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Di Rocco M, Forleo-Neto E, Pignolo RJ, Keen R, Orcel P, Funck-Brentano T, Roux C, Kolta S, Madeo A, Bubbear JS, Tabarkiewicz J, Szczepanek M, Bachiller-Corral J, Cheung AM, Dahir KM, Botman E, Raijmakers PG, Al Mukaddam M, Tile L, Portal-Celhay C, Sarkar N, Hou P, Musser BJ, Boyapati A, Mohammadi K, Mellis SJ, Rankin AJ, Economides AN, Trotter DG, Herman GA, O'Meara SJ, DelGizzi R, Weinreich DM, Yancopoulos GD, Eekhoff EMW, Kaplan FS. Garetosmab in fibrodysplasia ossificans progressiva: a randomized, double-blind, placebo-controlled phase 2 trial. Nat Med 2023; 29:2615-2624. [PMID: 37770652 PMCID: PMC10579054 DOI: 10.1038/s41591-023-02561-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 08/23/2023] [Indexed: 09/30/2023]
Abstract
Fibrodysplasia ossificans progressiva (FOP) is a rare disease characterized by heterotopic ossification (HO) in connective tissues and painful flare-ups. In the phase 2 LUMINA-1 trial, adult patients with FOP were randomized to garetosmab, an activin A-blocking antibody (n = 20) or placebo (n = 24) in period 1 (28 weeks), followed by an open-label period 2 (28 weeks; n = 43). The primary end points were safety and for period 1, the activity and size of HO lesions. All patients experienced at least one treatment-emergent adverse event during period 1, notably epistaxis, madarosis and skin abscesses. Five deaths (5 of 44; 11.4%) occurred in the open-label period and, while considered unlikely to be related, causality cannot be ruled out. The primary efficacy end point in period 1 (total lesion activity by PET-CT) was not met (P = 0.0741). As the development of new HO lesions was suppressed in period 1, the primary efficacy end point in period 2 was prospectively changed to the number of new HO lesions versus period 1. No placebo patients crossing over to garetosmab developed new HO lesions (0% in period 2 versus 40.9% in period 1; P = 0.0027). Further investigation of garetosmab in FOP is ongoing. ClinicalTrials.gov identifier NCT03188666 .
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Affiliation(s)
- Maja Di Rocco
- Department of Pediatrics, Unit of Rare Diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | | | - Richard Keen
- Centre for Metabolic Bone Disease Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - Philippe Orcel
- Department of Rheumatology - DMU Locomotion, Assistance Publique - Hôpitaux de Paris, Paris, France
- INSERM Université Paris Cité, Paris, France
| | - Thomas Funck-Brentano
- Department of Rheumatology - DMU Locomotion, Assistance Publique - Hôpitaux de Paris, Paris, France
- INSERM Université Paris Cité, Paris, France
| | - Christian Roux
- Department of Rheumatology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Sami Kolta
- Department of Rheumatology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Annalisa Madeo
- Department of Pediatrics, Unit of Rare Diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Judith S Bubbear
- Centre for Metabolic Bone Disease Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - Jacek Tabarkiewicz
- Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów University, Rzeszów, Poland
| | - Małgorzata Szczepanek
- Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów University, Rzeszów, Poland
| | | | - Angela M Cheung
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn M Dahir
- Vanderbilt University Medical Center, Program for Metabolic Bone Disorders, Nashville, TN, USA
| | - Esmée Botman
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers (UMC), Vrije Universiteit, Amsterdam UMC Expert Center in Rare Bone Disease, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mona Al Mukaddam
- Departments of Orthopaedics, Medicine and the Center for Research in FOP & Related Disorders, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lianne Tile
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Peijie Hou
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - E Marelise W Eekhoff
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers (UMC), Vrije Universiteit, Amsterdam UMC Expert Center in Rare Bone Disease, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Frederick S Kaplan
- Departments of Orthopaedics, Medicine and the Center for Research in FOP & Related Disorders, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Li D, Xu M, Hooper AT, Rofail D, Mohammadi KA, Chen Y, Ali S, Norton T, Weinreich DM, Musser BJ, Hamilton JD, Geba GP. Casirivimab + imdevimab accelerates symptom resolution linked to improved COVID-19 outcomes across susceptible antibody and risk profiles. Sci Rep 2023; 13:12784. [PMID: 37550377 PMCID: PMC10406852 DOI: 10.1038/s41598-023-39681-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/28/2023] [Indexed: 08/09/2023] Open
Abstract
Severe, protracted symptoms are associated with poor outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In a placebo-controlled study of casirivimab and imdevimab (CAS + IMD) in persons at high risk of severe coronavirus disease 2019 (COVID-19; n = 3816), evolution of individual symptoms was assessed for resolution patterns across risk factors, and baseline SARS-CoV-2-specific antibody responses against S1 and N domains. CAS + IMD versus placebo provided statistically significant resolution for 17/23 symptoms, with greater response linked to absence of endogenous anti-SARS-CoV-2 immunoglobulin (Ig)G, IgA, or specific neutralizing antibodies at baseline, or high baseline viral load. Resolution of five key symptoms (onset days 3-5)-dyspnea, cough, feeling feverish, fatigue, and loss of appetite-independently correlated with reduced hospitalization and death (hazard ratio range: 0.31-0.56; P < 0.001-0.043), and was more rapid in CAS + IMD-treated patients lacking robust early antibody responses. Those who seroconverted late still benefited from treatment. Thus, highly neutralizing COVID-19-specific antibodies provided by CAS + IMD treatment accelerated key symptom resolution associated with hospitalization and death in those at high risk for severe disease as well as in those lacking early, endogenous neutralizing antibody responses.
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Affiliation(s)
- Dateng Li
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Meng Xu
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Andrea T Hooper
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Diana Rofail
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Kusha A Mohammadi
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Yiziying Chen
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Shazia Ali
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Thomas Norton
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - David M Weinreich
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Bret J Musser
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Jennifer D Hamilton
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Gregory P Geba
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA.
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Yosipovitch G, Mollanazar N, Ständer S, Kwatra SG, Kim BS, Laws E, Mannent LP, Amin N, Akinlade B, Staudinger HW, Patel N, Yancopoulos GD, Weinreich DM, Wang S, Shi G, Bansal A, O'Malley JT. Dupilumab in patients with prurigo nodularis: two randomized, double-blind, placebo-controlled phase 3 trials. Nat Med 2023; 29:1180-1190. [PMID: 37142763 DOI: 10.1038/s41591-023-02320-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/24/2023] [Indexed: 05/06/2023]
Abstract
Prurigo nodularis (PN) is a chronic inflammatory skin disease with intensely pruritic nodules. The LIBERTY-PN PRIME and PRIME2 phase 3 trials enrolled adults with PN with ≥20 nodules and severe itch uncontrolled with topical therapies. Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin (IL)-4 and IL-13. Patients were randomized 1:1 to 300 mg dupilumab or placebo subcutaneously every 2 weeks for 24 weeks. The primary endpoint was pruritus improvement, measured by proportion of patients with a ≥4-point reduction in Worst Itch Numeric Rating Scale (WI-NRS) from baseline at week 24 (PRIME) or week 12 (PRIME2). Key secondary endpoints included nodule number reduction to ≤5 at week 24. PRIME and PRIME2 enrolled 151 and 160 patients, respectively. Both trials met all the pre-specified primary and key secondary endpoints. A ≥4-point WI-NRS reduction at week 24 in the dupilumab and placebo arms was achieved by 60.0% and 18.4% of patients, respectively, in PRIME (95% confidence interval (CI), 27.8-57.7 for the difference, P < 0.001) and at week 12 by 37.2% and 22.0% of patients, respectively, in PRIME2 (95% CI, 2.3-31.2; P = 0.022). Dupilumab demonstrated clinically meaningful and statistically significant improvements in itch and skin lesions versus placebo in PN. Safety was consistent with the known dupilumab safety profile.ClinicalTrials.gov identifiers: NCT04183335 and NCT04202679 .
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Affiliation(s)
| | - Nicholas Mollanazar
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Shawn G Kwatra
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian S Kim
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Nikhil Amin
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
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Somersan-Karakaya S, Mylonakis E, Mou J, Oviedo-Orta E, O’Brien MP, Mas Casullo V, Mahmood A, Hooper AT, Hussein M, Ali S, Marty FM, Forleo-Neto E, Bhore R, Hamilton JD, Herman GA, Hirshberg B, Weinreich DM. Effectiveness of Casirivimab and Imdevimab Antibody Combination in Immunocompromised Hospitalized Patients With Coronavirus Disease 2019: A Post Hoc Analysis in a Phase 1/2/3 Double-Blind Trial. Open Forum Infect Dis 2023; 10:ofad211. [PMID: 37229174 PMCID: PMC10205469 DOI: 10.1093/ofid/ofad211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/14/2023] [Indexed: 05/27/2023] Open
Abstract
Background Individuals who are immunocompromised (IC) are at high risk for severe coronavirus disease 2019 (COVID-19). Methods Post hoc analyses of a double-blind trial conducted prior to Omicron (June 2020-April 2021), in hospitalized patients with COVID-19 assessed viral load, clinical outcomes, and safety of casirivimab plus imdevimab (CAS + IMD) versus placebo in IC versus overall study patients. Results Ninety-nine of 1940 (5.1%) patients were IC. IC versus overall patients were more frequently seronegative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies (68.7% vs 41.2%) and had higher median baseline viral loads (7.21 vs 6.32 log10 copies/mL). On placebo, IC versus overall patients had slower viral load declines. CAS + IMD reduced viral load in IC and overall patients; least-squares mean difference versus placebo in time-weighted average change from baseline viral load at day 7 was -0.69 (95% confidence interval [CI], -1.25 to -.14) log10 copies/mL for IC patients and -0.31 (95% CI, -.42 to -.20) log10 copies/mL for overall patients. For IC patients, the cumulative incidence of death or mechanical ventilation at day 29 was lower with CAS + IMD (11.0%) versus placebo (17.2%), consistent with overall patients (15.7% CAS + IMD vs 18.3% placebo). IC and overall patients receiving CAS + IMD exhibited similar rates of treatment-emergent adverse events (30.4% and 26.6%, respectively), grade ≥2 hypersensitivity or infusion-related reactions (1.4% and 2.5%), and deaths (8.7% and 12.2%). Conclusions IC patients were more likely to exhibit high viral loads and be seronegative at baseline. For susceptible SARS-CoV-2 variants, CAS + IMD reduced viral load and resulted in fewer death or mechanical ventilation events in IC and overall study patients. There were no new safety findings among IC patients. Clinical Trials Registration. NCT04426695.
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Affiliation(s)
- Selin Somersan-Karakaya
- Correspondence: Selin Somersan-Karakaya, MD, Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Road, Tarrytown, NY 10591-6707 (); Meagan P. O’Brien, MD, Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Road, Tarrytown, NY 10591-6707 ()
| | | | - Jenni Mou
- Global Development, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | - Meagan P O’Brien
- Correspondence: Selin Somersan-Karakaya, MD, Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Road, Tarrytown, NY 10591-6707 (); Meagan P. O’Brien, MD, Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Road, Tarrytown, NY 10591-6707 ()
| | | | - Adnan Mahmood
- Global Development, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Andrea T Hooper
- Global Development, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Mohamed Hussein
- Medical Affairs, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Shazia Ali
- Global Development, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | - Eduardo Forleo-Neto
- Global Development, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Rafia Bhore
- Global Development, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Jennifer D Hamilton
- Global Development, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Gary A Herman
- Global Development, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Boaz Hirshberg
- Global Development, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
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5
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Hooper AT, Somersan-Karakaya S, McCarthy SE, Mylonakis E, Ali S, Mei J, Bhore R, Mahmood A, Geba GP, Dakin P, Weinreich DM, Yancopoulos GD, Herman GA, Hamilton JD. Casirivimab and Imdevimab Treatment Reduces Viral Load and Improves Clinical Outcomes in Seropositive Hospitalized COVID-19 Patients with Nonneutralizing or Borderline Neutralizing Antibodies. mBio 2022; 13:e0169922. [PMID: 36255239 PMCID: PMC9765482 DOI: 10.1128/mbio.01699-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/20/2022] [Indexed: 11/20/2022] Open
Abstract
We conducted a post hoc analysis in seropositive patients who were negative or borderline for functional neutralizing antibodies (NAbs) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at baseline from a phase 1, 2, and 3 trial of casirivimab and imdevimab (CAS+IMD) treatment in hospitalized coronavirus disease 2019 (COVID-19) patients on low-flow or no supplemental oxygen prior to the emergence of Omicron-lineage variants. Patients were randomized to a single dose of 2.4 g CAS+IMD, 8.0 g CAS+IMD, or placebo. Patients seropositive for anti-SARS-CoV-2 antibodies at baseline were analyzed by their baseline neutralizing antibody status. At baseline, 20.6% (178/864) of seropositive patients were negative or borderline for neutralizing antibodies, indicating negative or very low functionally neutralizing anti-SARS-CoV-2 antibodies. CAS+IMD reduced viral load in patients who were negative or borderline for neutralizing antibodies versus placebo, but not in patients who were positive for neutralizing antibodies. In patients who were negative or borderline for neutralizing antibodies, we observed a trend in reduction of the proportion of patients who died or required mechanical ventilation, as well as in all-cause mortality, by day 29 with CAS+IMD versus placebo. The proportions of patients who died or required mechanical ventilation from days 1 to 29 were 19.1% in the placebo group and 10.9% in the CAS+IMD combined-dose group, and the proportions of patients who died (all-cause mortality) from days 1 to 29 were 16.2% in the placebo group and 9.1% in the CAS+IMD combined-dose group. In patients who were positive for neutralizing antibodies, no measurable harm or benefit was observed in either the proportion of patients who died or required mechanical ventilation or the proportion of patients who died (all-cause mortality). In hospitalized COVID-19 patients on low-flow or no supplemental oxygen, CAS+IMD reduced viral load, the risk of death or mechanical ventilation, and all-cause mortality in seropositive patients who were negative or borderline for neutralizing antibodies. IMPORTANCE The clinical benefit of CAS+IMD in hospitalized seronegative patients with COVID-19 has previously been demonstrated, although these studies observed no clinical benefit in seropositive patients. As the prevalence of SARS-CoV-2-seropositive individuals rises due to both vaccination and previous infection, it is important to understand whether there is a subset of hospitalized patients with COVID-19 with antibodies against SARS-CoV-2 who could benefit from anti-SARS-CoV-2 monoclonal antibody treatment. This post hoc analysis demonstrates that there is a subset of hospitalized seropositive patients with inadequate SARS-CoV-2-neutralizing antibodies (i.e., those who were negative or borderline for neutralizing antibodies) who may still benefit from CAS+IMD treatment if infected with a susceptible SARS-CoV-2 variant. Therefore, utilizing serostatus alone to guide treatment decisions for patients with COVID-19 may fail to identify those seropositive patients who could benefit from anti-SARS-CoV-2 monoclonal antibody therapies known to be effective against circulating strains, dependent upon how effectively their endogenous antibodies neutralize SARS-CoV-2.
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Affiliation(s)
| | | | | | | | - Shazia Ali
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Jingning Mei
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Rafia Bhore
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Adnan Mahmood
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | | - Paula Dakin
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | | | | - Gary A. Herman
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
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Hussein M, Wei W, Mastey V, Sanchez RJ, Wang D, Murdock DJ, Hirshberg B, Weinreich DM, Jalbert JJ. Real-world effectiveness of casirivimab and imdevimab among patients diagnosed with COVID-19 in the ambulatory setting: a retrospective cohort study using a large claims database. BMJ Open 2022; 12:e064953. [PMID: 36535724 PMCID: PMC9764096 DOI: 10.1136/bmjopen-2022-064953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To assess the real-world effectiveness of casirivimab and imdevimab (CAS+IMD) versus no COVID-19 antibody treatment among patients diagnosed with COVID-19 in the ambulatory setting, including patients diagnosed during the Delta-dominant period prior to Omicron emergence. DESIGN Retrospective cohort study. SETTING Komodo Health closed claims database. PARTICIPANTS 13 273 128 patients diagnosed with COVID-19 (December 2020 through September 2021) were treated with CAS+IMD or untreated but treatment eligible under the Emergency Use Authorization (EUA). Each treated patient was exact and propensity score matched without replacement to up to five untreated EUA-eligible patients. INTERVENTIONS CAS+IMD. PRIMARY AND SECONDARY OUTCOME MEASURES Composite endpoint of 30-day all-cause mortality or COVID-19-related hospitalisation. Kaplan-Meier estimators were used to calculate outcome risks overall and across subgroups: age, COVID-19 vaccination status, immunocompromised status, and timing of diagnosis (December 2020 to June 2021, and July to September 2021). Cox proportional hazards models were used to estimate adjusted HRs (aHRs) and 95% CIs. RESULTS Among 75 159 CAS+IMD-treated and 1 670 338 EUA-eligible untreated patients, 73 759 treated patients were matched to 310 688 untreated patients; matched patients were ~50 years, ~60% were women and generally well balanced across risk factors. The 30-day risk of the composite outcome was 2.1% and 5.2% in the CAS+IMD-treated and CAS+IMD-untreated patients, respectively; equivalent to a 60% lower risk (aHR 0.40; 95% CI, 0.38 to 0.42). The effect of CAS+IMD was consistent across subgroups, including those who received a COVID-19 vaccine (aHR 0.48, 95% CI, 0.41 to 0.56), and those diagnosed during the Delta-dominant period (aHR 0.40, 95% CI, 0.38 to 0.42). CONCLUSIONS The real-world effectiveness of CAS+IMD is consistent with the efficacy for reducing all-cause mortality or COVID-19-related hospitalisation reported in clinical trials. Effectiveness is maintained across patient subgroups, including those prone to breakthrough infections, and was effective against susceptible variants including Delta. .
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Affiliation(s)
| | - Wenhui Wei
- Regeneron Pharmaceuticals Inc, Tarrytown, New York, USA
| | - Vera Mastey
- Regeneron Pharmaceuticals Inc, Tarrytown, New York, USA
| | | | - Degang Wang
- Regeneron Pharmaceuticals Inc, Tarrytown, New York, USA
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7
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Somersan-Karakaya S, Mylonakis E, Oviedo-Orta E, O’Brien MP, Casullo VM, Mou J, Xiao J, Bhore R, Mahmood A, Hooper AT, Hussein M, Ali S, Forleo-Neto E, Herman GA, Hirshberg B, Weinreich DM. 1079. Casirivimab and Imdevimab (CAS + IMD) Antibody Combination for the Treatment of Immunocomprised Hospitalized Patients with COVID-19. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Immunocompromised (IC) individuals are at high risk for severe COVID-19, with high morbidity and mortality. CAS+IMD is a monoclonal antibody combination that neutralizes susceptible SARS-CoV-2 variants. We examined the natural history of COVID-19 and the efficacy and safety of CAS+IMD in IC patients (pts) hospitalized with COVID-19.
Methods
In a phase 1/2/3 double-blind trial (NCT04426695) conducted Jun 2020 to Apr 2021, prior to the emergence of Omicron-lineage variants, hospitalized COVID-19 pts were randomized 1:1:1 to a single 2.4 g or 8.0 g dose (combined for analyses) of CAS+IMD or placebo (P). Post hoc analyses assessed change in viral load (VL), clinical outcomes (death or mechanical ventilation [MV]), and safety for IC pts with B-cell deficiency or dysfunction (Table 1) vs all pts.
Results
99/1940 (5.1%) treated pts were identified as IC (Table 2). At baseline, IC vs all pts were more likely to be seronegative for SARS-CoV-2 antibodies (68.7% vs 41.2%), and to have higher median VLs (7.21 vs 6.32 log10 copies/mL). Compared to all pts receiving P, IC pts receiving P had slower VL declines. Treatment with CAS+IMD led to a reduction in VL from baseline, with a least-squares mean time-weighted average change in VL difference vs P at Day 7 for IC pts of -0.69 (95% CI: -1.25, -0.41) vs -0.31 (CI: -0.42, -0.20) for all pts; treatment benefit persisted through Day 29 (Fig. 1). Although sample size was small for IC pts, trends in clinical outcomes of death or MV at Day 29 for IC pts (7/64 [11.0%] CAS+IMD vs 6/35 [17.2%] P) were consistent with those in all pts (200/1307 [15.3%] CAS+IMD vs 113/633 [17.9%] P). IC vs all pts treated with CAS+IMD exhibited similar rates of treatment emergent adverse events (TEAEs, 30.4% vs 26.6%), AEs of special interest (grade ≥2 hypersensitivity or infusion-related reactions; 1.4% vs 2.5%), and death (8.7% vs 12.2%; Table 3). IC and all pts exhibited fewer TEAEs with CAS+IMD vs P.
Conclusion
IC vs all pts hospitalized with COVID-19 were more likely to exhibit high VLs at baseline and to be seronegative. In the study, a single dose of CAS+IMD significantly reduced VL in IC pts (for variants circulating at the time, predominantly Alpha) and resulted in fewer events of death or MV. There were no new safety findings in IC pts vs all study pts.
Disclosures
Selin Somersan-Karakaya, PhD, BARDA: Grant/Research Support|Regeneron Pharmaceuticals, Inc.: Employement|Regeneron Pharmaceuticals, Inc.: Stocks/Bonds Eleftherios Mylonakis, MD, PhD, Chemic Labs/KODA Therapeutics: Grant/Research Support|Cidara: Grant/Research Support|Leidos Biomedical Research Inc./NCI: Grant/Research Support|NIH/NIAID, NIH/NIGMS: Grant/Research Support|Pfizer: Grant/Research Support|Regeneron Pharmaceuticals, Inc.: Grant/Research Support|SciClone Pharmaceuticals: Grant/Research Support Ernesto Oviedo-Orta, MD, PhD, MBA, Regeneron Pharmaceuticals, Inc.: Employement|Regeneron Pharmaceuticals, Inc.: Stocks/Bonds Meagan P. O’Brien, MD, Regeneron Pharmaceuticals, Inc.: Employement|Regeneron Pharmaceuticals, Inc.: Stocks/Bonds Veronica Mas Casullo, MD, Regeneron Pharmaceuticals, Inc.: Employement|Regeneron Pharmaceuticals, Inc.: Stocks/Bonds Jenni Mou, PhD, Regeneron Pharmaceuticals, Inc.: Employement|Regeneron Pharmaceuticals, Inc.: Stocks/Bonds Jing Xiao, PhD, Regeneron Pharmaceuticals, Inc.: Stocks/Bonds Rafia Bhore, PhD, Regeneron Pharmaceuticals, Inc.: Employement|Regeneron Pharmaceuticals, Inc.: Stocks/Bonds Adnan Mahmood, MD, Regeneron Pharmaceuticals, Inc.: Employement|Regeneron Pharmaceuticals, Inc.: Stocks/Bonds Andrea T. Hooper, PhD, Regeneron Pharmaceuticals, Inc.: Employement|Regeneron Pharmaceuticals, Inc.: Stocks/Bonds Mohamed Hussein, PhD, Regeneron Pharmaceuticals, Inc.: Employement|Regeneron Pharmaceuticals, Inc.: Stocks/Bonds Shazia Ali, PharmD, Regeneron Pharmaceuticals, Inc.: Employement|Regeneron Pharmaceuticals, Inc.: Stocks/Bonds Eduardo Forleo-Neto, MD, Regeneron Pharmaceuticals, Inc.: Employement|Regeneron Pharmaceuticals, Inc.: Stocks/Bonds Gary A. Herman, MD, Regeneron Pharmaceuticals, Inc.: Employement|Regeneron Pharmaceuticals, Inc.: Stocks/Bonds Boaz Hirshberg, MD, MBA, Regeneron Pharmaceuticals, Inc.: Employement|Regeneron Pharmaceuticals, Inc.: Stocks/Bonds David M. Weinreich, MD, Regeneron Pharmaceuticals, Inc.: Employement|Regeneron Pharmaceuticals, Inc.: Stocks/Bonds.
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Affiliation(s)
| | | | | | | | | | - Jenni Mou
- Regeneron Pharmaceuticals, Inc. , Tarrytown, New York
| | - Jing Xiao
- Regeneron Pharmaceuticals, Inc. , Tarrytown, New York
| | - Rafia Bhore
- Regeneron Pharmaceuticals, Inc. , Tarrytown, New York
| | - Adnan Mahmood
- Regeneron Pharmaceuticals, Inc. , Tarrytown, New York
| | | | | | - Shazia Ali
- Formerly of Regeneron Pharmaceuticals, Inc. , Tarrytown, New York
| | | | - Gary A Herman
- Regeneron Pharmaceuticals, Inc. , Tarrytown, New York
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Jalbert JJ, Hussein M, Mastey V, Sanchez RJ, Wang D, Murdock D, Fariñas L, Bussey J, Duart C, Hirshberg B, Weinreich DM, Wei W. Effectiveness of Subcutaneous Casirivimab and Imdevimab in Ambulatory Patients with COVID-19. Infect Dis Ther 2022; 11:2125-2139. [PMID: 36181639 PMCID: PMC9526200 DOI: 10.1007/s40121-022-00691-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/22/2022] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Data on real-world effectiveness of subcutaneous (SC) casirivimab and imdevimab (CAS+IMD) for the treatment of coronavirus disease 2019 (COVID-19) are limited. The objective of this study was to assess the effectiveness of SC CAS+IMD versus no antibody treatment among patients with COVID-19. METHODS This retrospective cohort study linked Komodo Health and CDR Maguire Health and Medical data. Patients diagnosed with COVID-19 in ambulatory settings (August 1-October 30, 2021) treated with SC CAS+IMD were exact- and propensity score-matched to fewer than five untreated treatment-eligible patients and followed for the composite endpoint of 30-day all-cause mortality or COVID-19-related hospitalization. Kaplan-Meier estimators were used to calculate outcome risk overall and across subgroups. Cox proportional-hazards models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI). RESULTS Of 13,522 patients treated with CAS+IMD, 12,972 were matched to 41,848 untreated patients. The 30-day composite outcome risk was 1.9% (95% CI 1.7-2.2) and 4.4% (95% CI 4.2-4.6) in the treated and untreated cohorts, respectively; treated patients had a 49% lower relative risk of the composite outcome (aHR 0.51; 95% CI 0.46-0.58) and a 67% relative risk of 30-day mortality (aHR 0.33, 95% CI 0.18-0.60). Effectiveness was consistent across vaccination status and various subgroups. DISCUSSION Patients with COVID-19 benefitted from treatment with SC CAS+IMD versus untreated patients. The results were consistent across subgroups of patients, including older adults, immunocompromised patients, and patients vaccinated against COVID-19. Results were robust across numerous sensitivity analyses. CONCLUSION SC CAS+IMD is effective in reducing 30-day COVID-19-related hospitalization or mortality in real-world outpatient settings during the Delta-dominant period.
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Affiliation(s)
- Jessica J Jalbert
- Regeneron Pharmaceuticals, Inc., 1 Rockwood Road, Sleepy Hollow, NY, 10510, USA.
| | | | - Vera Mastey
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Degang Wang
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Dana Murdock
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | | | | | | | - Wenhui Wei
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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9
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Herman GA, O'Brien MP, Forleo-Neto E, Sarkar N, Isa F, Hou P, Chan KC, Bar KJ, Barnabas RV, Barouch DH, Cohen MS, Hurt CB, Burwen DR, Marovich MA, Musser BJ, Davis JD, Turner KC, Mahmood A, Hooper AT, Hamilton JD, Parrino J, Subramaniam D, Baum A, Kyratsous CA, DiCioccio AT, Stahl N, Braunstein N, Yancopoulos GD, Weinreich DM, Chani A, Adepoju A, Mahmood A, Mortagy A, Dupljak A, Baum A, Brown A, Froment A, Hooper A, Margiotta A, Bombardier A, Islam A, Smith A, Dhillon A, McMillian A, Breazna A, Aslam A, Carpentino B, Kowal B, Siliverstein B, Horel B, Zhu B, Musser B, Bush B, Head B, Snow B, Zhu B, Debray C, Phillips C, Simiele C, Lee C, Nienstedt C, Trbovic C, Chan C(KC, Elliott C, Fish C, Ni C, Polidori C, Enciso C, Caira C, Powell C, Kyratsous CA, Baum C, McDonald C, Leigh C, Pan C, Wolken D, Manganello D, Liu D, Stein D, Weinreich DM, Hassan D, Gulabani D, Fix D, Leonard D, Sarda D, Bonhomme D, Kennedy D, Darcy D, Barron D, Hughes D, Rofail D, Kaur D, Ramesh D, Bianco D, Cohen D, Forleo-Neto E, Jean-Baptiste E, Bukhari E, Doyle E, Bucknam E, Labriola-Tomkins E, Nanna E, Huffman O'Keefe E, Gasparino E, Fung E, Isa F, To FY, Herman G, Yancopoulos GD, Bellingham G, Sumner G, Moggan G, Power G, Zeng H, Mariveles H, Gonzalez H, Kang H, Noor H, Minns I, Heirman I, Peszek I, Donohue J, Rusconi J, Austin J, Parrino J, Yo J, McDonnell J, Hamilton JD, Boarder J, Wei J, Yu J, Malia J, Tucciarone J, Tyler-Gale J, Davis JD, Strein J, Cohen J, Meyer J, Ursino J, Im J, Tramaglini J, Wolken J, Potter K, Scacalossi K, Naidu K, Browning K, Rutkowski K, Yau K, Woloshin K, Lewis-Amezcua K, Turner K, Dornheim K, Chiu K, Mohan K, McGuire K, Macci K, Ringleben K, Mohammadi K, Foster K, Knighton L, Lipsich L, Darling L, Boersma L, Cowen L, Hersh L, Jackson L, Purcell L, Sherpinsky L, Lai L, Faria L, Geissler L, Boppert L, Fiske L, Dickens M, Mancini M, Leigh MC, O'Brien MP, Batchelder M, Klinger M, Partridge M, Tarabocchia M, Wong M, Rodriguez M, Albizem M, O'Byrne M, Braunstein N, Sarkar N, Stahl N, Deitz N, Memblatt N, Shah N, Kumar N, Herrera O, Adedoyin O, Yellin O, Snodgrass P, Floody P, D'Ambrosio P, Gao P(X, Hou P, Hearld P, Li Q, Kitchenoff R, Ali R, Iyer R, Chava R, Alaj R, Pedraza R, Hamlin R, Hosain R, Gorawala R, White R, Yu R, Fogarty R, Dass SB, Bollini S, Ganguly S, DeCicco S, Patel S, Cassimaty S, Somersan-Karakaya S, McCarthy S, Henkel S, Ali S, Geila Shapiro S, Kim S, Nossoughi S, Bisulco S, Elkin S, Long S, Sivapalasingam S, Irvin S, Wilt S, Min T, Constant T, Devins T, DiCioccio T, Norton T, Bernardo T, Chuang TC, Wei V(J, Nuce V, Battini V, Caldwell W, Gao X, Chen X, Tian Y, Khan Y, Zhao Y, Kim Y, Dye B, Hurt CB, Burwen DR, Barouch DH, Burns D, Brown E, Bar KJ, Marovich M, Clement M, Cohen MS, Sista N, Barnabas RV, Zwerski S. Efficacy and safety of a single dose of casirivimab and imdevimab for the prevention of COVID-19 over an 8-month period: a randomised, double-blind, placebo-controlled trial. Lancet Infect Dis 2022; 22:1444-1454. [PMID: 35803290 PMCID: PMC9255947 DOI: 10.1016/s1473-3099(22)00416-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is an unmet need for COVID-19 prevention in patient populations who have not mounted or are not expected to mount an adequate immune response to complete COVID-19 vaccination. We previously reported that a single subcutaneous 1200 mg dose of the monoclonal antibody combination casirivimab and imdevimab (CAS + IMD) prevented symptomatic SARS-CoV-2 infections by 81·4% in generally healthy household contacts of SARS-CoV-2-infected individuals over a 1-month efficacy assessment period. Here we present additional results, including the 7-month follow-up period (months 2-8), providing additional insights about the potential for efficacy in pre-exposure prophylaxis settings. METHODS This was a randomised, double-blind, placebo-controlled trial done in the USA, Romania, and Moldova in 2020-2021, before the emergence of omicron (B.1.1.529) and omicron-lineage variants. Uninfected and unvaccinated household contacts of infected individuals, judged by the investigator to be in good health, were randomly assigned (1:1) to receive 1200 mg CAS + IMD or placebo by subcutaneous injection according to a central randomisation scheme provided by an interactive web response system; randomisation was stratified per site by the test results of a local diagnostic assay for SARS-CoV-2 and age group at baseline. COVID-19 vaccines were prohibited before randomisation, but participants were allowed to receive COVID-19 vaccination during the follow-up period. Participants who developed COVID-19 symptoms during the follow-up period underwent RT-PCR testing. Prespecified endpoints included the proportion of previously uninfected and baseline-seronegative participants (seronegative-modified full analysis set) who had RT-PCR-confirmed COVID-19 in the follow-up period (post-hoc for the timepoints of months 2-5 and 6-8 only) and underwent seroconversion (ie, became seropositive, considered a proxy for any SARS-CoV-2 infections [symptomatic and asymptomatic]; prespecified up to day 57, post-hoc for all timepoints thereafter). We also assessed the incidence of treatment-emergent adverse events. This study is registered with ClinicalTrials.gov, NCT04452318. FINDINGS From July 13, 2020, to Oct 4, 2021, 2317 participants who were RT-PCR-negative for SARS-CoV-2 were randomly assigned, of whom 1683 (841 assigned to CAS + IMD and 842 assigned to placebo) were seronegative at baseline. During the entirety of the 8-month study, CAS + IMD reduced the risk of COVID-19 by 81·2% (nominal p<0·0001) versus placebo (prespecified analysis). During the 7-month follow-up period, protection was greatest during months 2-5, with a 100% relative risk reduction in COVID-19 (nominal p<0·0001; post-hoc analysis). Efficacy waned during months 6-8 (post-hoc analysis). Seroconversion occurred in 38 (4·5%) of 841 participants in the CAS + IMD group and in 181 (21·5%) of 842 in the placebo group during the 8-month study (79·0% relative risk reduction vs placebo; nominal p<0·0001). Six participants in the placebo group were hospitalised due to COVID-19 versus none who received CAS + IMD. Serious treatment-emergent adverse events (including COVID-19) were reported in 24 (1·7%) of 1439 participants receiving CAS + IMD and in 23 (1·6%) of 1428 receiving placebo. Five deaths were reported, none of which were due to COVID-19 or related to the study drugs. INTERPRETATION CAS + IMD is not authorised in any US region as of Jan 24, 2022, because data show that CAS + IMD is not active against omicron-lineage variants. In this study, done before the emergence of omicron-lineage variants, a single subcutaneous 1200 mg dose of CAS + IMD protected against COVID-19 for up to 5 months of community exposure to susceptible strains of SARS-CoV-2 in the pre-exposure prophylaxis setting, in addition to the post-exposure prophylaxis setting that was previously shown. FUNDING Regeneron Pharmaceuticals, F Hoffmann-La Roche, US National Institute of Allergy and Infectious Diseases, US National Institutes of Health.
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10
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Paller AS, Simpson EL, Siegfried EC, Cork MJ, Wollenberg A, Arkwright PD, Soong W, Gonzalez ME, Schneider LC, Sidbury R, Lockshin B, Meltzer S, Wang Z, Mannent LP, Amin N, Sun Y, Laws E, Akinlade B, Dillon M, Kosloski MP, Kamal MA, Dubost-Brama A, Patel N, Weinreich DM, Yancopoulos GD, O'Malley JT, Bansal A. Dupilumab in children aged 6 months to younger than 6 years with uncontrolled atopic dermatitis: a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2022; 400:908-919. [PMID: 36116481 DOI: 10.1016/s0140-6736(22)01539-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/13/2022] [Accepted: 08/02/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Current systemic treatments for children younger than 6 years with moderate-to-severe atopic dermatitis that is uncontrolled with topical therapies might have suboptimal efficacy and safety. Dupilumab is approved for older children and adults with atopic dermatitis and for other type 2 inflammatory conditions. We aimed to evaluate efficacy and safety of dupilumab with concomitant low-potency topical corticosteroids in children aged 6 months to younger than 6 years with moderate-to-severe atopic dermatitis. METHODS This randomised, double-blind, placebo-controlled, parallel-group, phase 3 trial was conducted in 31 hospitals, clinics, and academic institutions in Europe and North America. Eligible patients were aged 6 months to younger than 6 years, with moderate-to-severe atopic dermatitis (Investigator's Global Assessment [IGA] score 3-4) diagnosed according to consensus criteria of the American Academy of Dermatology, and an inadequate response to topical corticosteroids. Patients were randomly assigned (1:1) to subcutaneous placebo or dupilumab (bodyweight ≥5 kg to <15 kg: 200 mg; bodyweight ≥15 kg to <30 kg: 300 mg) every 4 weeks plus low-potency topical corticosteroids (hydrocortisone acetate 1% cream) for 16 weeks. Randomisation was stratified by age, baseline bodyweight, and region. Patient allocation was done via a central interactive web response system, and treatment allocation was masked. The primary endpoint at week 16 was the proportion of patients with IGA score 0-1 (clear or almost clear skin). The key secondary endpoint (coprimary endpoint for the EU and EU reference market) at week 16 was the proportion of patients with at least a 75% improvement from baseline in Eczema Area and Severity Index (EASI-75). Primary analyses were done in the full analysis set (ie, all randomly assigned patients, as randomly assigned) and safety analyses were done in all patients who received any study drug. This study was registered with ClinicalTrials.gov, NCT03346434. FINDINGS Between June 30, 2020, and Feb 12, 2021, 197 patients were screened for eligibility, 162 of whom were randomly assigned to receive dupilumab (n=83) or placebo (n=79) plus topical corticosteroids. At week 16, significantly more patients in the dupilumab group than in the placebo group had IGA 0-1 (23 [28%] vs three [4%], difference 24% [95% CI 13-34]; p<0·0001) and EASI-75 (44 [53%] vs eight [11%], difference 42% [95% CI 29-55]; p<0·0001). Overall prevalence of adverse events was similar in the dupilumab group (53 [64%] of 83 patients) and placebo group (58 [74%] of 78 patients). Conjunctivitis incidence was higher in the dupilumab group (four [5%]) than the placebo group (none). No dupilumab-related adverse events were serious or led to treatment discontinuation. INTERPRETATION Dupilumab significantly improved atopic dermatitis signs and symptoms versus placebo in children younger than 6 years. Dupilumab was well tolerated and showed an acceptable safety profile, similar to results in older children and adults. FUNDING Sanofi and Regeneron Pharmaceuticals.
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Affiliation(s)
- Amy S Paller
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Dermatology, Ann and Robert H Lurie Children's Hospital, Chicago, IL, USA
| | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Elaine C Siegfried
- Department of Pediatrics, Saint Louis University, St Louis, MO, USA; Department of Pediatric Dermatology, Cardinal Glennon Children's Hospital, St Louis, MO, USA
| | - Michael J Cork
- Sheffield Dermatology Research, University of Sheffield, Sheffield, UK
| | - Andreas Wollenberg
- Department of Dermatology and Allergology, University Hospital, Ludwig-Maximilian University, Munich, Germany; Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Peter D Arkwright
- Lydia Becker Institute of Immunology & Inflammation, University of Manchester, Manchester, UK
| | - Weily Soong
- AllerVie Health, Alabama Allergy & Asthma Center, Birmingham, AL, USA
| | - Mercedes E Gonzalez
- The Phillip Frost Department of Dermatology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lynda C Schneider
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Robert Sidbury
- Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | | | - Steven Meltzer
- Beach Allergy and Asthma Specialty Group, Long Beach, CA, USA
| | | | | | - Nikhil Amin
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Yiping Sun
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
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11
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Isa F, Forleo-Neto E, Meyer J, Zheng W, Rasmussen S, Armas D, Oshita M, Brinson C, Folkerth S, Faria L, Heirman I, Sarkar N, Musser BJ, Bansal S, O'Brien MP, Turner KC, Ganguly S, Mahmood A, Dupljak A, Hooper AT, Hamilton JD, Kim Y, Kowal B, Soo Y, Geba GP, Lipsich L, Braunstein N, Yancopoulos GD, Weinreich DM, Herman GA. Repeat subcutaneous administration of casirivimab and imdevimab in adults is well-tolerated and prevents the occurrence of COVID-19. Int J Infect Dis 2022; 122:585-592. [PMID: 35788416 PMCID: PMC9249725 DOI: 10.1016/j.ijid.2022.06.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/13/2022] [Accepted: 06/27/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES A phase 1, double-blind, placebo-controlled trial was conducted to evaluate the safety, tolerability, and exploratory efficacy of repeat monthly doses of subcutaneous (SC) casirivimab and imdevimab (CAS+IMD) in uninfected adult volunteers. METHODS Participants were randomized (3:1) to SC CAS+IMD 1200 mg or placebo every 4 weeks for up to six doses. Primary and secondary end points evaluated safety, pharmacokinetics, and immunogenicity. Exploratory efficacy was evaluated by the incidence of COVID-19 or SARS-CoV-2 seroconversion. RESULTS In total, 969 participants received CAS+IMD. Repeat monthly dosing of SC CAS+IMD led to a 92.4% relative risk reduction in clinically defined COVID-19 compared with placebo (3/729 [0.4%] vs 13/240 [5.4%]; odds ratio 0.07 [95% CI 0.01-0.27]), and a 100% reduction in laboratory-confirmed COVID-19 (0/729 vs 10/240 [4.2%]; odds ratio 0.00). Development of anti-drug antibodies occurred in a small proportion of participants (<5%). No grade ≥3 injection-site reactions (ISRs) or hypersensitivity reactions were reported. Slightly more participants reported treatment-emergent adverse events with CAS+IMD (54.9%) than with placebo (48.3%), a finding that was due to grade 1-2 ISRs. Serious adverse events were rare. No deaths were reported in the 6-month treatment period. CONCLUSION Repeat monthly administration of 1200 mg SC CAS+IMD was well-tolerated, demonstrated low immunogenicity, and showed a substantial risk reduction in COVID-19 occurrence.
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Affiliation(s)
- Flonza Isa
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA,Corresponding authors
| | | | | | - Wenjun Zheng
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | | | | | | | - Lori Faria
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Neena Sarkar
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | | | | | | | | | - Ajla Dupljak
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | - Yunji Kim
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Bari Kowal
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Yuhwen Soo
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Leah Lipsich
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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12
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Sivapalasingam S, Lederer DJ, Bhore R, Hajizadeh N, Criner G, Hosain R, Mahmood A, Giannelou A, Somersan-Karakaya S, O’Brien MP, Boyapati A, Parrino J, Musser BJ, Labriola-Tompkins E, Ramesh D, Purcell LA, Gulabani D, Kampman W, Waldron A, Ng Gong M, Saggar S, Sperber SJ, Menon V, Stein DK, Sobieszczyk ME, Park W, Aberg JA, Brown SM, Kosmicki JA, Horowitz JE, Ferreira MA, Baras A, Kowal B, Thomas DiCioccio A, Akinlade B, Nivens MC, Braunstein N, Herman GA, Yancopoulos GD, Weinreich DM. Efficacy and Safety of Sarilumab in Hospitalized Patients With Coronavirus Disease 2019: A Randomized Clinical Trial. Clin Infect Dis 2022; 75:e380-e388. [PMID: 35219277 PMCID: PMC8903479 DOI: 10.1093/cid/ciac153] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Open-label platform trials and a prospective meta-analysis suggest efficacy of anti-interleukin (IL)-6R therapies in hospitalized patients with coronavirus disease 2019 (COVID-19) receiving corticosteroids. This study evaluated the efficacy and safety of sarilumab, an anti-IL-6R monoclonal antibody, in the treatment of hospitalized patients with COVID-19. METHODS In this adaptive, phase 2/3, randomized, double-blind, placebo-controlled trial, adults hospitalized with COVID-19 received intravenous sarilumab 400 mg or placebo. The phase 3 primary analysis population included patients with critical COVID-19 receiving mechanical ventilation (MV). The primary outcome was proportion of patients with ≥1-point improvement in clinical status from baseline to day 22. RESULTS There were 457 and 1365 patients randomized and treated in phases 2 and 3, respectively. In phase 3, patients with critical COVID-19 receiving MV (n = 298; 28.2% on corticosteroids), the proportion with ≥1-point improvement in clinical status (alive, not receiving MV) at day 22 was 43.2% for sarilumab and 35.5% for placebo (risk difference, +7.5%; 95% confidence interval [CI], -7.4 to 21.3; P =.3261), a relative risk improvement of 21.7%. In post hoc analyses pooling phase 2 and 3 critical patients receiving MV, the hazard ratio for death for sarilumab vs placebo was 0.76 (95% CI, .51 to 1.13) overall and 0.49 (95% CI, .25 to .94) in patients receiving corticosteroids at baseline. CONCLUSIONS This study did not establish the efficacy of sarilumab in hospitalized patients with severe/critical COVID-19. Post hoc analyses were consistent with other studies that found a benefit of sarilumab in patients receiving corticosteroids. CLINICAL TRIALS REGISTRATION NCT04315298.
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Affiliation(s)
| | | | - Rafia Bhore
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Negin Hajizadeh
- Institute for Clinical Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, New York, and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, New York, USA
| | - Gerard Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Romana Hosain
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Adnan Mahmood
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | | | | | - Anita Boyapati
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Janie Parrino
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Bret J Musser
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | - Divya Ramesh
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Lisa A Purcell
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Daya Gulabani
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Wendy Kampman
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Alpana Waldron
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | - Suraj Saggar
- Department of Infectious Disease, Holy Name Medical Center, Teaneck, New Jersey, USA
| | - Steven J Sperber
- Department of Infectious Disease, Hackensack Meridian School of Medicine and Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Vidya Menon
- Department of Medicine, NYC Health + Hospitals/Lincoln, Bronx, New York, USA
| | - David K Stein
- Department of Medicine, Jacobi Medical Center, Bronx, New York, USA
| | | | - William Park
- Pulmonary and Sleep Disorder Clinic, Valley Medical Center, Renton, Washington, USA
| | - Judith A Aberg
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USAand
| | - Samuel M Brown
- Department of Internal Medicine, Intermountain Medical Center and University of Utah, Salt Lake City, Utah, USA
| | | | | | | | - Aris Baras
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Bari Kowal
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | | | | | - Ned Braunstein
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Gary A Herman
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
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Portal-Celhay C, Forleo-Neto E, Eagan W, Musser BJ, Davis JD, Turner KC, Norton T, Hooper AT, Hamilton JD, Pan C, Mahmood A, Baum A, Kyratsous CA, Kim Y, Parrino J, Kampman W, Roque-Guerrero L, Stoici R, Fatakia A, Soo Y, Geba GP, Kowal B, DiCioccio AT, Stahl N, Lipsich L, Braunstein N, Herman GA, Yancopoulos GD, Weinreich DM. Virologic Efficacy of Casirivimab and Imdevimab COVID-19 Antibody Combination in Outpatients With SARS-CoV-2 Infection: A Phase 2 Dose-Ranging Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2225411. [PMID: 35969402 PMCID: PMC9379747 DOI: 10.1001/jamanetworkopen.2022.25411] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE The monoclonal antibody combination of casirivimab and imdevimab reduced viral load, hospitalization, or death when administered as a 1200-mg or greater intravenous (IV) dose in a phase 3 COVID-19 outpatient study. Subcutaneous (SC) and/or lower IV doses should increase accessibility and/or drug supplies for patients. OBJECTIVE To assess the virologic efficacy of casirivimab and imdevimab across different IV and SC doses compared with placebo. DESIGN, SETTING, AND PARTICIPANTS This phase 2, randomized, double-blind, placebo-controlled, parallel-group, dose-ranging study included outpatients with SARS-CoV-2 infection at 47 sites across the United States. Participants could be symptomatic or asymptomatic; symptomatic patients with risk factors for severe COVID-19 were excluded. Data were collected from December 15, 2020, to March 4, 2021. INTERVENTIONS Patients were randomized to a single IV dose (523 patients) of casirivimab and imdevimab at 300, 600, 1200, or 2400 mg or placebo; or a single SC dose (292 patients) of casirivimab and imdevimab at 600 or 1200 mg or placebo. MAIN OUTCOMES AND MEASURES The primary end point was the time-weighted average daily change from baseline (TWACB) in viral load from day 1 (baseline) through day 7 in patients seronegative for SARS-CoV-2 at baseline. RESULTS Among 815 randomized participants, 507 (282 randomized to IV treatment, 148 randomized to SC treatment, and 77 randomized to placebo) were seronegative at baseline and included in the primary efficacy analysis. Participants randomized to IV had a mean (SD) age of 34.6 (9.6) years (160 [44.6%] men; 14 [3.9%] Black; 121 [33.7%] Hispanic or Latino; 309 [86.1%] White); those randomized to SC had a mean age of 34.1 (10.0) years (102 [45.3%] men; 75 [34.7%] Hispanic or Latino; 6 [2.7%] Black; 190 [84.4%] White). All casirivimab and imdevimab treatments showed significant virologic reduction through day 7. Least-squares mean differences in TWACB viral load for casirivimab and imdevimab vs placebo ranged from -0.56 (95% CI; -0.89 to -0.24) log10 copies/mL for the 1200-mg IV dose to -0.71 (95% CI, -1.05 to -0.38) log10 copies/mL for the 2400-mg IV dose. There were no adverse safety signals or dose-related safety findings, grade 2 or greater infusion-related or hypersensitivity reactions, grade 3 or greater injection-site reactions, or fatalities. Two serious adverse events not related to COVID-19 or the study drug were reported. CONCLUSIONS AND RELEVANCE In this randomized clinical trial including outpatients with asymptomatic and low-risk symptomatic SARS-CoV-2, all IV and SC doses of casirivimab and imdevimab comparably reduced viral load. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04666441.
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Affiliation(s)
| | | | - Will Eagan
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | | | | | | | | | | | - Cynthia Pan
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | - Alina Baum
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | - Yunji Kim
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | | | | | - Roxana Stoici
- Global Clinical Professionals Research, St Petersburg, Florida
| | - Adil Fatakia
- Tandem Clinical Research LLC, Marrero, Louisiana
| | - Yuhwen Soo
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | - Bari Kowal
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | - Neil Stahl
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | - Leah Lipsich
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
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14
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Somersan-Karakaya S, Mylonakis E, Menon VP, Wells JC, Ali S, Sivapalasingam S, Sun Y, Bhore R, Mei J, Miller J, Cupelli L, Forleo-Neto E, Hooper AT, Hamilton JD, Pan C, Pham V, Zhao Y, Hosain R, Mahmood A, Davis JD, Turner KC, Kim Y, Cook A, Kowal B, Soo Y, DiCioccio AT, Geba GP, Stahl N, Lipsich L, Braunstein N, Herman GA, Yancopoulos GD, Weinreich DM. Casirivimab and Imdevimab for the Treatment of Hospitalized Patients With COVID-19. J Infect Dis 2022; 227:23-34. [PMID: 35895508 PMCID: PMC9384575 DOI: 10.1093/infdis/jiac320] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The open-label RECOVERY study reported improved survival in hospitalized, SARS-CoV-2 seronegative patients treated with casirivimab and imdevimab (CAS + IMD). METHODS In this phase 1/2/3, double-blind, placebo-controlled trial conducted prior to widespread circulation of Delta and Omicron, hospitalized COVID-19 patients were randomized (1:1:1) to 2.4 g or 8.0 g CAS + IMD or placebo, and characterized at baseline for viral load and SARS-CoV-2 serostatus. RESULTS In total, 1336 patients on low-flow or no supplemental (low-flow/no) oxygen were treated. The primary endpoint was met in seronegative patients, the least-squares mean difference (CAS + IMD versus placebo) for time-weighted average change from baseline in viral load through day 7 was -0.28 log10 copies/mL (95% confidence interval [CI], -.51 to -.05; P = .0172). The primary clinical analysis of death or mechanical ventilation from day 6 to 29 in patients with high viral load had a strong positive trend but did not reach significance. CAS + IMD numerically reduced all-cause mortality in seronegative patients through day 29 (relative risk reduction, 55.6%; 95% CI, 24.2%-74.0%). No safety concerns were noted. CONCLUSIONS In hospitalized COVID-19 patients on low-flow/no oxygen, CAS + IMD reduced viral load and likely improves clinical outcomes in the overall population, with the benefit driven by seronegative patients, and no harm observed in seropositive patients. CLINICAL TRIALS REGISTRATION NCT04426695.
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Affiliation(s)
- Selin Somersan-Karakaya
- Correspondence: Selin Somersan-Karakaya, MD, Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Road, Tarrytown, NY 10591-6707 ()
| | | | - Vidya P Menon
- NYC Health + Hospitals/Lincoln, The Bronx, New York, USA
| | | | - Shazia Ali
- Current affiliation: Priovant Therapeutics, Durham, NC
| | | | | | - Rafia Bhore
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Jingning Mei
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Jutta Miller
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Lisa Cupelli
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | | | | | - Cynthia Pan
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Viet Pham
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Yuming Zhao
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | - Adnan Mahmood
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - John D Davis
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | - Yunji Kim
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Amanda Cook
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Bari Kowal
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Yuhwen Soo
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | - Gregory P Geba
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Neil Stahl
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | - Ned Braunstein
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Gary A Herman
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
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15
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Lewis K, Peris K, Sekulic A, Stratigos AJ, Dunn L, Eroglu Z, Chang ALS, Migden MR, Yoo SY, Mohan K, Coates E, Okoye E, Bowler T, Baurain JF, Bechter O, Hauschild A, Butler MO, Hernandez-Aya L, Licitra L, Neves RI, Ruiz ES, Seebach F, Weinreich DM, Yancopoulos GD, Lowy I, Goncalves P, Fury MG. Abstract CT165: Primary analysis of phase 2 results for cemiplimab in patients with metastatic basal cell carcinoma who progressed on or were intolerant to hedgehog inhibitors. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Cemiplimab is the first treatment approved in the US (as cemiplimab-rwlc) for patients with metastatic basal cell carcinoma (mBCC) or locally advanced disease (laBCC) after hedgehog inhibitor (HHI) treatment or for whom an HHI is not appropriate. Cemiplimab provided substantial clinical benefit and an acceptable safety profile in patients with laBCC who discontinued HHI therapy due to progressive disease (PD), intolerance, or no better than stable disease (SD) after 9 months (NCT03132636). Here, we present the primary analysis of the mBCC cohort.
Methods: Patients with mBCC (nodal or distant) post-HHI treatment received cemiplimab 350 mg intravenously every 3 weeks for up to 93 weeks or until PD. The primary endpoint was objective response rate (ORR) by independent central review (ICR). Key secondary endpoints included safety and tolerability, ORR per investigator (INV) assessment, duration of response (DOR), progression-free survival (PFS), overall survival (OS), and complete response (CR) rate (data cutoff date: May 20, 2021).
Results: Fifty-four patients were enrolled (70.4% male; median age 63.5 years [range, 38−90]; Eastern Cooperative Oncology Group performance status 0 [66.7%] and 1 [33.3%]). Median duration of follow-up was 8.4 months (range 1.5-36.2). ORR per ICR was 24.1% (95% confidence interval [CI], 13.5-37.6); with 1 CR and 12 partial responses (PRs). ORR per INV was 25.9% (95% CI, 15.0-39.7), with 2 CRs and 12 PRs. Among responders, median time to response per ICR was 4.0 months (range, 2.0−10.5). Estimated median DOR per ICR was 16.7 months (95% CI, 9.8-not evaluable). Disease control rate was 63.0% (95% CI, 48.7-75.7) per ICR and 70.4% (95% CI, 56.4-82.0) per INV. Median OS was not reached. Median PFS per ICR was 8.3 months (95% CI, 4.2-15.9). The most common treatment-related adverse events were fatigue (37.0%), diarrhea (14.8%), pruritus (13.0%), hyperthyroidism (9.3%), and arthralgia (9.3%) as well as hypothyroidism, asthenia, constipation, and maculo-papular rash (7.4% each). There were no treatment-related deaths.
Conclusions: Cemiplimab provided clinically meaningful antitumor activity, including durable responses, and an acceptable safety profile in patients with mBCC who had progressed on or were intolerant to HHI therapy.
Citation Format: Karl Lewis, Ketty Peris, Aleksander Sekulic, Alexander J. Stratigos, Lara Dunn, Zeynep Eroglu, Anne Lynn S. Chang, Michael R. Migden, Suk-Young Yoo, Kosalai Mohan, Ebony Coates, Emmanuel Okoye, Timothy Bowler, Jean-François Baurain, Oliver Bechter, Axel Hauschild, Marcus O. Butler, Leonel Hernandez-Aya, Lisa Licitra, Rogerio I. Neves, Emily S. Ruiz, Frank Seebach, David M. Weinreich, George D. Yancopoulos, Israel Lowy, Priscila Goncalves, Matthew G. Fury. Primary analysis of phase 2 results for cemiplimab in patients with metastatic basal cell carcinoma who progressed on or were intolerant to hedgehog inhibitors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT165.
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Affiliation(s)
- Karl Lewis
- 1University of Colorado School of Medicine, Aurora, CO
| | - Ketty Peris
- 2Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Lara Dunn
- 5Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | | | - Jean-François Baurain
- 10Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | | | | | | | - Lisa Licitra
- 15Istituto Nazionale dei Tumori, University of Milan, Milan, Italy
| | | | - Emily S. Ruiz
- 17Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | | | | | - Israel Lowy
- 9Regeneron Pharmaceuticals, Inc, Tarrytown, NY
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16
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Sivapalasingam S, Saviolakis GA, Kulcsar K, Nakamura A, Conrad T, Hassanein M, Sumner G, Elango C, Kamal MA, Eng S, Kyratsous CA, Musser BJ, Frieman M, Kantrowitz J, Weinreich DM, Yancopoulos G, Stahl N, Lipsich L. Human Monoclonal Antibody Cocktail for the Treatment or Prophylaxis of Middle East Respiratory Syndrome Coronavirus. J Infect Dis 2022; 225:1765-1772. [PMID: 33507266 PMCID: PMC7928873 DOI: 10.1093/infdis/jiab036] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/27/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND REGN3048 and REGN3051 are human monoclonal antibodies (mAb) targeting the spike glycoprotein on the Middle East respiratory syndrome coronavirus (MERS-CoV), which binds to the receptor dipeptidyl peptidase-4 (DPP4) and is necessary for infection of susceptible cells. METHODS Preclinical study: REGN3048, REGN3051 and isotype immunoglobulin G (IgG) were administered to humanized DPP4 (huDPP4) mice 1 day prior to and 1 day after infection with MERS-CoV (Jordan strain). Virus titers and lung pathology were assessed. Phase 1 study: healthy adults received the combined mAb (n = 36) or placebo (n = 12) and followed for 121 days. Six dose levels were studied. Strict safety criteria were met prior to dose escalation. RESULTS Preclinical study: REGN3048 plus REGN3051, prophylactically or therapeutically, was substantially more effective for reducing viral titer, lung inflammation, and pathology in huDPP4 mice compared with control antibodies and to each antibody monotherapy. Phase 1 study: REGN3048 plus REGN3051 was well tolerated with no dose-limiting adverse events, deaths, serious adverse events, or infusion reactions. Each mAb displayed pharmacokinetics expected of human IgG1 antibodies; it was not immunogenic. CONCLUSIONS REGN3048 and REGN3051 in combination were well tolerated. The clinical and preclinical data support further development for the treatment or prophylaxis of MERS-CoV infection.
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Affiliation(s)
| | - George A Saviolakis
- DynPort Vaccine Company, General Dynamics Information Technology, Frederick, Maryland, USA
| | - Kirsten Kulcsar
- Department of Microbiology and Immunology, University of Maryland, Baltimore, Maryland, USA
| | | | | | | | - Giane Sumner
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | | | - Simon Eng
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | - Bret J Musser
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Matthew Frieman
- Department of Microbiology and Immunology, University of Maryland, Baltimore, Maryland, USA
| | | | | | | | - Neil Stahl
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Leah Lipsich
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
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17
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Tewari KS, Monk BJ, Vergote I, Miller A, de Melo AC, Kim HS, Kim YM, Lisyanskaya A, Samouëlian V, Lorusso D, Damian F, Chang CL, Gotovkin EA, Takahashi S, Ramone D, Pikiel J, Maćkowiak-Matejczyk B, Guerra Alía EM, Colombo N, Makarova Y, Rischin D, Lheureux S, Hasegawa K, Fujiwara K, Li J, Jamil S, Jankovic V, Chen CI, Seebach F, Weinreich DM, Yancopoulos GD, Lowy I, Mathias M, Fury MG, Oaknin A. Survival with Cemiplimab in Recurrent Cervical Cancer. N Engl J Med 2022; 386:544-555. [PMID: 35139273 DOI: 10.1056/nejmoa2112187] [Citation(s) in RCA: 149] [Impact Index Per Article: 74.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with recurrent cervical cancer have a poor prognosis. Cemiplimab, the fully human programmed cell death 1 (PD-1)-blocking antibody approved to treat lung and skin cancers, has been shown to have preliminary clinical activity in this population. METHODS In this phase 3 trial, we enrolled patients who had disease progression after first-line platinum-containing chemotherapy, regardless of their programmed cell death ligand 1 (PD-L1) status. Women were randomly assigned (1:1) to receive cemiplimab (350 mg every 3 weeks) or the investigator's choice of single-agent chemotherapy. The primary end point was overall survival. Progression-free survival and safety were also assessed. RESULTS A total of 608 women were enrolled (304 in each group). In the overall trial population, median overall survival was longer in the cemiplimab group than in the chemotherapy group (12.0 months vs. 8.5 months; hazard ratio for death, 0.69; 95% confidence interval [CI], 0.56 to 0.84; two-sided P<0.001). The overall survival benefit was consistent in both histologic subgroups (squamous-cell carcinoma and adenocarcinoma [including adenosquamous carcinoma]). Progression-free survival was also longer in the cemiplimab group than in the chemotherapy group in the overall population (hazard ratio for disease progression or death, 0.75; 95% CI, 0.63 to 0.89; two-sided P<0.001). In the overall population, an objective response occurred in 16.4% (95% CI, 12.5 to 21.1) of the patients in the cemiplimab group, as compared with 6.3% (95% CI, 3.8 to 9.6) in the chemotherapy group. An objective response occurred in 18% (95% CI, 11 to 28) of the cemiplimab-treated patients with PD-L1 expression greater than or equal to 1% and in 11% (95% CI, 4 to 25) of those with PD-L1 expression of less than 1%. Overall, grade 3 or higher adverse events occurred in 45.0% of the patients who received cemiplimab and in 53.4% of those who received chemotherapy. CONCLUSIONS Survival was significantly longer with cemiplimab than with single-agent chemotherapy among patients with recurrent cervical cancer after first-line platinum-containing chemotherapy. (Funded by Regeneron Pharmaceuticals and Sanofi; EMPOWER-Cervical 1/GOG-3016/ENGOT-cx9 ClinicalTrials.gov number, NCT03257267.).
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MESH Headings
- Adenocarcinoma/drug therapy
- Adenocarcinoma/mortality
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Biomarkers, Tumor/metabolism
- Carcinoma, Adenosquamous/drug therapy
- Carcinoma, Adenosquamous/mortality
- Disease Progression
- Female
- Humans
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Programmed Cell Death 1 Receptor/metabolism
- Quality of Life
- Survival Analysis
- Uterine Cervical Neoplasms/drug therapy
- Uterine Cervical Neoplasms/mortality
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Affiliation(s)
- Krishnansu S Tewari
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Bradley J Monk
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Ignace Vergote
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Austin Miller
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Andreia C de Melo
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Hee-Seung Kim
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Yong Man Kim
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Alla Lisyanskaya
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Vanessa Samouëlian
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Domenica Lorusso
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Fernanda Damian
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Chih-Long Chang
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Evgeniy A Gotovkin
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Shunji Takahashi
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Daniella Ramone
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Joanna Pikiel
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Beata Maćkowiak-Matejczyk
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Eva M Guerra Alía
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Nicoletta Colombo
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Yulia Makarova
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Danny Rischin
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Stephanie Lheureux
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Kosei Hasegawa
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Keiichi Fujiwara
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Jingjin Li
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Shaheda Jamil
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Vladimir Jankovic
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Chieh-I Chen
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Frank Seebach
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - David M Weinreich
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - George D Yancopoulos
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Israel Lowy
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Melissa Mathias
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Matthew G Fury
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
| | - Ana Oaknin
- From the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University of California, Irvine, Orange (K.S.T.); the Division of Gynecologic Oncology, Arizona Oncology, University of Arizona, and Creighton University, Phoenix (B.J.M.); the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium (I.V.); the Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (A.M.) and Regeneron Pharmaceuticals, Tarrytown (J.L., S.J., V.J., C.-I.C., F.S., D.M.W., G.D.Y., I.L., M.M., M.G.F.) - both in New York; the Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro (A.C.M.), Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (F.D.), and the Department of Clinical Oncology, Barretos Cancer Hospital (Pio XII Foundation), São Paulo (D. Ramone) - all in Brazil; the Department of Obstetrics and Gynecology, Seoul National University College of Medicine (H.-S.K.), and the Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan (Y.M.K.) - both in Seoul, South Korea; St. Petersburg State Budgetary Institution of Health Care, St. Petersburg (A.L.), the State Budget Health Care Institution Ivanovo Regional Oncology Dispensary, Ivanovna (E.A.G.), and the State Budgetary Institution of Health Care, Clinical Oncology Dispensary No. 1, Krasnodar (Y.M.) - all in Russia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (V.S.); the Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome (D.L.); the Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and the Department of Medicine, Mackay Medical College, Taipei, Taiwan (C.-L.C.); the Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (S.T.), and the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka (K.H., K.F.) - both in Japan; the Department of Oncology, Szpitale Pomorskie, Gdynia (J.P.), and the Department of Gynecologic Oncology, Białostockie Centrum Onkologii, Białostockie (B.M.-M.) - both in Poland; the Department of Medical Oncology, Hospital Ramón y Cajal, Madrid (E.M.G.A.); the Department of Gynecologic Oncology, University of Milan-Bicocca and Istituto Europeo di Oncologia IRCCS, Milan (N.C.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (D. Rischin); the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (S.L.); and the Gynecologic Cancer Program, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona (A.O.)
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O’Brien MP, Forleo-Neto E, Sarkar N, Isa F, Hou P, Chan KC, Musser BJ, Bar KJ, Barnabas RV, Barouch DH, Cohen MS, Hurt CB, Burwen DR, Marovich MA, Brown ER, Heirman I, Davis JD, Turner KC, Ramesh D, Mahmood A, Hooper AT, Hamilton JD, Kim Y, Purcell LA, Baum A, Kyratsous CA, Krainson J, Perez-Perez R, Mohseni R, Kowal B, DiCioccio AT, Geba GP, Stahl N, Lipsich L, Braunstein N, Herman G, Yancopoulos GD, Weinreich DM. Effect of Subcutaneous Casirivimab and Imdevimab Antibody Combination vs Placebo on Development of Symptomatic COVID-19 in Early Asymptomatic SARS-CoV-2 Infection: A Randomized Clinical Trial. JAMA 2022; 327:432-441. [PMID: 35029629 PMCID: PMC8808333 DOI: 10.1001/jama.2021.24939] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/24/2021] [Indexed: 12/16/2022]
Abstract
Importance Easy-to-administer anti-SARS-CoV-2 treatments may be used to prevent progression from asymptomatic infection to symptomatic disease and to reduce viral carriage. Objective To evaluate the effect of combination subcutaneous casirivimab and imdevimab on progression from early asymptomatic SARS-CoV-2 infection to symptomatic COVID-19. Design, Setting, and Participants Randomized, double-blind, placebo-controlled, phase 3 trial of close household contacts of a SARS-CoV-2-infected index case at 112 sites in the US, Romania, and Moldova enrolled July 13, 2020-January 28, 2021; follow-up ended March 11, 2021. Asymptomatic individuals (aged ≥12 years) were eligible if identified within 96 hours of index case positive test collection. Results from 314 individuals positive on SARS-CoV-2 reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR) testing are reported. Interventions Individuals were randomized 1:1 to receive 1 dose of subcutaneous casirivimab and imdevimab, 1200 mg (600 mg of each; n = 158), or placebo (n = 156). Main Outcomes and Measures The primary end point was the proportion of seronegative participants who developed symptomatic COVID-19 during the 28-day efficacy assessment period. The key secondary efficacy end points were the number of weeks of symptomatic SARS-CoV-2 infection and the number of weeks of high viral load (>4 log10 copies/mL). Results Among 314 randomized participants (mean age, 41.0 years; 51.6% women), 310 (99.7%) completed the efficacy assessment period; 204 were asymptomatic and seronegative at baseline and included in the primary efficacy analysis. Subcutaneous casirivimab and imdevimab, 1200 mg, significantly prevented progression to symptomatic disease (29/100 [29.0%] vs 44/104 [42.3%] with placebo; odds ratio, 0.54 [95% CI, 0.30-0.97]; P = .04; absolute risk difference, -13.3% [95% CI, -26.3% to -0.3%]). Casirivimab and imdevimab reduced the number of symptomatic weeks per 1000 participants (895.7 weeks vs 1637.4 weeks with placebo; P = .03), an approximately 5.6-day reduction in symptom duration per symptomatic participant. Treatment with casirivimab and imdevimab also reduced the number of high viral load weeks per 1000 participants (489.8 weeks vs 811.9 weeks with placebo; P = .001). The proportion of participants receiving casirivimab and imdevimab who had 1 or more treatment-emergent adverse event was 33.5% vs 48.1% for placebo, including events related (25.8% vs 39.7%) or not related (11.0% vs 16.0%) to COVID-19. Conclusions and Relevance Among asymptomatic SARS-CoV-2 RT-qPCR-positive individuals living with an infected household contact, treatment with subcutaneous casirivimab and imdevimab antibody combination vs placebo significantly reduced the incidence of symptomatic COVID-19 over 28 days. Trial Registration ClinicalTrials.gov Identifier: NCT04452318.
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Affiliation(s)
| | | | - Neena Sarkar
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | - Flonza Isa
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | - Peijie Hou
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | | | - Katharine J. Bar
- Department of Medicine, University of Pennsylvania, Philadelphia
- Department of Microbiology, University of Pennsylvania, Philadelphia
| | - Ruanne V. Barnabas
- Department of Global Health, University of Washington, Seattle
- Division of Allergy and Infectious Diseases, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Dan H. Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Myron S. Cohen
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill
| | - Christopher B. Hurt
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill
| | - Dale R. Burwen
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - Mary A. Marovich
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - Elizabeth R. Brown
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Biostatistics, University of Washington, Seattle
| | | | | | | | - Divya Ramesh
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | | | | | - Yunji Kim
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | - Alina Baum
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | | | | | | | - Bari Kowal
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | | | - Neil Stahl
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | - Leah Lipsich
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | - Gary Herman
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
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Gogishvili M, Melkadze T, Makharadze T, Giorgadze D, Dvorkin M, Penkov K, Laktionov K, Nemsadze G, Nechaeva M, Rozhkova I, Kalinka E, Gessner C, Moreno-Jaime B, Passalacqua R, Li S, McGuire K, Kaul M, Paccaly A, Quek RGW, Gao B, Seebach F, Weinreich DM, Yancopoulos GD, Lowy I, Gullo G, Rietschel P. Cemiplimab plus chemotherapy versus chemotherapy alone in non-small cell lung cancer: a randomized, controlled, double-blind phase 3 trial. Nat Med 2022; 28:2374-2380. [PMID: 36008722 PMCID: PMC9671806 DOI: 10.1038/s41591-022-01977-y] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/27/2022] [Indexed: 01/14/2023]
Abstract
First-line cemiplimab (anti-programmed cell death-1 (PD-1)) monotherapy has previously shown significant improvement in overall survival (OS) and progression-free survival (PFS) versus chemotherapy in patients with advanced non-small cell lung cancer (aNSCLC) and PD-ligand 1 (PD-L1) expression ≥50%. EMPOWER-Lung 3 ( NCT03409614 ), a double-blind, placebo-controlled, phase 3 study, examined cemiplimab plus platinum-doublet chemotherapy as first-line treatment for aNSCLC, irrespective of PD-L1 expression or histology. In this study, 466 patients with stage III/IV aNSCLC without EGFR, ALK or ROS1 genomic tumor aberrations were randomized (2:1) to receive cemiplimab 350 mg (n = 312) or placebo (n = 154) every 3 weeks for up to 108 weeks in combination with four cycles of platinum-doublet chemotherapy (followed by pemetrexed maintenance as indicated). In total, 57.1% (266/466 patients) had non-squamous NSCLC, and 85.2% (397/466 patients) had stage IV disease. The primary endpoint was OS. The trial was stopped early per recommendation of the independent data monitoring committee, based on meeting preset OS efficacy criteria: median OS was 21.9 months (95% confidence interval (CI), 15.5-not evaluable) with cemiplimab plus chemotherapy versus 13.0 months (95% CI, 11.9-16.1) with placebo plus chemotherapy (hazard ratio (HR) = 0.71; 95% CI, 0.53-0.93; P = 0.014). Grade ≥3 adverse events occurred with cemiplimab plus chemotherapy (43.6%, 136/312 patients) and placebo plus chemotherapy (31.4%, 48/153 patients). Cemiplimab is only the second anti-PD-1/PD-L1 agent to show efficacy in aNSCLC as both monotherapy and in combination with chemotherapy for both squamous and non-squamous histologies.
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Affiliation(s)
- Miranda Gogishvili
- High Technology Medical Centre, University Clinic Ltd., Tbilisi, Georgia
| | | | | | - Davit Giorgadze
- grid.444272.30000 0004 0514 5989David Tvildiani Medical University, Tbilisi, Georgia
| | - Mikhail Dvorkin
- State Budgetary Healthcare Institution of Omsk Region, Omsk, Russia
| | - Konstantin Penkov
- Private Medical Institution Euromedservice, Saint Petersburg, Russia
| | - Konstantin Laktionov
- grid.466904.90000 0000 9092 133XFederal State Budgetary Institution ‘N.N. Blokhin National Medical Research Center of Oncology’ of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Gia Nemsadze
- The Institute of Clinical Oncology, Tbilisi, Georgia
| | - Marina Nechaeva
- grid.488832.dChelyabinsk Regional Clinical Oncology Center, Chelyabinsk, Chelyabinsk, Russia
| | - Irina Rozhkova
- Kaluga Regional Clinical Oncology Dispensary, Kaluga, Russia
| | - Ewa Kalinka
- grid.415071.60000 0004 0575 4012Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland
| | - Christian Gessner
- POIS Leipzig GbR, Leipzig, Germany ,grid.9647.c0000 0004 7669 9786Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | | | | | - Siyu Li
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals, Inc., Tarrytown, NY USA
| | - Kristina McGuire
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals, Inc., Tarrytown, NY USA
| | - Manika Kaul
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals, Inc., Tarrytown, NY USA
| | - Anne Paccaly
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals, Inc., Tarrytown, NY USA
| | - Ruben G. W. Quek
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals, Inc., Tarrytown, NY USA
| | - Bo Gao
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals, Inc., Tarrytown, NY USA
| | - Frank Seebach
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals, Inc., Tarrytown, NY USA
| | - David M. Weinreich
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals, Inc., Tarrytown, NY USA
| | | | - Israel Lowy
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals, Inc., Tarrytown, NY USA
| | - Giuseppe Gullo
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals, Inc., Tarrytown, NY USA
| | - Petra Rietschel
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals, Inc., Tarrytown, NY USA
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20
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Stein D, Oviedo-Orta E, Kampman WA, McGinniss J, Betts G, McDermott M, Holly B, Lancaster JM, Braunstein N, Yancopoulos GD, Weinreich DM. Compassionate Use of REGEN-COV ® in Patients with COVID-19 and Immunodeficiency-Associated Antibody Disorders. Clin Infect Dis 2021; 75:e509-e515. [PMID: 34971385 PMCID: PMC8755381 DOI: 10.1093/cid/ciab1059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Indexed: 12/15/2022] Open
Abstract
Background Patients with immunodeficiency-associated antibody disorders are at a higher risk of prolonged/persistent COVID-19 infection, having no viable treatment options. Methods A retrospective analysis of patients with primary and/or secondary immunodeficiency-associated antibody disorders who received casirivimab and imdevimab (REGEN-COV®) under emergency compassionate use. Objective were to describe safety and response to REGEN-COV, focusing on the subset of patients who had COVID-19 duration ≥21 days before treatment. Results Quantitative (change in oxygenation status and/or viral load) and/or qualitative (physician-reported clinical status) outcomes data are reported from 64 patients. Improvement in ≥1 outcome was observed in 90.6% of the overall patient group. Thirty-seven of these had COVID-19 duration ≥21 days before treatment; median time from diagnosis to REGEN-COV treatment was 60.5 days. Of the 29 patients with COVID-19 duration ≥21 days before treatment and available outcome data, 96.6% showed improvement in ≥1 outcome. In the 14 patients with post-treatment reverse transcription–polymerase chain reaction (RT-PCR) results available, 11 (78.6%) reported a negative RT-PCR following treatment, with 5 (45.5%) and 8 (72.7%) patients reporting a negative RT-PCR within 5 days and 21 days of treatment, respectively. Ten of 85 patients (11.8%) experienced serious adverse events; only one was an infusion-related reaction, possibly related to REGEN-COV. Two deaths were reported; neither were attributed to REGEN-COV. Conclusions In this retrospective analysis of immunodeficient patients granted REGEN-COV under emergency compassionate use, REGEN-COV treatment was associated with rapid viral clearance and clinical improvement in patients with longstanding COVID-19. Adverse events were consistent with COVID-19 and its associated complications, and due to patients’ concurrent medical conditions.
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Affiliation(s)
- David Stein
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | | | | | | | | | | | - Beth Holly
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
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21
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Bacharier LB, Maspero JF, Katelaris CH, Fiocchi AG, Gagnon R, de Mir I, Jain N, Sher LD, Mao X, Liu D, Zhang Y, Khan AH, Kapoor U, Khokhar FA, Rowe PJ, Deniz Y, Ruddy M, Laws E, Patel N, Weinreich DM, Yancopoulos GD, Amin N, Mannent LP, Lederer DJ, Hardin M. Dupilumab in Children with Uncontrolled Moderate-to-Severe Asthma. N Engl J Med 2021; 385:2230-2240. [PMID: 34879449 DOI: 10.1056/nejmoa2106567] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Children with moderate-to-severe asthma continue to have disease complications despite the receipt of standard-of-care therapy. The monoclonal antibody dupilumab has been approved for the treatment of adults and adolescents with asthma as well as with other type 2 inflammatory diseases. METHODS In this 52-week phase 3, randomized, double-blind, placebo-controlled trial, we assigned 408 children between the ages of 6 and 11 years who had uncontrolled moderate-to-severe asthma to receive a subcutaneous injection of dupilumab (at a dose of 100 mg for those weighing ≤30 kg and 200 mg for those weighing >30 kg) or matched placebo every 2 weeks. All the children continued to receive a stable dose of standard background therapy. The primary end point was the annualized rate of severe asthma exacerbations. Secondary end points included the change from baseline in the percentage of predicted prebronchodilator forced expiratory volume in 1 second (ppFEV1) at week 12 and in the score on the Asthma Control Questionnaire 7 Interviewer-Administered (ACQ-7-IA) at week 24. End points were evaluated in the two primary efficacy populations who had either a type 2 inflammatory asthma phenotype (≥150 blood eosinophils per cubic millimeter or a fraction of exhaled nitric oxide of ≥20 ppb at baseline) or a blood eosinophil count of at least 300 cells per cubic millimeter at baseline. RESULTS In patients with the type 2 inflammatory phenotype, the annualized rate of severe asthma exacerbations was 0.31 (95% confidence interval [CI], 0.22 to 0.42) with dupilumab and 0.75 (95% CI, 0.54 to 1.03) with placebo (relative risk reduction in the dupilumab group, 59.3%; 95% CI, 39.5 to 72.6; P<0.001). The mean (±SE) change from baseline in the ppFEV1 was 10.5±1.0 percentage points with dupilumab and 5.3±1.4 percentage points with placebo (mean difference, 5.2 percentage points; 95% CI, 2.1 to 8.3; P<0.001). Dupilumab also resulted in significantly better asthma control than placebo (P<0.001). Similar results were observed in the patients with an eosinophil count of at least 300 cells per cubic millimeter at baseline. The incidence of serious adverse events was similar in the two groups. CONCLUSIONS Among children with uncontrolled moderate-to-severe asthma, those who received add-on dupilumab had fewer asthma exacerbations and better lung function and asthma control than those who received placebo. (Funded by Sanofi and Regeneron Pharmaceuticals; Liberty Asthma VOYAGE ClinicalTrials.gov number, NCT02948959.).
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Affiliation(s)
- Leonard B Bacharier
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Jorge F Maspero
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Constance H Katelaris
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Alessandro G Fiocchi
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Remi Gagnon
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Ines de Mir
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Neal Jain
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Lawrence D Sher
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Xuezhou Mao
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Dongfang Liu
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Yi Zhang
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Asif H Khan
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Upender Kapoor
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Faisal A Khokhar
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Paul J Rowe
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Yamo Deniz
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Marcella Ruddy
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Elizabeth Laws
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Naimish Patel
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - David M Weinreich
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - George D Yancopoulos
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Nikhil Amin
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Leda P Mannent
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - David J Lederer
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Megan Hardin
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
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Mylonakis E, Somersan-Karakaya S, Sivapalasingam S, Ali S, Sun Y, Bhore R, Mei J, Miller J, Cupelli L, Hooper AT, Hamilton JD, Pan C, Pham V, Zhao Y, Hosain R, Mahmood A, Davis JD, Turner KC, Kim Y, Cook A, Menon V, Wells JC, Kowal B, Soo Y, DiCioccio AT, Geba GP, Stahl N, Lipsich L, Braunstein N, Herman G, Yancopoulos GD, Weinreich DM. LB4. Casirivimab and Imdevimab for Treatment of Hospitalized Patients With COVID-19 Receiving Low Flow or No Supplemental Oxygen. Open Forum Infect Dis 2021. [PMCID: PMC8644229 DOI: 10.1093/ofid/ofab466.1645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Casirivimab and imdevimab (CAS/IMDEV) is authorized for emergency use in the US for outpatients with COVID-19. We present results from patient cohorts receiving low flow or no supplemental oxygen at baseline from a phase 1/2/3, randomized, double-blinded, placebo (PBO)-controlled trial of CAS/IMDEV in hospitalized patients (pts) with COVID-19.
Methods
Hospitalized COVID-19 pts were randomized 1:1:1 to 2.4 g or 8.0 g of IV CAS/IMDEV (co-administered) or PBO. Primary endpoints were time-weighted average (TWA) change in viral load from baseline (Day 1) to Day 7; proportion of pts who died or went on mechanical ventilation (MV) through Day 29. Safety was evaluated through Day 57. The study was terminated early due to low enrollment (no safety concerns).
Results
Analysis was performed in pooled cohorts (low flow or no supplemental oxygen) as well as combined treatment doses (2.4 g and 8.0 g). The prespecified primary virologic analysis was in seronegative (seroneg) pts (combined dose group n=360; PBO n=160), where treatment with CAS/IMDEV led to a significant reduction in viral load from Day 1–7 (TWA change: LS mean (SE): -0.28 (0.12); 95% CI: -0.51, -0.05; P=0.0172; Fig. 1). The primary clinical analysis had a strong positive trend, though it did not reach statistical significance (P=0.2048), and 4/6 clinical endpoints prespecified for hypothesis testing were nominally significant (Table 1). In seroneg pts, there was a 47.0% relative risk reduction (RRR) in the proportion of pts who died or went on MV from Day 1–29 (10.3% treated vs 19.4% PBO; nominal P=0.0061; Fig. 2). There was a 55.6% (6.7% treated vs 15.0% PBO; nominal P=0.0032) and 35.9% (7.3% treated vs 11.5% PBO; nominal P=0.0178) RRR in the prespecified secondary endpoint of mortality by Day 29 in seroneg pts and the overall population, respectively (Fig. 2). No harm was seen in seropositive patients, and no safety events of concern were identified.
Figure 1: TWA daily viral load decreased from baseline (Day 1) in seronegative patients receiving low flow or no supplemental oxygen
Table 1. Primary virologic and clinical endpoints
Figure 2: Clinical outcomes in hospitalized patients receiving low flow or no supplemental oxygen*
Conclusion
Co-administration of CAS/IMDEV led to a significant reduction in viral load in hospitalized, seroneg pts requiring low flow or no supplemental oxygen. In seroneg pts and the overall population, treatment also demonstrated clinically meaningful, nominally significant reductions in 28-day mortality and proportion of pts dying or requiring MV.
Disclosures
Eleftherios Mylonakis, MD, PhD, BARDA (Other Financial or Material Support, HHSO100201700020C)Chemic labs/KODA therapeutics (Grant/Research Support)Cidara (Grant/Research Support)Leidos Biomedical Research Inc/NCI (Grant/Research Support)NIH/NIAID (Grant/Research Support)NIH/NIGMS (Grant/Research Support)Pfizer (Grant/Research Support)Regeneron (Grant/Research Support)SciClone Pharmaceuticals (Grant/Research Support) Selin Somersan-Karakaya, MD, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder) Sumathi Sivapalasingam, MD, BARDA (Other Financial or Material Support, HHSO100201700020C)Excision BioTherapeutics (Employee)Regeneron Pharmaceuticals, Inc. (Shareholder, Other Financial or Material Support, Royalties, patents planned, issued or pending, former employee) Shazia Ali, PharmD, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder) Yiping Sun, PhD, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder) Rafia Bhore, PhD, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder) Jingning Mei, PhD, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder) Jutta Miller, BS, RN, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder) Lisa Cupelli, PhD, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee) Andrea T. Hooper, PhD, BARDA (Other Financial or Material Support, HHSO100201700020C)Pfizer, Inc. (Shareholder, Other Financial or Material Support, Former employee)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder, Royalties, patents planned, issued or pending) Jennifer D. Hamilton, PhD, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder, Royalties, patents planned, issued or pending) Cynthia Pan, BPharm, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder) Viet Pham, BS, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder) Yuming Zhao, MS, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder) Romana Hosain, MD, MPH, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder) Adnan Mahmood, MD, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder) John D. Davis, PhD, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder) Kenneth C. Turner, PhD, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder, Royalties, patents planned, issued or pending) Yunji Kim, PharmD, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder) Amanda Cook, BS, Dip Reg Aff, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder) Jason C. Wells, MD, BARDA (Other Financial or Material Support, HHSO100201700020C) Bari Kowal, MS, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder) Yuhwen Soo, PhD, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder) A. Thomas DiCioccio, PhD, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder) Gregory P. Geba, MD, DrPH, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Shareholder) Neil Stahl, PhD, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder, Royalties, patents planned, issued or pending) Leah Lipsich, PhD, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder) Ned Braunstein, MD, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder) Gary Herman, MD, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder, Royalties, patents planned, issued or pending) George D. Yancopoulos, MD, PhD, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder, Royalties, patents planned, issued or pending) David M. Weinreich, MD, BARDA (Other Financial or Material Support, HHSO100201700020C)Regeneron Pharmaceuticals, Inc. (Employee, Shareholder)
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Affiliation(s)
| | | | | | - Shazia Ali
- Regeneron Pharmaceuticals Inc., Tarrytown, New York
| | - Yiping Sun
- Regeneron Pharmaceuticals Inc., Tarrytown, New York
| | - Rafia Bhore
- Regeneron Pharmaceuticals Inc., Tarrytown, New York
| | - Jingning Mei
- Regeneron Pharmaceuticals Inc., Tarrytown, New York
| | - Jutta Miller
- Regeneron Pharmaceuticals Inc., Tarrytown, New York
| | - Lisa Cupelli
- Regeneron Pharmaceuticals Inc., Tarrytown, New York
| | | | | | - Cynthia Pan
- Regeneron Pharmaceuticals Inc., Tarrytown, New York
| | - Viet Pham
- Regeneron Pharmaceuticals Inc., Tarrytown, New York
| | - Yuming Zhao
- Regeneron Pharmaceuticals Inc., Tarrytown, New York
| | | | | | - John D Davis
- Regeneron Pharmaceuticals Inc., Tarrytown, New York
| | | | - Yunji Kim
- Regeneron Pharmaceuticals Inc., Tarrytown, New York
| | - Amanda Cook
- Regeneron Pharmaceuticals Inc., Tarrytown, New York
| | | | | | - Bari Kowal
- Regeneron Pharmaceuticals Inc., Tarrytown, New York
| | - Yuhwen Soo
- Regeneron Pharmaceuticals Inc., Tarrytown, New York
| | | | | | - Neil Stahl
- Regeneron Pharmaceuticals Inc., Tarrytown, New York
| | - Leah Lipsich
- Regeneron Pharmaceuticals Inc., Tarrytown, New York
| | | | - Gary Herman
- Regeneron Pharmaceuticals Inc., Tarrytown, New York
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Weinreich DM, Sivapalasingam S, Norton T, Ali S, Gao H, Bhore R, Xiao J, Hooper AT, Hamilton JD, Musser BJ, Rofail D, Hussein M, Im J, Atmodjo DY, Perry C, Pan C, Mahmood A, Hosain R, Davis JD, Turner KC, Baum A, Kyratsous CA, Kim Y, Cook A, Kampman W, Roque-Guerrero L, Acloque G, Aazami H, Cannon K, Simón-Campos JA, Bocchini JA, Kowal B, DiCioccio AT, Soo Y, Geba GP, Stahl N, Lipsich L, Braunstein N, Herman G, Yancopoulos GD. REGEN-COV Antibody Combination and Outcomes in Outpatients with Covid-19. N Engl J Med 2021; 385:e81. [PMID: 34587383 PMCID: PMC8522800 DOI: 10.1056/nejmoa2108163] [Citation(s) in RCA: 390] [Impact Index Per Article: 130.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the phase 1-2 portion of an adaptive trial, REGEN-COV, a combination of the monoclonal antibodies casirivimab and imdevimab, reduced the viral load and number of medical visits in patients with coronavirus disease 2019 (Covid-19). REGEN-COV has activity in vitro against current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern. METHODS In the phase 3 portion of an adaptive trial, we randomly assigned outpatients with Covid-19 and risk factors for severe disease to receive various doses of intravenous REGEN-COV or placebo. Patients were followed through day 29. A prespecified hierarchical analysis was used to assess the end points of hospitalization or death and the time to resolution of symptoms. Safety was also evaluated. RESULTS Covid-19-related hospitalization or death from any cause occurred in 18 of 1355 patients in the REGEN-COV 2400-mg group (1.3%) and in 62 of 1341 patients in the placebo group who underwent randomization concurrently (4.6%) (relative risk reduction [1 minus the relative risk], 71.3%; P<0.001); these outcomes occurred in 7 of 736 patients in the REGEN-COV 1200-mg group (1.0%) and in 24 of 748 patients in the placebo group who underwent randomization concurrently (3.2%) (relative risk reduction, 70.4%; P = 0.002). The median time to resolution of symptoms was 4 days shorter with each REGEN-COV dose than with placebo (10 days vs. 14 days; P<0.001 for both comparisons). REGEN-COV was efficacious across various subgroups, including patients who were SARS-CoV-2 serum antibody-positive at baseline. Both REGEN-COV doses reduced viral load faster than placebo; the least-squares mean difference in viral load from baseline through day 7 was -0.71 log10 copies per milliliter (95% confidence interval [CI], -0.90 to -0.53) in the 1200-mg group and -0.86 log10 copies per milliliter (95% CI, -1.00 to -0.72) in the 2400-mg group. Serious adverse events occurred more frequently in the placebo group (4.0%) than in the 1200-mg group (1.1%) and the 2400-mg group (1.3%); infusion-related reactions of grade 2 or higher occurred in less than 0.3% of the patients in all groups. CONCLUSIONS REGEN-COV reduced the risk of Covid-19-related hospitalization or death from any cause, and it resolved symptoms and reduced the SARS-CoV-2 viral load more rapidly than placebo. (Funded by Regeneron Pharmaceuticals and others; ClinicalTrials.gov number, NCT04425629.).
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MESH Headings
- Adolescent
- Adult
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/pharmacokinetics
- Antibodies, Monoclonal, Humanized/pharmacology
- Antibodies, Neutralizing/administration & dosage
- Antibodies, Neutralizing/pharmacology
- Antiviral Agents/administration & dosage
- Antiviral Agents/pharmacokinetics
- Antiviral Agents/pharmacology
- COVID-19/mortality
- Dose-Response Relationship, Drug
- Double-Blind Method
- Drug Combinations
- Female
- Hospitalization/statistics & numerical data
- Humans
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Pregnancy
- Pregnancy Complications, Infectious/drug therapy
- Proportional Hazards Models
- Viral Load/drug effects
- Young Adult
- COVID-19 Drug Treatment
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Affiliation(s)
- David M Weinreich
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Sumathi Sivapalasingam
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Thomas Norton
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Shazia Ali
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Haitao Gao
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Rafia Bhore
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Jing Xiao
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Andrea T Hooper
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Jennifer D Hamilton
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Bret J Musser
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Diana Rofail
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Mohamed Hussein
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Joseph Im
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Dominique Y Atmodjo
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Christina Perry
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Cynthia Pan
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Adnan Mahmood
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Romana Hosain
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - John D Davis
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Kenneth C Turner
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Alina Baum
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Christos A Kyratsous
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Yunji Kim
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Amanda Cook
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Wendy Kampman
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Lilia Roque-Guerrero
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Gerard Acloque
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Hessam Aazami
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Kevin Cannon
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - J Abraham Simón-Campos
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Joseph A Bocchini
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Bari Kowal
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - A Thomas DiCioccio
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Yuhwen Soo
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Gregory P Geba
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Neil Stahl
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Leah Lipsich
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Ned Braunstein
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - Gary Herman
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
| | - George D Yancopoulos
- From Regeneron Pharmaceuticals, Tarrytown (D.M.W., T.N., S.A., H.G., R.B., J.X., A.T.H., J.D.H., B.J.M., D.R., M.H., J.I., D.Y.A., C. Perry, C. Pan, A.M., R.H., J.D.D., K.C.T., A.B., C.A.K., Y.K., A.C., W.K., B.K., A.T.D., Y. S., G.P.G., N.S., L.L., N.B., G.H., G.D.Y.) and Excision BioTherapeutics, New York (S.S.) - both in New York; Bio-Medical Research (L.R.-G.) and Universal Medical and Research Center (G.A.) - both in Miami; Hope Clinical Research, Canoga Park, CA (H.A.); PMG Research of Wilmington, Wilmington, NC (K.C.); Köhler and Milstein Research, Hospital General Agustín O'Horan, Mérida, Mexico (J.A.S.-C.); and the Willis-Knighton Physician Network, Shreveport, LA (J.A.B)
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Wechsler ME, Ruddy MK, Pavord ID, Israel E, Rabe KF, Ford LB, Maspero JF, Abdulai RM, Hu CC, Martincova R, Jessel A, Nivens MC, Amin N, Weinreich DM, Yancopoulos GD, Goulaouic H. Efficacy and Safety of Itepekimab in Patients with Moderate-to-Severe Asthma. N Engl J Med 2021; 385:1656-1668. [PMID: 34706171 DOI: 10.1056/nejmoa2024257] [Citation(s) in RCA: 157] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Monoclonal antibodies targeting IgE, interleukin-4 and -13, and interleukin-5 are effective in treating severe type 2 asthma, but new targets are needed. Itepekimab is a new monoclonal antibody against the upstream alarmin interleukin-33. The efficacy and safety of itepekimab as monotherapy, as well as in combination with dupilumab, in patients with asthma are unclear. METHODS In a phase 2 trial, we randomly assigned, in a 1:1:1:1 ratio, adults with moderate-to-severe asthma receiving inhaled glucocorticoids plus long-acting beta-agonists (LABAs) to receive subcutaneous itepekimab (at a dose of 300 mg), itepekimab plus dupilumab (both at 300 mg; combination therapy), dupilumab (300 mg), or placebo every 2 weeks for 12 weeks. After randomization, LABA was discontinued at week 4, and inhaled glucocorticoids were tapered over weeks 6 through 9. The primary end point was an event indicating a loss of asthma control, assessed in the itepekimab group and the combination group, as compared with the placebo group. Secondary and other end points included lung function, asthma control, quality of life, type 2 biomarkers, and safety. RESULTS A total of 296 patients underwent randomization. By 12 weeks, an event indicating a loss of asthma control occurred in 22% of the patients in the itepekimab group, 27% of those in the combination group, and 19% of those in the dupilumab group, as compared with 41% of those in the placebo group; the corresponding odds ratios as compared with placebo were as follows: in the itepekimab group, 0.42 (95% confidence interval [CI], 0.20 to 0.88; P = 0.02); in the combination group, 0.52 (95% CI, 0.26 to 1.06; P = 0.07); and in the dupilumab group, 0.33 (95% CI, 0.15 to 0.70). As compared with placebo, the forced expiratory volume in 1 second before bronchodilator use increased with the itepekimab and dupilumab monotherapies but not with the combination therapy. Itepekimab treatment improved asthma control and quality of life, as compared with placebo, and led to a greater reduction in the mean blood eosinophil count. The incidence of adverse events was similar in all four trial groups. CONCLUSIONS Interleukin-33 blockade with itepekimab led to a lower incidence of events indicating a loss of asthma control than placebo and improved lung function in patients with moderate-to-severe asthma. (Funded by Sanofi and Regeneron Pharmaceuticals; ClinicalTrials.gov number, NCT03387852.).
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Affiliation(s)
- Michael E Wechsler
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Marcella K Ruddy
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Ian D Pavord
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Elliot Israel
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Klaus F Rabe
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Linda B Ford
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Jorge F Maspero
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Raolat M Abdulai
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Chih-Chi Hu
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Renata Martincova
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Andreas Jessel
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Michael C Nivens
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Nikhil Amin
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - David M Weinreich
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - George D Yancopoulos
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
| | - Helene Goulaouic
- From the Department of Medicine, National Jewish Health, Denver (M.E.W.); Regeneron Pharmaceuticals, Tarrytown, NY (M.K.R., M.C.N., N.A., D.M.W., G.D.Y.); NIHR Oxford Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (I.D.P.); Harvard Medical School and Brigham and Women's Hospital, Boston (E.I.); the Department of Medicine, Christian Albrechts University Kiel, Kiel, and LungenClinic Grosshansdorf and the Airway Research Center North at the German Center for Lung Research, Grosshansdorf - all in Germany (K.F.R.); the Asthma and Allergy Center, Bellevue, NE (L.B.F.); Fundación CIDEA (Centro de Investigación de Enfermedades Alérgicas y Respiratorias), Buenos Aires (J.F.M.); Sanofi, Cambridge, MA (R.M.A.); Sanofi, Bridgewater, NJ (C.-C.H., A.J.); Sanofi, Prague, Czech Republic (R.M.); and Sanofi, Chilly-Mazarin, France (H.G.)
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25
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O'Brien MP, Forleo-Neto E, Musser BJ, Isa F, Chan KC, Sarkar N, Bar KJ, Barnabas RV, Barouch DH, Cohen MS, Hurt CB, Burwen DR, Marovich MA, Hou P, Heirman I, Davis JD, Turner KC, Ramesh D, Mahmood A, Hooper AT, Hamilton JD, Kim Y, Purcell LA, Baum A, Kyratsous CA, Krainson J, Perez-Perez R, Mohseni R, Kowal B, DiCioccio AT, Stahl N, Lipsich L, Braunstein N, Herman G, Yancopoulos GD, Weinreich DM. Subcutaneous REGEN-COV Antibody Combination to Prevent Covid-19. N Engl J Med 2021; 385:1184-1195. [PMID: 34347950 PMCID: PMC8362593 DOI: 10.1056/nejmoa2109682] [Citation(s) in RCA: 300] [Impact Index Per Article: 100.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND REGEN-COV (previously known as REGN-COV2), a combination of the monoclonal antibodies casirivimab and imdevimab, has been shown to markedly reduce the risk of hospitalization or death among high-risk persons with coronavirus disease 2019 (Covid-19). Whether subcutaneous REGEN-COV prevents severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and subsequent Covid-19 in persons at high risk for infection because of household exposure to a person with SARS-CoV-2 infection is unknown. METHODS We randomly assigned, in a 1:1 ratio, participants (≥12 years of age) who were enrolled within 96 hours after a household contact received a diagnosis of SARS-CoV-2 infection to receive a total dose of 1200 mg of REGEN-COV or matching placebo administered by means of subcutaneous injection. At the time of randomization, participants were stratified according to the results of the local diagnostic assay for SARS-CoV-2 and according to age. The primary efficacy end point was the development of symptomatic SARS-CoV-2 infection through day 28 in participants who did not have SARS-CoV-2 infection (as measured by reverse-transcriptase-quantitative polymerase-chain-reaction assay) or previous immunity (seronegativity). RESULTS Symptomatic SARS-CoV-2 infection developed in 11 of 753 participants in the REGEN-COV group (1.5%) and in 59 of 752 participants in the placebo group (7.8%) (relative risk reduction [1 minus the relative risk], 81.4%; P<0.001). In weeks 2 to 4, a total of 2 of 753 participants in the REGEN-COV group (0.3%) and 27 of 752 participants in the placebo group (3.6%) had symptomatic SARS-CoV-2 infection (relative risk reduction, 92.6%). REGEN-COV also prevented symptomatic and asymptomatic infections overall (relative risk reduction, 66.4%). Among symptomatic infected participants, the median time to resolution of symptoms was 2 weeks shorter with REGEN-COV than with placebo (1.2 weeks and 3.2 weeks, respectively), and the duration of a high viral load (>104 copies per milliliter) was shorter (0.4 weeks and 1.3 weeks, respectively). No dose-limiting toxic effects of REGEN-COV were noted. CONCLUSIONS Subcutaneous REGEN-COV prevented symptomatic Covid-19 and asymptomatic SARS-CoV-2 infection in previously uninfected household contacts of infected persons. Among the participants who became infected, REGEN-COV reduced the duration of symptomatic disease and the duration of a high viral load. (Funded by Regeneron Pharmaceuticals and others; ClinicalTrials.gov number, NCT04452318.).
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Affiliation(s)
- Meagan P O'Brien
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Eduardo Forleo-Neto
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Bret J Musser
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Flonza Isa
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Kuo-Chen Chan
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Neena Sarkar
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Katharine J Bar
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Ruanne V Barnabas
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Dan H Barouch
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Myron S Cohen
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Christopher B Hurt
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Dale R Burwen
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Mary A Marovich
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Peijie Hou
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Ingeborg Heirman
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - John D Davis
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Kenneth C Turner
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Divya Ramesh
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Adnan Mahmood
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Andrea T Hooper
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Jennifer D Hamilton
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Yunji Kim
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Lisa A Purcell
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Alina Baum
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Christos A Kyratsous
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - James Krainson
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Richard Perez-Perez
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Rizwana Mohseni
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Bari Kowal
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - A Thomas DiCioccio
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Neil Stahl
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Leah Lipsich
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Ned Braunstein
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - Gary Herman
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - George D Yancopoulos
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
| | - David M Weinreich
- From Regeneron Pharmaceuticals, Tarrytown, NY (M.P.O., E.F.-N., B.J.M., F.I., K.-C.C., N. Sarkar, P.H., I.H., J.D.D., K.C.T., D.R., A.M., A.T.H., J.D.H., Y.K., L.A.P., A.B., C.A.K., B.K., A.T.D., N. Stahl, L.L., N.B., G.H., G.D.Y., D.M.W.); the Departments of Medicine and Microbiology, University of Pennsylvania, Philadelphia (K.J.B.); the Departments of Global Health and Epidemiology and the Division of Allergy and Infectious Diseases, University of Washington, and the Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center - both in Seattle (R.V.B.); the Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston (D.H.B.); the Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., C.B.H.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD (D.R.B., M.A.M.); Clinical Trials of Florida (J.K.) and Medical Research of Westchester (R.P.-P.) - both in Miami; and the Catalina Research Institute, Montclair, CA (R.M.)
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O'Brien MP, Forleo-Neto E, Sarkar N, Isa F, Hou P, Chan KC, Musser BJ, Bar KJ, Barnabas RV, Barouch DH, Cohen MS, Hurt CB, Burwen DR, Marovich MA, Brown ER, Heirman I, Davis JD, Turner KC, Ramesh D, Mahmood A, Hooper AT, Hamilton JD, Kim Y, Purcell LA, Baum A, Kyratsous CA, Krainson J, Perez-Perez R, Mohseni R, Kowal B, DiCioccio AT, Stahl N, Lipsich L, Braunstein N, Herman G, Yancopoulos GD, Weinreich DM. Subcutaneous REGEN-COV Antibody Combination in Early Asymptomatic SARS-CoV-2 Infection: A Randomized Clinical Trial. medRxiv 2021:2021.06.14.21258569. [PMID: 34159343 PMCID: PMC8219113 DOI: 10.1101/2021.06.14.21258569] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
IMPORTANCE Easy-to-administer antiviral treatments may be used to prevent progression from asymptomatic infection to COVID-19 and to reduce viral carriage. OBJECTIVE Evaluate the efficacy and safety of subcutaneous casirivimab and imdevimab antibody combination (REGEN-COV) to prevent progression from early asymptomatic SARS-CoV-2 infection to COVID-19. DESIGN Randomized, double-blind, placebo-controlled, phase 3 study that enrolled asymptomatic close contacts living with a SARS-CoV-2-infected household member (index case). Participants who were SARS-CoV-2 RT-qPCR-positive at baseline were included in the analysis reported here. SETTING Multicenter trial conducted at 112 sites in the United States, Romania, and Moldova. PARTICIPANTS Asymptomatic individuals ≥12 years of age were eligible if identified within 96 hours of collection of the index case's positive SARS-CoV-2 test sample. INTERVENTIONS A total of 314 asymptomatic, SARS-CoV-2 RT-qPCR-positive individuals living with an infected household contact were randomized 1:1 to receive a single dose of subcutaneous REGEN-COV 1200mg (n=158) or placebo (n=156). MAIN OUTCOMES AND MEASURES The primary endpoint was the proportion of participants who developed symptomatic COVID-19 during the 28-day efficacy assessment period. The key secondary efficacy endpoints were the number of weeks of symptomatic SARS-CoV-2 infection and the number of weeks of high viral load (>4 log10 copies/mL). Safety was assessed in all treated participants. RESULTS Subcutaneous REGEN-COV 1200mg significantly prevented progression from asymptomatic to symptomatic disease compared with placebo (31.5% relative risk reduction; 29/100 [29.0%] vs 44/104 [42.3%], respectively; P=.0380). REGEN-COV reduced the overall population burden of high-viral load weeks (39.7% reduction vs placebo; 48 vs 82 total weeks; P=.0010) and of symptomatic weeks (45.3% reduction vs placebo; 89.6 vs 170.3 total weeks; P=.0273), the latter corresponding to an approximately 5.6-day reduction in symptom duration per symptomatic participant. Six placebo-treated participants had a COVID-19-related hospitalization or ER visit versus none for those receiving REGEN-COV. The proportion of participants receiving placebo who had ≥1 treatment-emergent adverse events was 48.1% compared with 33.5% for those receiving REGEN-COV, including events related (39.7% vs 25.8%, respectively) or not related (16.0% vs 11.0%, respectively) to COVID-19. CONCLUSIONS AND RELEVANCE Subcutaneous REGEN-COV 1200mg prevented progression from asymptomatic SARS-CoV-2 infection to COVID-19, reduced the duration of high viral load and symptoms, and was well tolerated. TRIAL REGISTRATION ClinicalTrials.gov Identifier, NCT04452318.
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Affiliation(s)
| | | | - Neena Sarkar
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Flonza Isa
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Peijie Hou
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | - Katharine J Bar
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Microbiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruanne V Barnabas
- Department of Global Health, University of Washington, Seattle, WA, USA; Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Dan H Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Myron S Cohen
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Christopher B Hurt
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Dale R Burwen
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Mary A Marovich
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Elizabeth R Brown
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - John D Davis
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Divya Ramesh
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | | | - Yunji Kim
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Alina Baum
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | | | | | - Bari Kowal
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Neil Stahl
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Leah Lipsich
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Gary Herman
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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Brown DM, Wykoff CC, Boyer D, Heier JS, Clark WL, Emanuelli A, Higgins PM, Singer M, Weinreich DM, Yancopoulos GD, Berliner AJ, Chu K, Reed K, Cheng Y, Vitti R. Evaluation of Intravitreal Aflibercept for the Treatment of Severe Nonproliferative Diabetic Retinopathy: Results From the PANORAMA Randomized Clinical Trial. JAMA Ophthalmol 2021; 139:946-955. [PMID: 34351414 PMCID: PMC8343518 DOI: 10.1001/jamaophthalmol.2021.2809] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Question Does treatment of moderately severe to severe nonproliferative diabetic retinopathy (NPDR) with intravitreal aflibercept injections result in 2-step or greater improvement on the Diabetic Retinopathy Severity Scale in more eyes, fewer vision-threatening complications, and fewer center-involved diabetic macular edema events from baseline through 100 weeks compared with sham injections? Findings In this randomized clinical trial of 402 patients with moderately severe to severe NPDR without diabetic macular edema, more eyes treated with intravitreal aflibercept injections showed a 2-step or greater improvement on the Diabetic Retinopathy Severity Scale at 24, 52, and 100 weeks, with significantly fewer vision-threatening complications and center-involved diabetic macular edema events. No differences in mean change in best-corrected visual acuity at weeks 52 and 100 were observed. Meaning In this study, anatomic improvement was more likely to occur in eyes with moderately severe to severe NPDR that were treated with intravitreal aflibercept injections; in year 2, fixed dosing appeared necessary to maintain anatomic benefit. Importance Proactive treatment of nonproliferative diabetic retinopathy (NPDR) reduces the risk of progression to vision-threatening complications. Objective To evaluate vascular endothelial growth factor blockade therapy with intravitreal aflibercept injections in eyes with severe NPDR without diabetic macular edema (DME). Design, Setting, and Participants The Study of the Efficacy and Safety of Intravitreal Aflibercept for the Improvement of Moderately Severe to Severe Nonproliferative Diabetic Retinopathy (PANORAMA) was a double-masked 100-week randomized clinical trial conducted in multiple centers worldwide. The study included 402 adults with Diabetic Retinopathy Severity Scale (DRSS) level 47 or 53 with no DME and best-corrected visual acuity of 20/40 or better. Interventions Intravitreal injections of aflibercept, 2 mg, every 16 weeks after 3 initial monthly doses and one 8-week interval (aflibercept 2q16 group); intravitreal injections of aflibercept, 2 mg, every 8 weeks after 5 initial monthly doses, with pro re nata (PRN) dosing beginning at week 56 (aflibercept 2q8/PRN group); or sham injections (control group). Main Outcomes and Measures Proportions of eyes with a 2-step or greater improvement in DRSS level, vision-threatening complications, and center-involved DME from baseline to weeks 24, 52, and 100. Results Among 402 participants (1 eye per participant), the mean (SD) age was 55.7 (10.5) years; 225 (56.0%) were male, and 310 (77.1%) were White. A total of 135 were randomized to the aflibercept 2q16 group, 134 to the aflibercept 2q8/PRN group, and 133 to the control group. At 24 weeks, treatment with aflibercept resulted in a 2-step or greater improvement in DRSS level in 157 of 269 eyes (58.4%) in the combined aflibercept groups vs 8 of 133 eyes (6.0%) in the control group (adjusted difference, 52.3%; 95% CI, 45.2%-59.5%; P < .001). At 52 weeks, 88 of 135 eyes (65.2%) in the aflibercept 2q16 group (adjusted difference, 50.1%; 95% CI, 40.1%-60.1%) and 107 of 134 eyes (79.9%) in the aflibercept 2q8/PRN group (adjusted difference, 64.8%; 95% CI, 55.8%-73.9%) compared with 20 of 133 eyes (15.0%) in the control group (P < .001 for both comparisons) showed a 2-step or greater improvement in DRSS level. Fewer eyes treated with aflibercept vs sham injections developed vision-threatening complications and/or center-involved DME through week 100 (22 of 135 eyes [16.3%] in the 2q16 group [adjusted difference, −34.2%; 95% CI, −44.6 to −23.8] and 25 of 134 eyes [18.7%] in the 2q8/PRN group [adjusted difference, −31.7%; 95% CI, −42.5 to −20.9] compared with 67 of 133 eyes [50.4%] in the control group; P < .001 for both comparisons). No new safety signals were identified. Conclusions and Relevance In this study, significantly more eyes with moderately severe to severe NPDR that were treated with aflibercept showed a 2-step or greater improvement in DRSS level at 24, 52, and 100 weeks, and significantly fewer eyes treated with aflibercept vs sham developed vision-threatening complications and center-involved DME. Outcomes on the DRSS between year 1 and 2 emphasize the need for ongoing vascular endothelial growth factor suppression and adherence. Trial Registration ClinicalTrials.gov Identifier: NCT02718326
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Affiliation(s)
- David M Brown
- Retina Consultants of Texas (Retina Consultants of America), Houston, Texas
| | - Charles C Wykoff
- Retina Consultants of Texas (Retina Consultants of America), Houston, Texas.,Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - David Boyer
- Retina-Vitreous Associates Medical Group, Los Angeles, California
| | | | | | - Andres Emanuelli
- Retina Care, Arecibo, Puerto Rico.,Emanuelli Research and Development Center, Arecibo, Puerto Rico
| | | | - Michael Singer
- Medical Center Ophthalmology Associates, San Antonio, Texas
| | | | | | | | - Karen Chu
- Regeneron Pharmaceuticals, Tarrytown, New York
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Copin R, Baum A, Wloga E, Pascal KE, Giordano S, Fulton BO, Zhou A, Negron N, Lanza K, Chan N, Coppola A, Chiu J, Ni M, Wei Y, Atwal GS, Hernandez AR, Saotome K, Zhou Y, Franklin MC, Hooper AT, McCarthy S, Hamon S, Hamilton JD, Staples HM, Alfson K, Carrion R, Ali S, Norton T, Somersan-Karakaya S, Sivapalasingam S, Herman GA, Weinreich DM, Lipsich L, Stahl N, Murphy AJ, Yancopoulos GD, Kyratsous CA. The monoclonal antibody combination REGEN-COV protects against SARS-CoV-2 mutational escape in preclinical and human studies. Cell 2021; 184:3949-3961.e11. [PMID: 34161776 PMCID: PMC8179113 DOI: 10.1016/j.cell.2021.06.002] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/15/2021] [Accepted: 05/28/2021] [Indexed: 01/21/2023]
Abstract
Monoclonal antibodies against SARS-CoV-2 are a clinically validated therapeutic option against COVID-19. Because rapidly emerging virus mutants are becoming the next major concern in the fight against the global pandemic, it is imperative that these therapeutic treatments provide coverage against circulating variants and do not contribute to development of treatment-induced emergent resistance. To this end, we investigated the sequence diversity of the spike protein and monitored emergence of virus variants in SARS-COV-2 isolates found in COVID-19 patients treated with the two-antibody combination REGEN-COV, as well as in preclinical in vitro studies using single, dual, or triple antibody combinations, and in hamster in vivo studies using REGEN-COV or single monoclonal antibody treatments. Our study demonstrates that the combination of non-competing antibodies in REGEN-COV provides protection against all current SARS-CoV-2 variants of concern/interest and also protects against emergence of new variants and their potential seeding into the population in a clinical setting.
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Affiliation(s)
- Richard Copin
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Alina Baum
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Elzbieta Wloga
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | | | | | | | - Anbo Zhou
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Nicole Negron
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Kathryn Lanza
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Newton Chan
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Angel Coppola
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Joyce Chiu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Min Ni
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Yi Wei
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | | | | | - Kei Saotome
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Yi Zhou
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | | | | | - Shane McCarthy
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Sara Hamon
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | | | - Hilary M Staples
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX 78245, USA
| | - Kendra Alfson
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX 78245, USA
| | - Ricardo Carrion
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX 78245, USA
| | - Shazia Ali
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Thomas Norton
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | | | | | - Gary A Herman
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | | | - Leah Lipsich
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Neil Stahl
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
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Rabe KF, Celli BR, Wechsler ME, Abdulai RM, Luo X, Boomsma MM, Staudinger H, Horowitz JE, Baras A, Ferreira MA, Ruddy MK, Nivens MC, Amin N, Weinreich DM, Yancopoulos GD, Goulaouic H. Safety and efficacy of itepekimab in patients with moderate-to-severe COPD: a genetic association study and randomised, double-blind, phase 2a trial. Lancet Respir Med 2021; 9:1288-1298. [PMID: 34302758 DOI: 10.1016/s2213-2600(21)00167-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Genetic data implicate IL-33 in asthma susceptibility. Itepekimab, a monoclonal antibody targeting IL-33, demonstrated clinical activity in asthma, with potential in chronic obstructive pulmonary disease (COPD). In this study we first aimed to test the hypothesis that genetic variants in the IL-33 pathway were also associated with COPD. On the basis of the strong association of IL-33 pathway genes with pulmonary diseases like asthma and COPD, we conducted this phase 2a trial to assess the safety and efficacy of itepekimab in patients with moderate-to-severe COPD on a stable regimen of triple-inhaled or double-inhaled background maintenance therapy. METHODS In this two-part study, genetic analyses of loss-of-function and gain-of-function variants in the IL-33 pathway, previously associated with asthma risk, were initially characterised for COPD. We then did a double-blind, phase 2a trial comparing itepekimab with placebo in patients with moderate-to-severe COPD despite standard therapy, at 83 study sites in ten countries. Patients aged 40-75 years who were current or former smokers, had been diagnosed with COPD for at least 1 year, and were on a stable regimen of triple-inhaled or double-inhaled background maintenance therapy, were randomly assigned (1:1) to receive itepekimab 300 mg or placebo, administered as two subcutaneous injections every 2 weeks for 24-52 weeks. The primary endpoint of the phase 2a trial was annualised rate of moderate-to-severe acute exacerbations of COPD during the treatment period. The key secondary outcome was change in prebronchodilator FEV1 from baseline to weeks 16-24. Prespecified subgroup analyses were done for each of the endpoints, including by smoking status. Efficacy and safety analyses were done in all participants who received at least one dose of assigned treatment (modified intention-to-treat population). This trial is registered at ClinicalTrials.gov (NCT03546907). FINDINGS Genetic analyses demonstrated association of loss of function in IL33 with reduced COPD risk, and gain of function in IL33 and IL1RL1 variants with increased risk. Subsequent to this, in the phase 2 trial, 343 patients were randomly assigned to placebo (n=171) or itepekimab (n=172) from July 16, 2018, to Feb 19, 2020. Annualised rates of acute exacerbations of COPD were 1·61 (95% CI 1·32-1·97) in the placebo group and 1·30 (1·05-1·61) in the itepekimab group (relative risk [RR] 0·81 [95% CI 0·61-1·07], p=0·13), and least squares mean prebronchodilator FEV1 change from baseline to weeks 16-24 was 0·0 L (SD 0·02) and 0·06 L (0·02; difference 0·06 L [95% CI 0·01-0·10], p=0·024). When analysis was restricted to former smokers, treatment with itepekimab was associated with nominally significant reductions in acute exacerbations of COPD (RR 0·58 [95% CI 0·39-0·85], p=0·0061) and FEV1 improvement (least squares mean difference 0·09 L [0·02-0·15], p=0·0076) compared with placebo. Current smokers treated with itepekimab showed no treatment benefit versus placebo for exacerbations (RR 1·09 [0·74-1·61], p=0·65) or FEV1 (least squares mean difference 0·02 [-0·05 to 0·09], p=0·54). Treatment-emergent adverse events (TEAEs) occurred in 135 (78%) patients in the itepekimab group and 136 (80%) in the placebo group. The most common TEAEs were nasopharyngitis (28 [16%] in the itepekimab group vs 29 [17%] in the placebo group), bronchitis (18 [10%] vs 14 [8%]), headache (14 [8%] vs 23 [13%]), and upper respiratory tract infection (13 [8%] vs 15 [9%]). INTERPRETATION The primary endpoint in the overall population was not met, subgroup analysis showed that itepekimab reduced exacerbation rate and improved lung function in former smokers with COPD. Two phase 3 clinical studies are ongoing to confirm the efficacy and safety profile of itepekimab in former smokers with COPD. FUNDING Sanofi and Regeneron Pharmaceuticals.
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Affiliation(s)
- Klaus F Rabe
- LungenClinic Grosshansdorf, Grosshansdorf, Germany; Christian Albrechts University of Kiel, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany.
| | - Bartolome R Celli
- Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | - Aris Baras
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | | | | | - Nikhil Amin
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
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O’Brien MP, Forleo-Neto E, Musser BJ, Isa F, Chan KC, Sarkar N, Bar KJ, Barnabas RV, Barouch DH, Cohen MS, Hurt CB, Burwen DR, Marovich MA, Hou P, Heirman I, Davis JD, Turner KC, Ramesh D, Mahmood A, Hooper AT, Hamilton JD, Kim Y, Purcell LA, Baum A, Kyratsous CA, Krainson J, Perez-Perez R, Mohseni R, Kowal B, DiCioccio AT, Stahl N, Lipsich L, Braunstein N, Herman G, Yancopoulos GD, Weinreich DM. Subcutaneous REGEN-COV Antibody Combination for Covid-19 Prevention. medRxiv 2021:2021.06.14.21258567. [PMID: 34159344 PMCID: PMC8219114 DOI: 10.1101/2021.06.14.21258567] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Casirivimab and imdevimab (REGEN-COV™) markedly reduces risk of hospitalization or death in high-risk individuals with Covid-19. Here we explore the possibility that subcutaneous REGEN-COV prevents SARS-CoV-2 infection and subsequent Covid-19 in individuals at high risk of contracting SARS-CoV-2 by close exposure in a household with a documented SARS-CoV-2-infected individual. Methods Individuals ≥12 years were enrolled within 96 hours of a household contact being diagnosed with SARS-CoV-2 and randomized 1:1 to receive 1200 mg REGEN-COV or placebo via subcutaneous injection. The primary efficacy endpoint was the proportion of participants without evidence of infection (SARS-CoV-2 RT-qPCR-negative) or prior immunity (seronegative) who subsequently developed symptomatic SARS-CoV-2 infection during a 28-day efficacy assessment period. Results Subcutaneous REGEN-COV significantly prevented symptomatic SARS-CoV-2 infection compared with placebo (81.4% risk reduction; 11/753 [1.5%] vs. 59/752 [7.8%], respectively; P<0.0001), with 92.6% risk reduction after the first week (2/753 [0.3%] vs. 27/752 [3.6%], respectively). REGEN-COV also prevented overall infections, either symptomatic or asymptomatic (66.4% risk reduction). Among infected participants, the median time to resolution of symptoms was 2 weeks shorter with REGEN-COV vs. placebo (1.2 vs. 3.2 weeks, respectively), and the duration of time with high viral load (>104 copies/mL) was lower (0.4 vs. 1.3 weeks, respectively). REGEN-COV was generally well tolerated. Conclusions Administration of subcutaneous REGEN-COV prevented symptomatic Covid-19 and asymptomatic SARS-CoV-2 infection in uninfected household contacts of infected individuals. Among individuals who became infected, REGEN-COV reduced the duration of symptomatic disease, decreased maximal viral load, and reduced the duration of detectable virus.(ClinicalTrials.gov number, NCT04452318.).
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Affiliation(s)
| | | | | | - Flonza Isa
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Neena Sarkar
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Katharine J. Bar
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Microbiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruanne V. Barnabas
- Department of Global Health, University of Washington, Seattle, WA, USA; Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Dan H. Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Myron S. Cohen
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christopher B. Hurt
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dale R. Burwen
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Mary A. Marovich
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Peijie Hou
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | | | - Divya Ramesh
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | | | - Yunji Kim
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Alina Baum
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | | | | | - Bari Kowal
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Neil Stahl
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Leah Lipsich
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Gary Herman
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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Gevaert P, De Craemer J, De Ruyck N, Rottey S, de Hoon J, Hellings PW, Volckaert B, Lesneuck K, Orengo JM, Atanasio A, Kamal MA, Abdallah H, Kamat V, Dingman R, DeVeaux M, Ramesh D, Perlee L, Wang CQ, Weinreich DM, Herman G, Yancopoulos GD, O'Brien MP. Novel antibody cocktail targeting Bet v 1 rapidly and sustainably treats birch allergy symptoms in a phase 1 study. J Allergy Clin Immunol 2021; 149:189-199. [PMID: 34126156 DOI: 10.1016/j.jaci.2021.05.039] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/06/2021] [Accepted: 05/14/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND The efficacy of an allergen-specific IgG cocktail to treat cat allergy suggests that allergen-specific IgG may be a major protective mechanism elicited by allergen immunotherapy. OBJECTIVES Extending these findings, we tested a Bet v 1-specific antibody cocktail in birch-allergic subjects. METHODS This was a phase 1, randomized, double-blind, study with 2 parts. Part A administered ascending doses of the Bet v 1-specific antibody cocktail REGN5713/14/15 (150-900 mg) in 32 healthy adults. Part B administered a single subcutaneous 900-mg dose or placebo in 64 birch-allergic subjects. Total nasal symptom score response to titrated birch extract nasal allergen challenge and skin prick test (SPT) with birch and alder allergen were assessed at screening and days 8, 29, 57, and 113 (SPT only); basophil activation tests (n = 26) were conducted. RESULTS Single-dose REGN5713/14/15 significantly reduced total nasal symptom score following birch nasal allergen challenge relative to baseline. Differences in total nasal symptom score areas under the curve (0-1 hour) for subjects treated with REGN5713/14/15 versus those given placebo (day 8: -1.17, P = .001; day 29: -1.18, P = .001; day 57: -0.85, P = .024) and titration SPT with birch difference in area under the curve of mean wheal diameters for subjects treated with REGN5713/14/15 versus placebo (all P < .001) were sustained for ≥2 months; similar results were observed with alder SPT. REGN5713/14/15 was well tolerated. Basophil responsiveness to birch-related allergens was significantly decreased in subjects treated with REGN5713/14/15 versus those given placebo on days 8, 57, and 113 (all P < .01). CONCLUSIONS Single-dose REGN5713/14/15 was well tolerated and provided a rapid (1 week) and durable (2 months) reduction in allergic symptoms after birch allergen nasal allergen challenge, potentially offering a new paradigm for the treatment of birch allergy symptoms.
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Affiliation(s)
- Philippe Gevaert
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Jarno De Craemer
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Natalie De Ruyck
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Sylvie Rottey
- Drug Research Unit Ghent, Ghent University Hospital, Ghent, Belgium
| | - Jan de Hoon
- Center for Clinical Pharmacology, UZ Leuven, Leuven, Belgium
| | - Peter W Hellings
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium; Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium; Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Bram Volckaert
- SGS Belgium Clinical Pharmacology Unit Antwerpen, Antwerp, Belgium
| | - Kristof Lesneuck
- SGS Belgium Clinical Pharmacology Unit Antwerpen, Antwerp, Belgium
| | | | | | | | | | | | | | | | | | | | | | | | - Gary Herman
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY
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Dakin P, Kivitz AJ, Gimbel JS, Skrepnik N, DiMartino SJ, Emeremni CA, Gao H, Stahl N, Weinreich DM, Yancopoulos GD, Geba GP. Efficacy and safety of fasinumab in patients with chronic low back pain: a phase II/III randomised clinical trial. Ann Rheum Dis 2021; 80:509-517. [PMID: 33199274 PMCID: PMC7958114 DOI: 10.1136/annrheumdis-2020-217259] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To study the efficacy and safety of fasinumab in moderate-to-severe, chronic low back pain (CLBP). METHODS In this phase II/III, double-blind, placebo-controlled study, patients with CLBP aged ≥35 years with inadequate pain relief/intolerance to acetaminophen, non-steroidal anti-inflammatory drugs and opioids were randomised to fasinumab 6 or 9 mg subcutaneous every 4 weeks (Q4W), 9 mg intravenous every 8 weeks (Q8W) or placebo. Primary endpoint was change from baseline to week 16 in average daily low back pain intensity (LBPI) numeric rating score. Key secondary efficacy variables included Roland-Morris Disability Questionnaire (RMDQ) and Patient Global Assessment (PGA). The results are based on a modified intent-to-treat analysis of 563/800 planned patients when enrolment was stopped early given emerging signals of joint risk in other osteoarthritis (OA) studies at doses being tested here. RESULTS Significant placebo-adjusted LBPI reductions at week 16 were observed for fasinumab 9 mg Q4W and Q8W (least squares mean (standard error) -0.7 (0.3); both nominal p<0.05), but not 6 mg (-0.3 (0.3); p=0.39). RMDQ and PGA improvements to week 16 were greatest for fasinumab 9 mg intravenous. Numerically greater efficacy occurred in patients with, versus those without, peripheral OA (pOA) over 16 weeks. Treatment-emergent adverse events (AEs) occurred in 274/418 (65.6%) patients in the combined fasinumab groups and 94/140 (67.1%) placebo patients. Joint AEs, mostly rapid progressive OA type 1, were more frequent in the combined fasinumab groups (19 events in 16 patients (3.8%) vs 1 event in 1 patient (0.7%) for placebo); all except one occurred in pOA patients. CONCLUSIONS Fasinumab highest doses, but not lower dose, improved both CLBP pain and function. Most joint AEs occurred in pOA patients, consistent with earlier findings in symptomatic OA. Further study is needed of patients with CLBP with and without pOA to determine optimal benefit-risk.
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Affiliation(s)
- Paula Dakin
- Global Clinical Development, Regeneron Pharmaceuticals Inc, Tarrytown, New York, USA
| | - Alan J Kivitz
- Department of Rheumatology, Altoona Center for Research, Duncansville, Pennsylvania, USA
| | | | - Nebojsa Skrepnik
- Research Center, Tucson Orthopedic Institute, Tucson, Arizona, USA
| | - Stephen J DiMartino
- Global Clinical Development, Regeneron Pharmaceuticals Inc, Tarrytown, New York, USA
| | | | - Haitao Gao
- R&D, Regeneron Pharmaceuticals Inc, Basking Ridge, New Jersey, USA
| | - Neil Stahl
- Global Clinical Development, Regeneron Pharmaceuticals Inc, Tarrytown, New York, USA
| | - David M Weinreich
- Global Clinical Development, Regeneron Pharmaceuticals Inc, Tarrytown, New York, USA
| | - George D Yancopoulos
- Global Clinical Development, Regeneron Pharmaceuticals Inc, Tarrytown, New York, USA
| | - Gregory P Geba
- Global Clinical Development, Regeneron Pharmaceuticals Inc, Tarrytown, New York, USA
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Sezer A, Kilickap S, Gümüş M, Bondarenko I, Özgüroğlu M, Gogishvili M, Turk HM, Cicin I, Bentsion D, Gladkov O, Clingan P, Sriuranpong V, Rizvi N, Gao B, Li S, Lee S, McGuire K, Chen CI, Makharadze T, Paydas S, Nechaeva M, Seebach F, Weinreich DM, Yancopoulos GD, Gullo G, Lowy I, Rietschel P. Cemiplimab monotherapy for first-line treatment of advanced non-small-cell lung cancer with PD-L1 of at least 50%: a multicentre, open-label, global, phase 3, randomised, controlled trial. Lancet 2021; 397:592-604. [PMID: 33581821 DOI: 10.1016/s0140-6736(21)00228-2] [Citation(s) in RCA: 371] [Impact Index Per Article: 123.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/04/2020] [Accepted: 01/04/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND We aimed to examine cemiplimab, a programmed cell death 1 inhibitor, in the first-line treatment of advanced non-small-cell lung cancer with programmed cell death ligand 1 (PD-L1) of at least 50%. METHODS In EMPOWER-Lung 1, a multicentre, open-label, global, phase 3 study, eligible patients recruited in 138 clinics from 24 countries (aged ≥18 years with histologically or cytologically confirmed advanced non-small-cell lung cancer, an Eastern Cooperative Oncology Group performance status of 0-1; never-smokers were ineligible) were randomly assigned (1:1) to cemiplimab 350 mg every 3 weeks or platinum-doublet chemotherapy. Crossover from chemotherapy to cemiplimab was allowed following disease progression. Primary endpoints were overall survival and progression-free survival per masked independent review committee. Primary endpoints were assessed in the intention-to-treat population and in a prespecified PD-L1 of at least 50% population (per US Food and Drug Administration request to the sponsor), which consisted of patients with PD-L1 of at least 50% per 22C3 assay done according to instructions for use. Adverse events were assessed in all patients who received at least one dose of the assigned treatment. This study is registered with ClinicalTrials.gov, NCT03088540 and is ongoing. FINDINGS Between June 27, 2017 and Feb 27, 2020, 710 patients were randomly assigned (intention-to-treat population). In the PD-L1 of at least 50% population, which consisted of 563 patients, median overall survival was not reached (95% CI 17·9-not evaluable) with cemiplimab (n=283) versus 14·2 months (11·2-17·5) with chemotherapy (n=280; hazard ratio [HR] 0·57 [0·42-0·77]; p=0·0002). Median progression-free survival was 8·2 months (6·1-8·8) with cemiplimab versus 5·7 months (4·5-6·2) with chemotherapy (HR 0·54 [0·43-0·68]; p<0·0001). Significant improvements in overall survival and progression-free survival were also observed with cemiplimab in the intention-to-treat population despite a high crossover rate (74%). Grade 3-4 treatment-emergent adverse events occurred in 98 (28%) of 355 patients treated with cemiplimab and 135 (39%) of 342 patients treated with chemotherapy. INTERPRETATION Cemiplimab monotherapy significantly improved overall survival and progression-free survival compared with chemotherapy in patients with advanced non-small-cell lung cancer with PD-L1 of at least 50%, providing a potential new treatment option for this patient population. FUNDING Regeneron Pharmaceuticals and Sanofi.
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Affiliation(s)
- Ahmet Sezer
- Department of Medical Oncology, Başkent University, Adana, Turkey.
| | - Saadettin Kilickap
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Mahmut Gümüş
- Department of Medical Oncology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Igor Bondarenko
- Department of Oncology and Medical Radiology; Dnipropetrovsk Medical Academy, Dnipro, Ukraine
| | - Mustafa Özgüroğlu
- Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | | | - Haci M Turk
- Department of Medical Oncology, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey
| | - Irfan Cicin
- Department of Medical Oncology, Trakya University, Edirne, Turkey
| | - Dmitry Bentsion
- Radiotherapy Department, Sverdlovsk Regional Oncology Centre, Sverdlovsk, Russia
| | | | - Philip Clingan
- Southern Medical Day Care Centre and Illawarra Health and Medical Research Institute, University of Wollongong-Illawarra Cancer Centre, Wollongong Hospital, Wollongong, NSW, Australia
| | - Virote Sriuranpong
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Naiyer Rizvi
- Division of Hematology-Oncology, Columbia University Medical Center, New York, New York, NY, USA
| | - Bo Gao
- Regeneron Pharmaceuticals, Basking Ridge, New Jersey, USA
| | - Siyu Li
- Regeneron Pharmaceuticals, Basking Ridge, New Jersey, USA
| | - Sue Lee
- Regeneron Pharmaceuticals, Basking Ridge, New Jersey, USA
| | | | - Chieh-I Chen
- Regeneron Pharmaceuticals, Basking Ridge, New Jersey, USA
| | | | - Semra Paydas
- Department of Medical Oncology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | | | - Frank Seebach
- Regeneron Pharmaceuticals, Tarrytown, New York, NY, USA
| | | | | | | | - Israel Lowy
- Regeneron Pharmaceuticals, Tarrytown, New York, NY, USA
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Weinreich DM, Sivapalasingam S, Norton T, Ali S, Gao H, Bhore R, Musser BJ, Soo Y, Rofail D, Im J, Perry C, Pan C, Hosain R, Mahmood A, Davis JD, Turner KC, Hooper AT, Hamilton JD, Baum A, Kyratsous CA, Kim Y, Cook A, Kampman W, Kohli A, Sachdeva Y, Graber X, Kowal B, DiCioccio T, Stahl N, Lipsich L, Braunstein N, Herman G, Yancopoulos GD. REGN-COV2, a Neutralizing Antibody Cocktail, in Outpatients with Covid-19. N Engl J Med 2021; 384:238-251. [PMID: 33332778 PMCID: PMC7781102 DOI: 10.1056/nejmoa2035002] [Citation(s) in RCA: 1204] [Impact Index Per Article: 401.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Recent data suggest that complications and death from coronavirus disease 2019 (Covid-19) may be related to high viral loads. METHODS In this ongoing, double-blind, phase 1-3 trial involving nonhospitalized patients with Covid-19, we investigated two fully human, neutralizing monoclonal antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein, used in a combined cocktail (REGN-COV2) to reduce the risk of the emergence of treatment-resistant mutant virus. Patients were randomly assigned (1:1:1) to receive placebo, 2.4 g of REGN-COV2, or 8.0 g of REGN-COV2 and were prospectively characterized at baseline for endogenous immune response against SARS-CoV-2 (serum antibody-positive or serum antibody-negative). Key end points included the time-weighted average change in viral load from baseline (day 1) through day 7 and the percentage of patients with at least one Covid-19-related medically attended visit through day 29. Safety was assessed in all patients. RESULTS Data from 275 patients are reported. The least-squares mean difference (combined REGN-COV2 dose groups vs. placebo group) in the time-weighted average change in viral load from day 1 through day 7 was -0.56 log10 copies per milliliter (95% confidence interval [CI], -1.02 to -0.11) among patients who were serum antibody-negative at baseline and -0.41 log10 copies per milliliter (95% CI, -0.71 to -0.10) in the overall trial population. In the overall trial population, 6% of the patients in the placebo group and 3% of the patients in the combined REGN-COV2 dose groups reported at least one medically attended visit; among patients who were serum antibody-negative at baseline, the corresponding percentages were 15% and 6% (difference, -9 percentage points; 95% CI, -29 to 11). The percentages of patients with hypersensitivity reactions, infusion-related reactions, and other adverse events were similar in the combined REGN-COV2 dose groups and the placebo group. CONCLUSIONS In this interim analysis, the REGN-COV2 antibody cocktail reduced viral load, with a greater effect in patients whose immune response had not yet been initiated or who had a high viral load at baseline. Safety outcomes were similar in the combined REGN-COV2 dose groups and the placebo group. (Funded by Regeneron Pharmaceuticals and the Biomedical and Advanced Research and Development Authority of the Department of Health and Human Services; ClinicalTrials.gov number, NCT04425629.).
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Affiliation(s)
- David M Weinreich
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Sumathi Sivapalasingam
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Thomas Norton
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Shazia Ali
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Haitao Gao
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Rafia Bhore
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Bret J Musser
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Yuhwen Soo
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Diana Rofail
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Joseph Im
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Christina Perry
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Cynthia Pan
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Romana Hosain
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Adnan Mahmood
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - John D Davis
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Kenneth C Turner
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Andrea T Hooper
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Jennifer D Hamilton
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Alina Baum
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Christos A Kyratsous
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Yunji Kim
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Amanda Cook
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Wendy Kampman
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Anita Kohli
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Yessica Sachdeva
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Ximena Graber
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Bari Kowal
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Thomas DiCioccio
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Neil Stahl
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Leah Lipsich
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Ned Braunstein
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - Gary Herman
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
| | - George D Yancopoulos
- From Regeneron Pharmaceuticals, Tarrytown, NY (D.M.W., S.S., T.N., S.A., H.G., R.B., B.J.M., Y. Soo, D.R., J.I., C. Perry, C. Pan, R.H., A.M., J.D.D., K.C.T., A.T.H., J.D.H., A.B., C.A.K., Y.K., A.C., W.K., B.K., T.D., N.S., L.L., N.B., G.H., G.D.Y.); Arizona Liver Health, Tucson (A.K.), and Arizona Liver Health, Chandler (Y. Sachdeva); and AGA Clinical Trials, Hialeah, FL (X.G.)
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Paller AS, Siegfried EC, Thaçi D, Wollenberg A, Cork MJ, Arkwright PD, Gooderham M, Beck LA, Boguniewicz M, Sher L, Weisman J, O'Malley JT, Patel N, Hardin M, Graham NM, Ruddy M, Sun X, Davis JD, Kamal MA, Khokhar FA, Weinreich DM, Yancopoulos GD, Beazley B, Bansal A, Shumel B. Efficacy and safety of dupilumab with concomitant topical corticosteroids in children 6 to 11 years old with severe atopic dermatitis: A randomized, double-blinded, placebo-controlled phase 3 trial. J Am Acad Dermatol 2020; 83:1282-1293. [DOI: 10.1016/j.jaad.2020.06.054] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/18/2020] [Accepted: 06/12/2020] [Indexed: 12/20/2022]
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Simões EAF, Forleo-Neto E, Geba GP, Kamal M, Yang F, Cicirello H, Houghton MR, Rideman R, Zhao Q, Benvin SL, Hawes A, Fuller ED, Wloga E, Pizarro JMN, Munoz FM, Rush SA, McLellan JS, Lipsich L, Stahl N, Yancopoulos GD, Weinreich DM, Kyratsous CA, Sivapalasingam S. Suptavumab for the Prevention of Medically Attended Respiratory Syncytial Virus Infection in Preterm Infants. Clin Infect Dis 2020; 73:e4400-e4408. [PMID: 32897368 PMCID: PMC8653633 DOI: 10.1093/cid/ciaa951] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/08/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of childhood medically attended respiratory infection (MARI). METHODS We conducted a randomized, double-blind, placebo-controlled phase 3 trial in 1154 preterm infants of 1 or 2 doses of suptavumab, a human monoclonal antibody that can bind and block a conserved epitope on RSV A and B subtypes, for the prevention of RSV MARI. The primary endpoint was proportion of subjects with RSV-confirmed hospitalizations or outpatient lower respiratory tract infection (LRTI). RESULTS There were no significant differences between primary endpoint rates (8.1%, placebo; 7.7%, 1-dose; 9.3%, 2-dose). Suptavumab prevented RSV A infections (relative risks, .38; 95% confidence interval [CI], .14-1.05 in the 1-dose group and .39 [95% CI, .14-1.07] in the 2-dose group; nominal significance of combined suptavumab group vs placebo; P = .0499), while increasing the rate of RSV B infections (relative risk 1.36 [95% CI, .73-2.56] in the 1-dose group and 1.69 [95% CI, .92-3.08] in the 2-dose group; nominal significance of combined suptavumab group vs placebo; P = .12). Sequenced RSV isolates demonstrated no suptavumab epitope changes in RSV A isolates, while all RSV B isolates had 2-amino acid substitution in the suptavumab epitope that led to loss of neutralization activity. Treatment emergent adverse events were balanced across treatment groups. CONCLUSIONS Suptavumab did not reduce overall RSV hospitalizations or outpatient LRTI because of a newly circulating mutant strain of RSV B. Genetic variation in circulating RSV strains will continue to challenge prevention efforts. CLINICAL TRIALS REGISTRATION NCT02325791. https://clinicaltrials.gov/ct2/show/NCT02325791.
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Affiliation(s)
- Eric A F Simões
- Department of Pediatrics, University of Colorado School of Medicine, and The Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - Gregory P Geba
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Mohamed Kamal
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Feng Yang
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | | | - Ronald Rideman
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Qiong Zhao
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Sarah L Benvin
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Alicia Hawes
- Regeneron Genetics Center, Tarrytown, New York, USA
| | | | - Elzbieta Wloga
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Jose M Novoa Pizarro
- Facultad Medicina Universidad del Desarrollo/CAS, Hospital Padre Hurtado, Santiago, Chile
| | - Flor M Munoz
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Scott A Rush
- Department of Molecular Biosciences, University of Texas at Austin, Austin, Texas, USA
| | - Jason S McLellan
- Department of Molecular Biosciences, University of Texas at Austin, Austin, Texas, USA
| | - Leah Lipsich
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Neil Stahl
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
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Boyapati A, Schwartzman S, Msihid J, Choy E, Genovese MC, Burmester GR, Lam G, Kimura T, Sadeh J, Weinreich DM, Yancopoulos GD, Graham NMH. Association of High Serum Interleukin-6 Levels With Severe Progression of Rheumatoid Arthritis and Increased Treatment Response Differentiating Sarilumab From Adalimumab or Methotrexate in a Post Hoc Analysis. Arthritis Rheumatol 2020; 72:1456-1466. [PMID: 32343882 PMCID: PMC7496495 DOI: 10.1002/art.41299] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 04/23/2020] [Indexed: 12/11/2022]
Abstract
Objective The development of biomarkers to guide treatment decisions is a major research focus in rheumatoid arthritis (RA). Patients with RA have elevated interleukin‐6 (IL‐6) levels; however, the utility of IL‐6 as a predictor of treatment response is unclear. This study was undertaken to investigate, by post hoc analysis, whether baseline IL‐6 levels are predictive of sarilumab treatment responses in 2 phase III studies. Methods Serum IL‐6 concentrations were measured in patients with RA prior to receiving sarilumab 200 mg (n = 148) or adalimumab 40 mg (n = 152) every 2 weeks (in the MONARCH trial; ClinicalTrials.gov identifier: NCT02332590) or sarilumab 150 mg, sarilumab 200 mg, or placebo every 2 weeks plus methotrexate (MTX) (n = 401, n = 396, and n = 397, respectively) (in the MOBILITY trial; ClinicalTrials.gov identifier: NCT01061736). Efficacy and patient‐reported outcomes were compared between and within groups according to IL‐6 tertile using linear and logistic regression. Results In MONARCH, patients with high baseline IL‐6 levels (all ≥3 times the upper limit of normal; n = 100) had higher disease activity at baseline than those with low IL‐6 levels (n = 100). The magnitude of clinical improvement over 24 weeks with sarilumab versus adalimumab was greater in patients with high compared to those with low baseline IL‐6 levels. In MOBILITY, compared to patients with low IL‐6 levels (n = 397), patients with high IL‐6 levels (n = 398) had higher disease activity and joint damage at baseline, were more likely to have joint progression, and had less clinical improvement over 52 weeks’ treatment with placebo plus MTX compared to sarilumab 150 mg or 200 mg plus MTX. Baseline IL‐6 and C‐reactive protein levels were both predictive of outcomes. Safety profiles were similar between defined IL‐6 tertiles. Conclusion IL‐6 may be a prognostic marker of disease progression and severity, and patients with high IL‐6 levels may be likely to benefit from sarilumab compared to adalimumab or MTX. Prospective validation is warranted to confirm the results of these post hoc analyses.
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Affiliation(s)
| | | | | | - Ernest Choy
- Cardiff University School of Medicine, Cardiff, UK
| | | | | | - Gordon Lam
- Atrium Health, Charlotte, North Carolina
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Raal FJ, Rosenson RS, Reeskamp LF, Hovingh GK, Kastelein JJP, Rubba P, Ali S, Banerjee P, Chan KC, Gipe DA, Khilla N, Pordy R, Weinreich DM, Yancopoulos GD, Zhang Y, Gaudet D. Evinacumab for Homozygous Familial Hypercholesterolemia. N Engl J Med 2020; 383:711-720. [PMID: 32813947 DOI: 10.1056/nejmoa2004215] [Citation(s) in RCA: 351] [Impact Index Per Article: 87.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Homozygous familial hypercholesterolemia is characterized by premature cardiovascular disease caused by markedly elevated levels of low-density lipoprotein (LDL) cholesterol. This disorder is associated with genetic variants that result in virtually absent (null-null) or impaired (non-null) LDL-receptor activity. Loss-of-function variants in the gene encoding angiopoietin-like 3 (ANGPTL3) are associated with hypolipidemia and protection against atherosclerotic cardiovascular disease. Evinacumab, a monoclonal antibody against ANGPTL3, has shown potential benefit in patients with homozygous familial hypercholesterolemia. METHODS In this double-blind, placebo-controlled, phase 3 trial, we randomly assigned in a 2:1 ratio 65 patients with homozygous familial hypercholesterolemia who were receiving stable lipid-lowering therapy to receive an intravenous infusion of evinacumab (at a dose of 15 mg per kilogram of body weight) every 4 weeks or placebo. The primary outcome was the percent change from baseline in the LDL cholesterol level at week 24. RESULTS The mean baseline LDL cholesterol level in the two groups was 255.1 mg per deciliter, despite the receipt of maximum doses of background lipid-lowering therapy. At week 24, patients in the evinacumab group had a relative reduction from baseline in the LDL cholesterol level of 47.1%, as compared with an increase of 1.9% in the placebo group, for a between-group least-squares mean difference of -49.0 percentage points (95% confidence interval [CI], -65.0 to -33.1; P<0.001); the between-group least-squares mean absolute difference in the LDL cholesterol level was -132.1 mg per deciliter (95% CI, -175.3 to -88.9; P<0.001). The LDL cholesterol level was lower in the evinacumab group than in the placebo group in patients with null-null variants (-43.4% vs. +16.2%) and in those with non-null variants (-49.1% vs. -3.8%). Adverse events were similar in the two groups. CONCLUSIONS In patients with homozygous familial hypercholesterolemia receiving maximum doses of lipid-lowering therapy, the reduction from baseline in the LDL cholesterol level in the evinacumab group, as compared with the small increase in the placebo group, resulted in a between-group difference of 49.0 percentage points at 24 weeks. (Funded by Regeneron Pharmaceuticals; ELIPSE HoFH ClinicalTrials.gov number, NCT03399786.).
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Affiliation(s)
- Frederick J Raal
- From the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Cardiometabolics Unit, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York (R.S.R.), and Regeneron Pharmaceuticals, Tarrytown (S.A., P.B, K.-C.C., D.A.G., N.K., R.P., D.M.W. G.D.Y., Y.Z.) - both in New York; the Department of Vascular Medicine, University of Amsterdam, Amsterdam (L.F.R., G.K.H., J.J.P.K.); the Department of Internal Medicine and Surgery, Federico II University, Naples, Italy (P.R.); and the Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, QC, Canada (D.G.)
| | - Robert S Rosenson
- From the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Cardiometabolics Unit, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York (R.S.R.), and Regeneron Pharmaceuticals, Tarrytown (S.A., P.B, K.-C.C., D.A.G., N.K., R.P., D.M.W. G.D.Y., Y.Z.) - both in New York; the Department of Vascular Medicine, University of Amsterdam, Amsterdam (L.F.R., G.K.H., J.J.P.K.); the Department of Internal Medicine and Surgery, Federico II University, Naples, Italy (P.R.); and the Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, QC, Canada (D.G.)
| | - Laurens F Reeskamp
- From the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Cardiometabolics Unit, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York (R.S.R.), and Regeneron Pharmaceuticals, Tarrytown (S.A., P.B, K.-C.C., D.A.G., N.K., R.P., D.M.W. G.D.Y., Y.Z.) - both in New York; the Department of Vascular Medicine, University of Amsterdam, Amsterdam (L.F.R., G.K.H., J.J.P.K.); the Department of Internal Medicine and Surgery, Federico II University, Naples, Italy (P.R.); and the Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, QC, Canada (D.G.)
| | - G Kees Hovingh
- From the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Cardiometabolics Unit, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York (R.S.R.), and Regeneron Pharmaceuticals, Tarrytown (S.A., P.B, K.-C.C., D.A.G., N.K., R.P., D.M.W. G.D.Y., Y.Z.) - both in New York; the Department of Vascular Medicine, University of Amsterdam, Amsterdam (L.F.R., G.K.H., J.J.P.K.); the Department of Internal Medicine and Surgery, Federico II University, Naples, Italy (P.R.); and the Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, QC, Canada (D.G.)
| | - John J P Kastelein
- From the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Cardiometabolics Unit, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York (R.S.R.), and Regeneron Pharmaceuticals, Tarrytown (S.A., P.B, K.-C.C., D.A.G., N.K., R.P., D.M.W. G.D.Y., Y.Z.) - both in New York; the Department of Vascular Medicine, University of Amsterdam, Amsterdam (L.F.R., G.K.H., J.J.P.K.); the Department of Internal Medicine and Surgery, Federico II University, Naples, Italy (P.R.); and the Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, QC, Canada (D.G.)
| | - Paolo Rubba
- From the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Cardiometabolics Unit, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York (R.S.R.), and Regeneron Pharmaceuticals, Tarrytown (S.A., P.B, K.-C.C., D.A.G., N.K., R.P., D.M.W. G.D.Y., Y.Z.) - both in New York; the Department of Vascular Medicine, University of Amsterdam, Amsterdam (L.F.R., G.K.H., J.J.P.K.); the Department of Internal Medicine and Surgery, Federico II University, Naples, Italy (P.R.); and the Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, QC, Canada (D.G.)
| | - Shazia Ali
- From the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Cardiometabolics Unit, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York (R.S.R.), and Regeneron Pharmaceuticals, Tarrytown (S.A., P.B, K.-C.C., D.A.G., N.K., R.P., D.M.W. G.D.Y., Y.Z.) - both in New York; the Department of Vascular Medicine, University of Amsterdam, Amsterdam (L.F.R., G.K.H., J.J.P.K.); the Department of Internal Medicine and Surgery, Federico II University, Naples, Italy (P.R.); and the Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, QC, Canada (D.G.)
| | - Poulabi Banerjee
- From the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Cardiometabolics Unit, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York (R.S.R.), and Regeneron Pharmaceuticals, Tarrytown (S.A., P.B, K.-C.C., D.A.G., N.K., R.P., D.M.W. G.D.Y., Y.Z.) - both in New York; the Department of Vascular Medicine, University of Amsterdam, Amsterdam (L.F.R., G.K.H., J.J.P.K.); the Department of Internal Medicine and Surgery, Federico II University, Naples, Italy (P.R.); and the Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, QC, Canada (D.G.)
| | - Kuo-Chen Chan
- From the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Cardiometabolics Unit, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York (R.S.R.), and Regeneron Pharmaceuticals, Tarrytown (S.A., P.B, K.-C.C., D.A.G., N.K., R.P., D.M.W. G.D.Y., Y.Z.) - both in New York; the Department of Vascular Medicine, University of Amsterdam, Amsterdam (L.F.R., G.K.H., J.J.P.K.); the Department of Internal Medicine and Surgery, Federico II University, Naples, Italy (P.R.); and the Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, QC, Canada (D.G.)
| | - Daniel A Gipe
- From the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Cardiometabolics Unit, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York (R.S.R.), and Regeneron Pharmaceuticals, Tarrytown (S.A., P.B, K.-C.C., D.A.G., N.K., R.P., D.M.W. G.D.Y., Y.Z.) - both in New York; the Department of Vascular Medicine, University of Amsterdam, Amsterdam (L.F.R., G.K.H., J.J.P.K.); the Department of Internal Medicine and Surgery, Federico II University, Naples, Italy (P.R.); and the Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, QC, Canada (D.G.)
| | - Nagwa Khilla
- From the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Cardiometabolics Unit, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York (R.S.R.), and Regeneron Pharmaceuticals, Tarrytown (S.A., P.B, K.-C.C., D.A.G., N.K., R.P., D.M.W. G.D.Y., Y.Z.) - both in New York; the Department of Vascular Medicine, University of Amsterdam, Amsterdam (L.F.R., G.K.H., J.J.P.K.); the Department of Internal Medicine and Surgery, Federico II University, Naples, Italy (P.R.); and the Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, QC, Canada (D.G.)
| | - Robert Pordy
- From the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Cardiometabolics Unit, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York (R.S.R.), and Regeneron Pharmaceuticals, Tarrytown (S.A., P.B, K.-C.C., D.A.G., N.K., R.P., D.M.W. G.D.Y., Y.Z.) - both in New York; the Department of Vascular Medicine, University of Amsterdam, Amsterdam (L.F.R., G.K.H., J.J.P.K.); the Department of Internal Medicine and Surgery, Federico II University, Naples, Italy (P.R.); and the Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, QC, Canada (D.G.)
| | - David M Weinreich
- From the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Cardiometabolics Unit, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York (R.S.R.), and Regeneron Pharmaceuticals, Tarrytown (S.A., P.B, K.-C.C., D.A.G., N.K., R.P., D.M.W. G.D.Y., Y.Z.) - both in New York; the Department of Vascular Medicine, University of Amsterdam, Amsterdam (L.F.R., G.K.H., J.J.P.K.); the Department of Internal Medicine and Surgery, Federico II University, Naples, Italy (P.R.); and the Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, QC, Canada (D.G.)
| | - George D Yancopoulos
- From the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Cardiometabolics Unit, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York (R.S.R.), and Regeneron Pharmaceuticals, Tarrytown (S.A., P.B, K.-C.C., D.A.G., N.K., R.P., D.M.W. G.D.Y., Y.Z.) - both in New York; the Department of Vascular Medicine, University of Amsterdam, Amsterdam (L.F.R., G.K.H., J.J.P.K.); the Department of Internal Medicine and Surgery, Federico II University, Naples, Italy (P.R.); and the Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, QC, Canada (D.G.)
| | - Yi Zhang
- From the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Cardiometabolics Unit, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York (R.S.R.), and Regeneron Pharmaceuticals, Tarrytown (S.A., P.B, K.-C.C., D.A.G., N.K., R.P., D.M.W. G.D.Y., Y.Z.) - both in New York; the Department of Vascular Medicine, University of Amsterdam, Amsterdam (L.F.R., G.K.H., J.J.P.K.); the Department of Internal Medicine and Surgery, Federico II University, Naples, Italy (P.R.); and the Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, QC, Canada (D.G.)
| | - Daniel Gaudet
- From the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Cardiometabolics Unit, Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York (R.S.R.), and Regeneron Pharmaceuticals, Tarrytown (S.A., P.B, K.-C.C., D.A.G., N.K., R.P., D.M.W. G.D.Y., Y.Z.) - both in New York; the Department of Vascular Medicine, University of Amsterdam, Amsterdam (L.F.R., G.K.H., J.J.P.K.); the Department of Internal Medicine and Surgery, Federico II University, Naples, Italy (P.R.); and the Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, QC, Canada (D.G.)
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Bateman ED, Khan AH, Xu Y, Guyot P, Chao J, Kamat S, Rowe P, Burnett H, Msihid J, Weinreich DM, Pavord ID. Response to comment on: Pairwise indirect treatment comparison of dupilumab versus other biologics in patients with uncontrolled persistent asthma (Respir. Med. 2020). Respir Med 2020; 191:106106. [PMID: 32839071 DOI: 10.1016/j.rmed.2020.106106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Eric D Bateman
- Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
| | | | - Yingxin Xu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | | | | | | | | | | | - Ian D Pavord
- Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Migden MR, Khushalani NI, Chang ALS, Lewis KD, Schmults CD, Hernandez-Aya L, Meier F, Schadendorf D, Guminski A, Hauschild A, Wong DJ, Daniels GA, Berking C, Jankovic V, Stankevich E, Booth J, Li S, Weinreich DM, Yancopoulos GD, Lowy I, Fury MG, Rischin D. Cemiplimab in locally advanced cutaneous squamous cell carcinoma: results from an open-label, phase 2, single-arm trial. Lancet Oncol 2020; 21:294-305. [PMID: 31952975 DOI: 10.1016/s1470-2045(19)30728-4] [Citation(s) in RCA: 267] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/15/2019] [Accepted: 10/25/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cemiplimab has shown substantial antitumour activity in patients with metastatic cutaneous squamous cell carcinoma. Patients with locally advanced cutaneous squamous cell carcinoma have poor prognosis with conventional systemic therapy. We present a primary analysis of the safety and antitumour activity of cemiplimab in patients with locally advanced cutaneous squamous cell carcinoma. METHODS This pivotal open-label, phase 2, single-arm trial was done across 25 outpatient clinics, primarily at academic medical centres, in Australia, Germany, and the USA. Eligible patients (aged ≥18 years with histologically confirmed locally advanced cutaneous squamous cell carcinoma and an Eastern Cooperative Oncology Group performance status of 0-1) received cemiplimab 3 mg/kg intravenously over 30 min every 2 weeks for up to 96 weeks. Tumour measurements were done every 8 weeks. The primary endpoint was objective response, defined as the proportion of patients with complete or partial response, according to independent central review as per Response Evaluation Criteria in Solid Tumors version 1.1 for radiological scans and WHO criteria for medical photography. Data cutoff was Oct 10, 2018, when the fully enrolled cohort reached the prespecified timepoint for the primary analysis. Analyses were done as per the intention-to-treat principle. The safety analysis comprised all patients who received at least one dose of cemiplimab. This study is registered with ClinicalTrials.gov, number NCT02760498. FINDINGS Between June 14, 2016, and April 25, 2018, 78 patients were enrolled and treated with cemiplimab. The median duration of study follow-up was 9·3 months (IQR 5·1-15·7) at the time of data cutoff. An objective response was observed in 34 (44%; 95% CI 32-55) of 78 patients. The best overall response was ten (13%) patients with a complete response and 24 (31%) with a partial response. Grade 3-4 treatment-emergent adverse events occurred in 34 (44%) of 78 patients; the most common were hypertension in six (8%) patients and pneumonia in four (5%). Serious treatment-emergent adverse events occurred in 23 (29%) of 78 patients. One treatment-related death was reported that occurred after onset of aspiration pneumonia. INTERPRETATION Cemiplimab showed antitumour activity and an acceptable safety profile in patients with locally advanced cutaneous squamous cell carcinoma for whom there was no widely accepted standard of care. FUNDING Regeneron Pharmaceuticals and Sanofi.
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Affiliation(s)
- Michael R Migden
- Departments of Dermatology and Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | | | - Anne Lynn S Chang
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | - Karl D Lewis
- University of Colorado Denver, School of Medicine, Aurora, CO, USA
| | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Leonel Hernandez-Aya
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Friedegund Meier
- Department of Dermatology, University Hospital Dresden, Dresden, Germany
| | - Dirk Schadendorf
- University Hospital Essen, Essen and German Cancer Consortium, Essen, Germany
| | - Alexander Guminski
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia
| | | | | | - Gregory A Daniels
- Division of Hematology and Oncology, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Carola Berking
- Department of Dermatology and Allergy, Munich University Hospital (LMU), Munich, Germany
| | | | | | | | - Siyu Li
- Regeneron Pharmaceuticals, Basking Ridge, NJ, USA
| | | | | | - Israel Lowy
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | - Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia
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Karlan B, Lu J, Navale L, Rasmussen E, Sun YN, Vergote IB, Kuchimanchi M, Warner D, Weinreich DM. Exposure-response relationship of open-label (OL) AMG 386 monotherapy in patients (pts) with recurrent ovarian cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.5072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5072 Background: AMG 386, an investigational peptibody, inhibits tumor angiogenesis by preventing angiopoietins 1/2 and Tie2 receptor interaction. A phase II, double-blind, controlled study (NCT00479817) evaluated toxicity and efficacy of AMG 386 + paclitaxel (P) in recurrent ovarian cancer pts. Increased AMG 386 exposure in that study was associated with longer progression-free survival (PFS; Lu et al., JCO 2010; 28 [Suppl]: 5042). Here, these analyses were applied to pts electing OL AMG 386 monotherapy after progression in the placebo group. Methods: Pts with recurrent epithelial ovarian, fallopian tube, or peritoneal cancer (≤3 prior anticancer therapies, GOG ≤1) were randomized 1:1:1 to P IV QW (3 on/1 off) + AMG 386 (3 or 10 mg/kg) or placebo IV QW. In the placebo group, pts who progressed and stayed eligible could receive OL AMG 386 10 mg/kg IV QW monotherapy. In pts receiving AMG 386 monotherapy, post-hoc analyses evaluated PFS per RECIST, objective response rate (ORR), adverse events (AEs), and the relationships between high and low AMG 386 exposure (based on a median AUCSS of 10.6 mg*hr/mL) and efficacy (PFS per RECIST, ORR). Results: 161 pts were randomized. 18 pts received OL AMG 386 monotherapy (range: 1-56 infusions). At the time of analysis, PFS was 3.2 mo. ORR was 0%. 6 pts had stable disease (SD), 7 had progressive disease (PD). Common AEs were abdominal pain (n = 6), fatigue (n = 5), peripheral edema (n = 5), nausea (n = 5), urinary tract infection (n = 5), and vomiting (n = 5); grade ≥ 3 AEs in more than 1 pt were pleural effusion (n = 2; all grade 3), small intestinal obstruction (n = 2; all grade 3), and ovarian cancer (n = 2; all grade 5). PFS was longer in the high- (n = 9) vs low-exposure (n = 9) group (7.2 vs 1.8 mo; HR = .266, p = .041). Precrossover PFS was similar between high- and low-exposure groups (5.5 vs 4.5 mo; HR = 1.146, p = .812). For both groups, ORR was 0%. In the high-exposure group, 4 pts had SD, 3 had PD. In the low-exposure group, 2 pts had SD, 4 had PD. Conclusions: In line with results from a phase II study of AMG 386 + P, pts with recurrent ovarian cancer who received AMG 386 monotherapy and had high AMG 386 exposure had longer PFS than pts with low exposure. Toxicity was similar in both groups.
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Affiliation(s)
- Beth Karlan
- Cedars-Sinai Medical Center, Division of Gynecologic Oncology, Los Angeles, CA
| | - Jianfeng Lu
- Amgen Inc., Department of Pharmacokinetics and Drug Metabolism, Thousand Oaks, CA
| | - Lynn Navale
- Amgen Inc., Department of Biostatistics, Thousand Oaks, CA
| | - Erik Rasmussen
- Amgen Inc., Department of Biostatistics, Thousand Oaks, CA
| | - Yu-Nien Sun
- Amgen Inc., Department of Pharmacokinetics and Drug Metabolism, Thousand Oaks, CA
| | - Ignace B. Vergote
- University Hospital Leuven, Department of Obstetrics and Gynecology, Leuven, Belgium
| | - Mita Kuchimanchi
- Amgen Inc., Department of Pharmacokinetics and Drug Metabolism, Thousand Oaks, CA
| | - Douglas Warner
- Amgen Inc., Department of Clinical Development, Thousand Oaks, CA
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Karlan BY, Oza AM, Richardson GE, Provencher DM, Hansen VL, Buck M, Chambers SK, Ghatage P, Pippitt CH, Brown JV, Covens A, Nagarkar RV, Davy M, Leath CA, Nguyen H, Stepan DE, Weinreich DM, Tassoudji M, Sun YN, Vergote IB. Randomized, Double-Blind, Placebo-Controlled Phase II Study of AMG 386 Combined With Weekly Paclitaxel in Patients With Recurrent Ovarian Cancer. J Clin Oncol 2012; 30:362-71. [DOI: 10.1200/jco.2010.34.3178] [Citation(s) in RCA: 181] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To estimate the efficacy and toxicity of AMG 386, an investigational peptide-Fc fusion protein that neutralizes the interaction between the Tie2 receptor and angiopoietin-1/2, plus weekly paclitaxel in patients with recurrent ovarian cancer. Patients and Methods Patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer were randomly assigned 1:1:1 to receive paclitaxel (80 mg/m2 once weekly [QW], 3 weeks on/1 week off) plus intravenous AMG 386 10 mg/kg QW (arm A), AMG 386 3 mg/kg QW (arm B), or placebo QW (arm C). The primary end point was progression-free survival (PFS). Secondary end points included overall survival, objective response, CA-125 response, safety, and pharmacokinetics. Results One hundred sixty-one patients were randomly assigned. Median PFS was 7.2 months (95% CI, 5.3 to 8.1 months) in arm A, 5.7 months (95% CI, 4.6 to 8.0 months) in arm B, and 4.6 months (95% CI, 1.9 to 6.7 months) in arm C. The hazard ratio for arms A and B combined versus arm C was 0.76 (95% CI, 0.52 to 1.12; P = .165). Further analyses suggested an exploratory dose-response effect for PFS across arms (Tarone's test, P = .037). Objective response rates for arms A, B, and C were 37%, 19%, and 27%, respectively. The incidence of grade ≥ 3 adverse events (AEs) in arms A, B, and C was 65%, 55%, and 64%, respectively. Frequent AEs included hypertension (8%, 6%, and 5% in arms A, B, and C, respectively), peripheral edema (71%, 51%, and 22% in arms A, B, and C, respectively), and hypokalemia (21%, 15%, and 5% in arms A, B, and C, respectively). AMG 386 exhibited linear pharmacokinetic properties at the tested doses. Conclusion AMG 386 combined with weekly paclitaxel was tolerable, with a manageable and distinct toxicity profile. The data suggest evidence of antitumor activity and a dose-response effect, warranting further studies in ovarian cancer.
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Affiliation(s)
| | - Amit M. Oza
- Author affiliations appear at the end of this article
| | | | | | | | - Martin Buck
- Author affiliations appear at the end of this article
| | | | | | | | - John V. Brown
- Author affiliations appear at the end of this article
| | - Allan Covens
- Author affiliations appear at the end of this article
| | | | - Margaret Davy
- Author affiliations appear at the end of this article
| | | | - Hoa Nguyen
- Author affiliations appear at the end of this article
| | | | | | | | - Yu-Nien Sun
- Author affiliations appear at the end of this article
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Doi T, Ohtsu A, Fuse N, Yoshino T, Tahara M, Suzuki N, Shibayama K, Takahara E, Nakai K, Weinreich DM. Abstract 3280: Phase 1 study of AMG 386, an anti-angiogenic Fc fusion protein targeting angiopoietin-1 and -2, in Japanese patients with advanced solid tumors. Cancer Res 2011. [DOI: 10.1158/1538-7445.am2011-3280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: AMG 386, a first-in-class investigational peptide-Fc fusion protein (peptibody), blocks angiogenesis via inhibiting the interaction between angiopoietin-1 and -2 and the Tie2 receptor. This first-in Japanese study evaluated the safety, tolerability, and pharmacokinetics (PK) of AMG 386 in patients with advanced solid tumors.
Method: This is the dose escalation, non-randomized, open-label, Phase 1 study of AMG 386 (JapicCTI-101161(en)) in Japanese patients with advanced solid tumors. Six patients were enrolled in each cohort (3, 10 or 30 mg/kg), and received AMG 386 intravenously once weekly to evaluate safety and PK profile as monotherapy. Dose-limiting toxicity (DLT) and PK profile were assessed for 28 days after initial dosing of AMG 386. DLT was defined as any related, grade ≥ 4 hematologic, grade ≥ 3 non-hematologic toxicity, or > 10 times upper limits of normal (ULN) AST or ALT elevation. Tumor response was evaluated per RECIST 1.0. The patients continued to receive AMG 386 until DLT or disease progression.
Results: Eighteen Japanese patients (median age, 57.5 years old; male/female=10/8; mean body weight, 55.7 kg) with ECOG 0-1 received at least 1 dose of AMG 386. The median number of doses was 5.5, 6 and 6 in 3, 10 and 30 mg/kg cohort, respectively. Tumor types included gastric (6 including GIST), rectal (4 including rectal cartinoid), pancreatic (3), colon (2), breast (1), endometrial (1) and bladder (1). No DLTs were observed in this study. Adverse events (AEs) were reported in all patients. The most common grade ≥ 3 AEs were Gamma-glutamyltransferase increased, which were not considered related to AMG 386. Four serious adverse events were reported; only cholecystitis in a patient with colon cancer was considered to be related to AMG 386. No neutralizing anti-AMG 386 antibodies were detected. PK in the dose range of 3 to 30 mg/kg of AMG 386 was dose-linear and terminal-phase elimination half-life values (t1/2,Z) ranged from 91.6 to 110 hours. Total serum clearance appeared to be similar across the dose range. After the 4th administration, Cmin appeared to reach an approximately constant value in 3 cohorts. The accumulation ratio was approximately 1.2 to 1.3. Two patients had a partial response (PR) as a best response. Stable disease as best response was reported in 2 patients, and progressive disease was reported in 14 patients. Patients with colon cancer in 3 mg/kg cohort and bladder cancer in 30 mg/kg cohort are still continuing the study treatment with PR for 56 weeks and 24 weeks, respectively. Conclusions: Weekly administration of AMG 386 (3, 10 or 30 mg/kg) was well tolerated in Japanese patients with advanced solid tumors. The safety and PK profiles in Japanese were similar to those previously observed in non-Japanese patients. AMG 386 monotherapy has shown some monotherapy activity with 2 confirmed PRs in this heavily pre-treated patient population.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3280. doi:10.1158/1538-7445.AM2011-3280
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Affiliation(s)
- Toshihiko Doi
- 1National Cancer Center Hospital East, Kashiwa, Japan
| | - Atsushi Ohtsu
- 1National Cancer Center Hospital East, Kashiwa, Japan
| | - Nozomu Fuse
- 1National Cancer Center Hospital East, Kashiwa, Japan
| | | | - Makoto Tahara
- 1National Cancer Center Hospital East, Kashiwa, Japan
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Abstract
Whereas spontaneous point mutation operates on nucleotides individually, sexual recombination manipulates the set of nucleotides within an allele as an essentially particulate unit. In principle, these two different scales of variation enable selection to follow fitness gradients in two different spaces: in nucleotide sequence space and allele sequence space respectively. Epistasis for fitness at these two scales, between nucleotides and between genes, may be qualitatively different and may significantly influence the advantage of mutation-based and recombination-based evolutionary trajectories respectively. We examine scenarios where the genetic sequence within a gene strongly influences the fitness effect of a mutation in that gene, whereas epistatic interactions between sites in different genes are weak or absent. We find that, in cases where beneficial alleles of a gene differ from one another at several nucleotide sites, sexual populations can exhibit enormous benefit compared with asexual populations: not only discovering fit genotypes faster than asexual populations, but also discovering high-fitness genotypes that are effectively not evolvable in asexual populations.
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Affiliation(s)
- R A Watson
- Natural Systems Group, School of Electronics and Computer Science, Southampton University, Southampton, UK.
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Elaraj DM, Weinreich DM, Varghese S, Puhlmann M, Hewitt SM, Carroll NM, Feldman ED, Turner EM, Alexander HR. The role of interleukin 1 in growth and metastasis of human cancer xenografts. Clin Cancer Res 2006; 12:1088-96. [PMID: 16489061 DOI: 10.1158/1078-0432.ccr-05-1603] [Citation(s) in RCA: 222] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Interleukin 1 (IL-1) is a pluripotent cytokine that promotes angiogenesis, tumor growth, and metastasis in experimental models; its presence in some human cancers is associated with aggressive tumor biology. The purpose of these studies was to characterize the role of IL-1 in human cancers and determine if inhibition of IL-1 via its receptor antagonist, IL-1Ra, alters tumor growth and metastatic potential. METHODS IL-1 mRNA or protein levels were determined in clinical tumor samples, cancer cell lines, and xenografts using quantitative reverse transcription-PCR or ELISA. Biological activity of tumor-derived IL-1 protein was shown via induction of permeability across endothelial cell monolayers. The effects of recombinant IL-1Ra on tumor lines in culture (cell proliferation and IL-8 secretion) and in xenograft models (tumor growth, metastatic potential, and intratumoral levels of IL-8 and VEGF) were characterized. The effects of IL-1Ra-mediated regression of xenograft growth on angiogenic proteins (IL-8 and VEGF) were evaluated in an IL-1-producing melanoma (SMEL) xenograft model. RESULTS IL-1 mRNA was highly expressed in more than half of all tested metastatic human tumor specimens including non-small-cell lung carcinoma, colorectal adenocarcinoma, and melanoma tumor samples. Constitutive IL-1 mRNA expression was identified in several cancer cell lines; tumor supernatant from these cell lines produced a significant increase in endothelial cell monolayer permeability, a hallmark event in early angiogenesis, in an IL-1-dependent manner. Moreover, systemic recombinant IL-1Ra resulted in significant inhibition of xenograft growth and neovessel density of IL-1-producing, but not non-IL-1-producing, tumor cell lines. Subsequent analysis of SMEL, a melanoma cell line with constitutive IL-1 production, showed that neither exogenous IL-1 nor IL-1Ra altered tumor cell proliferation rates in vitro. Gene expression analyses of IL-1Ra-treated SMEL xenografts showed a >3-fold down-regulation of 100 genes compared with control including a marked down-regulation of IL-8 and VEGF. CONCLUSIONS These data show that the IL-1 gene is frequently expressed in metastases from patients with several types of human cancers. IL-1Ra inhibits xenograft growth in IL-1-producing tumors but has no direct antiproliferative effects in vitro; decreased tumor levels of IL-8 and VEGF may be an early surrogate of IL-1Ra-mediated antitumor activity. IL-1Ra may have a role alone or with other agents in the treatment of human cancers.
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MESH Headings
- Animals
- Cell Line, Tumor
- Cell Membrane Permeability/drug effects
- Cell Proliferation/drug effects
- Cells, Cultured
- Dose-Response Relationship, Drug
- Endothelial Cells/drug effects
- Endothelial Cells/physiology
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Interleukin 1 Receptor Antagonist Protein
- Interleukin-1/genetics
- Interleukin-1/pharmacology
- Interleukin-1/physiology
- Interleukin-8/biosynthesis
- Melanoma, Experimental/drug therapy
- Melanoma, Experimental/genetics
- Melanoma, Experimental/metabolism
- Mice
- Mice, Nude
- Neoplasm Metastasis/prevention & control
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Sialoglycoproteins/metabolism
- Sialoglycoproteins/pharmacology
- Time Factors
- Vascular Endothelial Growth Factor A/biosynthesis
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Dina M Elaraj
- Surgical Metabolism Section, Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland 20892-1201, USA
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Feldman ED, Weinreich DM, Carroll NM, Burness ML, Feldman AL, Turner E, Xu H, Alexander HR. Interferon gamma-inducible protein 10 selectively inhibits proliferation and induces apoptosis in endothelial cells. Ann Surg Oncol 2006; 13:125-33. [PMID: 16378159 DOI: 10.1245/aso.2006.03.038] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Accepted: 08/02/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Interferon gamma-inducible protein 10 (IP-10) has antitumor effects in various murine models. The IP-10 receptor has two distinct splice variants, CXCR3A and CXCR3B, that have paradoxical effects after ligand-receptor interaction. METHODS To characterize the putative antiangiogenic effects of IP-10, we measured proliferation rates and apoptosis in human umbilical vein endothelial cells (HUVECs), fibroblasts, and A375 melanoma or WIDR adenocarcinoma cell lines after exposure to the recombinant protein. CXCR3A (activating) and CXCR3B (inhibitory/proapoptotic) messenger RNA (mRNA) expression levels in fibroblasts, 2 human tumor cell lines, T lymphocytes, and HUVECs of varying cell densities were characterized. RESULTS IP-10 resulted in dose-dependent and selective inhibition of proliferation and countered the proliferative effects of vascular endothelial growth factor in HUVECs but did not affect fibroblasts or 2 human tumor cell lines. In addition, IP-10 resulted in potent and selective induction of apoptosis in HUVECS but had no effect on fibroblasts or A375 melanoma. Confluent HUVECs had a predominance of mRNA for the CXCR3B splice variant by reverse transcriptase-polymerase chain reaction, and the ratio of CXCR3B to CXCR3A mRNA was >40 in HUVECs, compared with </=10 in the other cell types. Moreover, CXCR3B mRNA levels were significantly higher in proliferating compared with confluent HUVECs. In vivo, systemic IP-10 administration resulted in slower A375 xenograft growth rates compared with control-treated animals, and immunohistochemical staining showed decreased microvessel density in xenografts of IP-10-treated mice. CONCLUSIONS IP-10 has antiangiogenic properties and selective effects on endothelial tissue that may be secondary to higher levels of the CXCR3B inhibitory/proapoptotic receptor in that cell type, particularly in its actively proliferating state.
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Affiliation(s)
- Elizabeth D Feldman
- Surgical Metabolism Section, Surgery Branch, National Cancer Institute, National Institutes of Health, Building 10, Room 2B07, Bethesda, Maryland 20892-1502, USA
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Puhlmann M, Weinreich DM, Farma JM, Carroll NM, Turner EM, Alexander HR. Interleukin-1beta induced vascular permeability is dependent on induction of endothelial tissue factor (TF) activity. J Transl Med 2005; 3:37. [PMID: 16197553 PMCID: PMC1276820 DOI: 10.1186/1479-5876-3-37] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2005] [Accepted: 09/30/2005] [Indexed: 11/20/2022] Open
Abstract
IL-1β is a pleotropic cytokine that may mediate increased procoagulant activity and permeability in endothelial tissue during inflammatory conditions. The procoagulant effects of IL-1β are mediated through induction of tissue factor (TF) but its alterations on vascular permeability are not well characterized. We found that IL-1β induced a rapid and dose-dependent increase in TF activity in human umbilical vein endothelial cells (ECs) under routine culture conditions. However, IL-1β caused a rapid and marked increase in permeability across confluent EC monolayers using a two-compartment in vitro model only in the presence of factor VIII-deficient plasma that was completely abrogated by neutralizing anti-TF antibody pre-treatment. In vitro permeability was associated with loss of EC surface expression of VE-cadherin and contraction of F-actin cytoskeletal elements that resulted in EC intercellular gap formation. These data demonstrate that IL-1β induces marked changes in permeability across activated endothelium via a TF dependent mechanism and suggest that modulation of TF activity may represent a strategy to treat various acute and chronic inflammatory conditions mediated by this cytokine.
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Affiliation(s)
- Markus Puhlmann
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - David M Weinreich
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Jeffrey M Farma
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Nancy M Carroll
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Ewa M Turner
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - H Richard Alexander
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, 20892, USA
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Carroll NM, Elaraj DM, Puhlmann M, Weinreich DM, Turner EM, Xu H, Alexander HR. Alterations in tumor necrosis factor-induced endothelial cell procoagulant activity by hyperthermia. Int J Cancer 2004; 111:457-62. [PMID: 15221977 DOI: 10.1002/ijc.20272] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
TNF is a cytokine with potent antitumor activity in murine models and when administered clinically via regional perfusion. There is substantial evidence that this antitumor activity depends in large part on TNF's procoagulant effect on tumor neovasculature, which is mediated by induction of endothelial cell tissue factor (TF), a component of the extrinsic clotting cascade. In regional perfusion of a cancer-bearing limb or organ, TNF is always administered under hyperthermic temperatures; however, little is known about the effect of hyperthermia on TNF-mediated procoagulant activity in endothelium. We examined the effects of hyperthermia on TNF-mediated procoagulant activity in human umbilical vein endothelial cells (HUVECs). HUVECs were exposed to TNF at normothermic (37 degrees C) and hyperthermic (41 degrees C) temperatures for 90 min, then assayed for clotting activity, TF protein production and mRNA production of TF and tissue factor pathway inhibitor-2 (TFPI-2), an endogenous inducible inhibitor of TF activity in HUVECs. TNF treatment at 41 degrees C significantly reduced clotting activity, TF protein and mRNA as well as TFPI-2 mRNA compared to treatment at 37 degrees C. These data show that hyperthermia significantly reduces the procoagulant effects of TNF on endothelial tissue compared to normothermia, which may have important clinical implications for the use of TNF in regional perfusion.
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Affiliation(s)
- Nancy M Carroll
- Surgical Metabolism Section, Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-1502, USA
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Weinreich DM, Elaraj DM, Puhlmann M, Hewitt SM, Carroll NM, Feldman ED, Turner EM, Spiess PJ, Alexander HR. Effect of interleukin 1 receptor antagonist gene transduction on human melanoma xenografts in nude mice. Cancer Res 2003; 63:5957-61. [PMID: 14522922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Interleukin (IL)-1 is a pleiotropic inflammatory cytokine that promotes angiogenesis and enhances tumor growth and metastases. We evaluated the effects of IL-1 receptor antagonist (IL-1ra) on tumor growth and metastases in human melanoma xenografts. We selected two human melanoma lines (SMEL and PMEL) with differential (high versus low, respectively) constitutive production of IL-1 by ELISA. The IL-1ra gene was isolated from monocyte RNA by PCR and retrovirally transduced into SMEL and PMEL. In vitro cell proliferation was evaluated using a WST-1 assay. Athymic nude mice received s.c. or i.v. injection with parental, vector-transduced, or IL-1ra-transduced melanoma cells, and tumor growth, lung metastases, and histology were characterized. IL-1 was produced by SMEL in vitro and ex vivo (117 and 67 pg/ml/10(6) cells/24 h, respectively), but not by PMEL (15 and 0 pg/ml/10(6) cells/24 h, respectively). Neither made IL-1ra natively. Gene-transduced cell lines secreted >1000 pg/ml/10(6) cells/24 h of IL-1ra by ELISA. In vitro proliferation of each parental cell line was comparable to the proliferation rate of each transduced cell line. IL-1ra-transduced SMEL (SMEL/IL-1ra) showed significantly slower tumor growth compared with null-transduced and parental cell lines (P < 0.001, ANOVA-Bonferroni/Dunn). There was no difference in growth rates between PMEL and IL-1ra-transduced PMEL (PMEL/IL-1ra). A mixing study of SMEL and SMEL/IL-1ra showed significant inhibition of tumor growth at various ratios (P < 0.001, ANOVA-Bonferroni/Dunn). There were significantly fewer lung metastases with SMEL/IL-1ra versus SMEL (P < 0.002). IL-1ra decreases in vivo growth and metastatic potential of a human melanoma xenograft that constitutively secretes IL-1. This effect may be exploitable using clinically available IL-1ra for the treatment of human cancers.
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Affiliation(s)
- David M Weinreich
- The Surgical Metabolism Section, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland 20892-1502, USA
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Abstract
Progressive growth of unresectable metastatic or primary malignancies confined to the liver is a significant clinical problem. Approximately 25% of patients with colorectal cancer will develop metastatic disease exclusively or largely confined to liver, the vast majority of which are not amenable to surgical resection. Despite aggressive systemic or regional chemotherapy, survival is only 12 to 18 months. More than 80% of patients with ocular melanoma develop liver metastases as the first site of recurrent disease, and death from hepatic disease progression typically occurs 2 to 7 months after diagnosis. In addition, the liver is also the preferred site of metastatic disease for gastrointestinal or pancreatic neuroendocrine tumors. A number of physiological and anatomic features of the liver make it an ideal organ for regionally directed therapy to allow dose intensification to the cancer-burdened area while reducing or eliminating unnecessary systemic toxicity. To that end, complete vascular isolation and perfusion of the liver using a recirculating extracorporeal circuit, also called isolated hepatic perfusion (IHP), has been under clinical evaluation at our institution and others. In this article, we review the current results with IHP and its potential utility in the treatment of patients with unresectable hepatic malignancies.
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Affiliation(s)
- David M Weinreich
- Metabolism Section, Surgery Branch, National Cancer Institute, Bethesda, MD 20892, USA
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