Anti-inflammatory drugs may prevent death but fail to speed up recovery in COVID-19 patients
An Original Investigation published on July 10, 2023, entitled, "Abatacept, Cenicriviroc, or Infliximab for Treatment of Adults Hospitalized With COVID-19 Pneumonia A Randomized Clinical Trial" by Dr Jane and colleagues published in JAMA concluded that among hospitalized patients with COVID-19 pneumonia, time to recovery is not decreased by Abatacept, cenicriviroc, or infliximab in comparison with standard care.
It is already known that there is an association between Immune dysregulation and poorer outcomes in COVID-19. Considering this, the present team of researchers investigated whether abatacept, cenicriviroc, or infliximab provides benefits when added to standard care for COVID-19 pneumonia. (3 substudies reported from 95 hospitals at 85 clinical research sites in the US and Latin America). They measured time to recovery by day 28 evaluated using an 8-point ordinal scale as the primary outcome
The key points of the study are:
- Hospitalized patients 18 years or older with confirmed SARS-CoV-2 infection within 14 days
- The evidence of pulmonary involvement underwent randomization (October 2020 and December 2021).
- Dosages are a Single infusion of abatacept at 10 mg/kg; maximum dose, 1000 mg, 5 mg/kg infliximab or cenicriviroc 28-day course orally, 300-mg loading dose followed by 150 mg twice daily.
- Number of participants: 1971 of mean age of 54.8 years and 1218 men.
- The primary endpoint was not significantly different for abatacept, cenicriviroc or infliximab with recovery rate ratio or RRR, of 1.12, 1.01 and 1.12 respectively when compared with placebo.
- All-cause 28-day mortality for abatacept vs placebo, cenicriviroc vs placebo and infliximab vs placebo was 11% vs 15.1%, 13.8 % vs 11.9 % and 10.1 % vs 14.5 %.
- The odds ratio were 0.62, 1.18 and 0.59 respectively.
- In all 3 substudies, safety outcomes were comparable between active treatment and placebo, including secondary infections,
The study limitations are questions on whether results are limited to the variants represented at that time, unavailability of data on participant vaccination status, and chances of negative results.
Based on the study’s results, researchers concluded that in COVID-19 pneumonia, time to recovery among hospitalized patients is no different for abatacept, cenicriviroc, or infliximab vs placebo
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