therapy, Combination
• Female
• Hospitalization (statistics & numerical data)
• Humans
• Infusions, Intravenous
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Patient Acuity
• Risk Factors
• SARS-CoV-2 (isolation & purification)
• Viral Load (drug effects)
• Young Adult
• COVID-19 Drug Treatment