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Lu H, Zhang G, Mao J, Chen X, Zhan Y, Lin L, Zhang T, Tang Y, Lin F, Zhu F, Lin Y, Zeng Y, Zhang K, Yuan W, Liang Z, Sun R, Huo L, Hu P, Lin Y, Zhuang X, Wei Z, Chen X, Yan W, Yan X, Mu L, Lin Z, Tu X, Tan H, Huang F, Hu Z, Li H, Li G, Fu H, Yang Z, Chen X, Wang FS, Zhong N. Efficacy and safety of GST-HG171 in adult patients with mild to moderate COVID-19: a randomised, double-blind, placebo-controlled phase 2/3 trial. EClinicalMedicine 2024; 71:102582. [PMID: 38618202 PMCID: PMC11015484 DOI: 10.1016/j.eclinm.2024.102582] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 04/16/2024] Open
Abstract
Background GST-HG171 is a potent, broad-spectrum, orally bioavailable small-molecule 3C like protease inhibitor that has demonstrated greater potency and efficacy compared to Nirmatrelvir in pre-clinical studies. We aimed to evaluate the efficacy and safety of orally administered GST-HG171 plus Ritonavir in patients with coronavirus disease 2019 (COVID-19) infected with emerging XBB and non-XBB variants. Methods This randomised, double-blind, placebo-controlled phase 2/3 trial was conducted in 47 sites in China among adult patients with mild-to-moderate COVID-19 with symptoms onset ≤72 h. Eligible patients were randomised 1:1 to receive GST-HG171 (150 mg) plus Ritonavir (100 mg) or corresponding placebo tablets twice daily for 5 days, with stratification factors including the risk level of disease progression and vaccination status. The primary efficacy endpoint was time to sustained recovery of clinical symptoms within 28 days, defined as a score of 0 for 11 COVID-19-related target symptoms for 2 consecutive days, assessed in the modified intention-to-treat (mITT) population. This trial was registered at ClinicalTrials.gov (NCT05656443) and Chinese Clinical Trial Registry (ChiCTR2200067088). Findings Between Dec 19, 2022, and May 4, 2023, 1525 patients were screened. Among 1246 patients who underwent randomisation, most completed basic (21.2%) or booster (74.9%) COVID-19 immunization, and most had a low risk of disease progression at baseline. 610 of 617 who received GST-HG171 plus Ritonavir and 603 of 610 who received placebo were included in the mITT population. Patients who received GST-HG171 plus Ritonavir showed shortened median time to sustained recovery of clinical symptoms compared to the placebo group (13.0 days [95.45% confidence interval 12.0-15.0] vs. 15.0 days [14.0-15.0], P = 0.031). Consistent results were observed in both SARS-CoV-2 XBB (45.7%, 481/1053 of mITT population) and non-XBB variants (54.3%, 572/1053 of mITT population) subgroups. Incidence of adverse events was similar in the GST-HG171 plus Ritonavir (320/617, 51.9%) and placebo group (298/610, 48.9%). The most common adverse events in both placebo and treatment groups were hypertriglyceridaemia (10.0% vs. 14.7%). No deaths occurred. Interpretation Treatment with GST-HG171 plus Ritonavir has demonstrated benefits in symptom recovery and viral clearance among low-risk vaccinated adult patients with COVID-19, without apparent safety concerns. As most patients were treated within 2 days after symptom onset in our study, confirming the potential benefits of symptom recovery for patients with a longer duration between symptom onset and treatment initiation will require real-world studies. Funding Fujian Akeylink Biotechnology Co., Ltd.
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Affiliation(s)
- Hongzhou Lu
- The Third People's Hospital of Shenzhen, Shenzhen, China
- National Clinical Research Center for Infectious Diseases, Shenzhen, China
| | - George Zhang
- Fujian Akeylink Biotechnology Co., Ltd., Shanghai, China
| | - John Mao
- Fujian Akeylink Biotechnology Co., Ltd., Shanghai, China
| | | | - Yangqing Zhan
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Ling Lin
- Sanya Central Hospital (The Third People's Hospital of Hainan Province), Sanya, China
| | | | - Yanan Tang
- Fujian Akeylink Biotechnology Co., Ltd., Shanghai, China
| | - Feng Lin
- Hainan General Hospital, Haikou, China
| | | | - Yuanlong Lin
- The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Yiming Zeng
- Fujian Medical University 2nd Affiliated Hospital, Fuzhou, China
| | - Kaiyu Zhang
- The First Hospital of Jilin University, Changchun, China
| | - Wenfang Yuan
- Shijiazhuang Fifth Hospital, Shijiazhuang, China
| | - Zhenyu Liang
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Ruilin Sun
- Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Liya Huo
- Nanyang Central Hospital, Nanyang, China
| | - Peng Hu
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yihua Lin
- The First Affiliated Hospital of Xiamen University, Xiamen, China
| | | | | | | | - Wenhao Yan
- Fujian Akeylink Biotechnology Co., Ltd., Shanghai, China
| | - Xiuping Yan
- Fujian Akeylink Biotechnology Co., Ltd., Shanghai, China
| | | | | | | | - Hongshan Tan
- Fujian Akeylink Biotechnology Co., Ltd., Shanghai, China
| | - Fuhu Huang
- Fujian Cosunter Pharmaceutical Co., Ltd., Fuzhou, China
| | - Zhiqiang Hu
- Fujian Cosunter Pharmaceutical Co., Ltd., Fuzhou, China
| | - Hongming Li
- Fujian Cosunter Pharmaceutical Co., Ltd., Fuzhou, China
| | - Guoping Li
- Fujian Cosunter Pharmaceutical Co., Ltd., Fuzhou, China
| | - Haijun Fu
- Shanghai Zenith Medical Research Co., Ltd., Shanghai, China
| | - Zifeng Yang
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Xinwen Chen
- Guangzhou National Laboratory, Guangdong Province, China
| | - Fu-Sheng Wang
- The Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, China
| | - Nanshan Zhong
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
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Zhang X, Guan L, Li N, Wang Y, Li L, Liu M, He Q, Lu J, Zeng H, Yu S, Guo X, Gong J, Li J, Gao F, Wu X, Chen S, Wang Q, Wang Z, Huang W, Mao Q, Liang Z, Xu M. Establishment of the First National Standard for Neutralizing Antibodies against SARS-CoV-2 XBB Variants. Viruses 2024; 16:554. [PMID: 38675896 PMCID: PMC11053542 DOI: 10.3390/v16040554] [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: 03/16/2024] [Revised: 03/29/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
Neutralizing antibodies (NtAbs) against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are indicators of vaccine efficacy that enable immunity surveillance. However, the rapid mutation of SARS-CoV-2 variants prevents the timely establishment of standards required for effective XBB vaccine evaluation. Therefore, we prepared four candidate standards (No. 11, No. 44, No. 22, and No. 33) using plasma, purified immunoglobulin, and a broad-spectrum neutralizing monoclonal antibody. Collaborative calibration was conducted across nine Chinese laboratories using neutralization methods against 11 strains containing the XBB and BA.2.86 sublineages. This study demonstrated the reduced neutralization potency of the first International Standard antibodies to SARS-CoV-2 variants of concern against XBB variants. No. 44 displayed broad-spectrum neutralizing activity against XBB sublineages, effectively reduced interlaboratory variability for nearly all XBB variants, and effectively minimized the geometric mean titer (GMT) difference between the live and pseudotyped virus. No. 22 showed a broader spectrum and higher neutralizing activity against all strains but failed to reduce interlaboratory variability. Thus, No. 44 was approved as a National Standard for NtAbs against XBB variants, providing a unified NtAb measurement standard for XBB variants for the first time. Moreover, No. 22 was approved as a national reference reagent for NtAbs against SARS-CoV-2, offering a broad-spectrum activity reference for current and potentially emerging variants.
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Affiliation(s)
- Xuanxuan Zhang
- Institute of Biological Products, National Institutes for Food and Drug Control, NHC Key Laboratory of Research on Quality and Standardization of Biotech Products, State Key Laboratory of Drug Regulatory Science, Beijing 102629, China; (X.Z.); (L.G.); (Y.W.); (L.L.); (M.L.); (Q.H.); (F.G.); (X.W.); (W.H.)
| | - Lidong Guan
- Institute of Biological Products, National Institutes for Food and Drug Control, NHC Key Laboratory of Research on Quality and Standardization of Biotech Products, State Key Laboratory of Drug Regulatory Science, Beijing 102629, China; (X.Z.); (L.G.); (Y.W.); (L.L.); (M.L.); (Q.H.); (F.G.); (X.W.); (W.H.)
| | - Na Li
- Beijing Minhai Biotechnology Co., Ltd., Beijing 102600, China;
| | - Ying Wang
- Institute of Biological Products, National Institutes for Food and Drug Control, NHC Key Laboratory of Research on Quality and Standardization of Biotech Products, State Key Laboratory of Drug Regulatory Science, Beijing 102629, China; (X.Z.); (L.G.); (Y.W.); (L.L.); (M.L.); (Q.H.); (F.G.); (X.W.); (W.H.)
| | - Lu Li
- Institute of Biological Products, National Institutes for Food and Drug Control, NHC Key Laboratory of Research on Quality and Standardization of Biotech Products, State Key Laboratory of Drug Regulatory Science, Beijing 102629, China; (X.Z.); (L.G.); (Y.W.); (L.L.); (M.L.); (Q.H.); (F.G.); (X.W.); (W.H.)
| | - Mingchen Liu
- Institute of Biological Products, National Institutes for Food and Drug Control, NHC Key Laboratory of Research on Quality and Standardization of Biotech Products, State Key Laboratory of Drug Regulatory Science, Beijing 102629, China; (X.Z.); (L.G.); (Y.W.); (L.L.); (M.L.); (Q.H.); (F.G.); (X.W.); (W.H.)
| | - Qian He
- Institute of Biological Products, National Institutes for Food and Drug Control, NHC Key Laboratory of Research on Quality and Standardization of Biotech Products, State Key Laboratory of Drug Regulatory Science, Beijing 102629, China; (X.Z.); (L.G.); (Y.W.); (L.L.); (M.L.); (Q.H.); (F.G.); (X.W.); (W.H.)
| | - Jiansheng Lu
- Yunnan Institute for Food and Drug Control, Kunming 650106, China; (J.L.); (H.Z.)
| | - Haiyuan Zeng
- Yunnan Institute for Food and Drug Control, Kunming 650106, China; (J.L.); (H.Z.)
| | - Shan Yu
- Jiangsu Institute for Food and Drug Control, Nanjing 210019, China;
| | - Xinyi Guo
- Hualan Biological Engineering Chongqing Co., Ltd., Chongqing 408107, China;
| | - Jiali Gong
- China Resources Boya Bio-Pharmaceutical Group Co., Ltd., Fuzhou 344000, China;
| | - Jing Li
- Beijing Kexing Zhongwei Biotechnology Co., Ltd., Beijing 102600, China;
| | - Fan Gao
- Institute of Biological Products, National Institutes for Food and Drug Control, NHC Key Laboratory of Research on Quality and Standardization of Biotech Products, State Key Laboratory of Drug Regulatory Science, Beijing 102629, China; (X.Z.); (L.G.); (Y.W.); (L.L.); (M.L.); (Q.H.); (F.G.); (X.W.); (W.H.)
| | - Xing Wu
- Institute of Biological Products, National Institutes for Food and Drug Control, NHC Key Laboratory of Research on Quality and Standardization of Biotech Products, State Key Laboratory of Drug Regulatory Science, Beijing 102629, China; (X.Z.); (L.G.); (Y.W.); (L.L.); (M.L.); (Q.H.); (F.G.); (X.W.); (W.H.)
| | - Si Chen
- Drug and Vaccine Research Center, Guangzhou National Laboratory, Guangzhou 510535, China; (S.C.); (Q.W.); (Z.W.)
| | - Qian Wang
- Drug and Vaccine Research Center, Guangzhou National Laboratory, Guangzhou 510535, China; (S.C.); (Q.W.); (Z.W.)
| | - Zhongfang Wang
- Drug and Vaccine Research Center, Guangzhou National Laboratory, Guangzhou 510535, China; (S.C.); (Q.W.); (Z.W.)
| | - Weijin Huang
- Institute of Biological Products, National Institutes for Food and Drug Control, NHC Key Laboratory of Research on Quality and Standardization of Biotech Products, State Key Laboratory of Drug Regulatory Science, Beijing 102629, China; (X.Z.); (L.G.); (Y.W.); (L.L.); (M.L.); (Q.H.); (F.G.); (X.W.); (W.H.)
| | - Qunying Mao
- Institute of Biological Products, National Institutes for Food and Drug Control, NHC Key Laboratory of Research on Quality and Standardization of Biotech Products, State Key Laboratory of Drug Regulatory Science, Beijing 102629, China; (X.Z.); (L.G.); (Y.W.); (L.L.); (M.L.); (Q.H.); (F.G.); (X.W.); (W.H.)
| | - Zhenglun Liang
- Institute of Biological Products, National Institutes for Food and Drug Control, NHC Key Laboratory of Research on Quality and Standardization of Biotech Products, State Key Laboratory of Drug Regulatory Science, Beijing 102629, China; (X.Z.); (L.G.); (Y.W.); (L.L.); (M.L.); (Q.H.); (F.G.); (X.W.); (W.H.)
| | - Miao Xu
- Institute of Biological Products, National Institutes for Food and Drug Control, NHC Key Laboratory of Research on Quality and Standardization of Biotech Products, State Key Laboratory of Drug Regulatory Science, Beijing 102629, China; (X.Z.); (L.G.); (Y.W.); (L.L.); (M.L.); (Q.H.); (F.G.); (X.W.); (W.H.)
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Selvavinayagam ST, Karishma SJ, Hemashree K, Yong YK, Suvaithenamudhan S, Rajeshkumar M, Aswathy B, Kalaivani V, Priyanka J, Kumaresan A, Kannan M, Gopalan N, Chandramathi S, Vignesh R, Murugesan A, Anshad AR, Ganesh B, Joseph N, Babu H, Govindaraj S, Larsson M, Kandasamy SL, Palani S, Singh K, Byrareddy SN, Velu V, Shankar EM, Raju S. Clinical characteristics and novel mutations of omicron subvariant XBB in Tamil Nadu, India - a cohort study. Lancet Reg Health Southeast Asia 2023; 19:100272. [PMID: 38076717 PMCID: PMC10709680 DOI: 10.1016/j.lansea.2023.100272] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/13/2023] [Accepted: 08/20/2023] [Indexed: 04/14/2024]
Abstract
BACKGROUND Despite the continued vaccination efforts, there had been a surge in breakthrough infections, and the emergence of the B.1.1.529 omicron variant of SARS-CoV-2 in India. There is a paucity of information globally on the role of newer XBB variants in community transmission. Here, we investigated the mutational patterns among hospitalised patients infected with the XBB omicron sub-variant, and checked if there was any association between the rise in the number of COVID-19 cases and the observed novel mutations in Tamil Nadu, India. METHODS Nasopharyngeal and oropharyngeal swabs, collected from symptomatic and asymptomatic COVID-19 patients were subjected to real-time PCR followed by Next Generation Sequencing (NGS) to rule out the ambiguity of mutations in viruses isolated from the patients (n = 98). Using the phylogenetic association, the mutational patterns were used to corroborate clinico-demographic characteristics and disease severity among the patients. FINDINGS Overall, we identified 43 mutations in the S gene across 98 sequences, of which two were novel mutations (A27S and T747I) that have not been reported previously with XBB sub-variants in the available literature. Additionally, the XBB sequences from our cohort had more mutations than omicron B.1.1.529. The phylogenetic analysis comprising six major branches clearly showed convergent evolution of XBB. Our data suggests that age, and underlying conditions (e.g., diabetes, hypertension, and cardiovascular disease) or secondary complications confers increased susceptibility to infection rather than vaccination status or prior exposure. Many vaccinated individuals showed evidence of a breakthrough infection, with XBB.3 being the predominant variant identified in the study population. INTERPRETATION Our study indicates that the XBB variant is highly evasive from available vaccines and may be more transmissible, and potentially could emerge as the 'next' predominant variant, which likely could overwhelm the existing variants of SARS-CoV-2 omicron variants. FUNDING National Health Mission (India), SIDASARC, VINNMER (Sweden), ORIP/NIH (USA).
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Affiliation(s)
- Sivaprakasam T. Selvavinayagam
- State Public Health Laboratory, Directorate of Public Health and Preventive Medicine, DMS Campus, Teynampet, Chennai, Tamil Nadu 600 006, India
| | - Sree J. Karishma
- Infection and Inflammation, Department of Biotechnology, Central University of Tamil Nadu, Thiruvarur 610 005, India
| | - Kannan Hemashree
- State Public Health Laboratory, Directorate of Public Health and Preventive Medicine, DMS Campus, Teynampet, Chennai, Tamil Nadu 600 006, India
| | - Yean K. Yong
- Laboratory Centre, Xiamen University Malaysia, Sepang, Selangor 43 900, Malaysia
| | - Suvaiyarasan Suvaithenamudhan
- Infection and Inflammation, Department of Biotechnology, Central University of Tamil Nadu, Thiruvarur 610 005, India
- Department of Bioinformatics, Bishop Heber College, Tiruchirappalli, Tamil Nadu 620 017, India
| | - Manivannan Rajeshkumar
- State Public Health Laboratory, Directorate of Public Health and Preventive Medicine, DMS Campus, Teynampet, Chennai, Tamil Nadu 600 006, India
| | - Bijulal Aswathy
- Infection and Inflammation, Department of Biotechnology, Central University of Tamil Nadu, Thiruvarur 610 005, India
| | - Vasudevan Kalaivani
- State Public Health Laboratory, Directorate of Public Health and Preventive Medicine, DMS Campus, Teynampet, Chennai, Tamil Nadu 600 006, India
| | - Jayapal Priyanka
- State Public Health Laboratory, Directorate of Public Health and Preventive Medicine, DMS Campus, Teynampet, Chennai, Tamil Nadu 600 006, India
| | - Anandhazhvar Kumaresan
- State Public Health Laboratory, Directorate of Public Health and Preventive Medicine, DMS Campus, Teynampet, Chennai, Tamil Nadu 600 006, India
| | - Meganathan Kannan
- Blood and Vascular Biology, Department of Biotechnology, Central University of Tamil Nadu, Thiruvarur 610 005, India
| | - Natarajan Gopalan
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur 610 005, India
| | - Samudi Chandramathi
- Department of Medical Microbiology, University of Malaya, Lembah Pantai, Kuala Lumpur 50603, Malaysia
| | - Ramachandran Vignesh
- Faculty of Medicine, Preclinical Department, Royal College of Medicine Perak, Universiti Kuala Lumpur, Ipoh, Perak 30450, Malaysia
| | - Amudhan Murugesan
- Department of Microbiology, The Government Theni Medical College and Hospital, Theni, India
| | - Abdul R. Anshad
- Infection and Inflammation, Department of Biotechnology, Central University of Tamil Nadu, Thiruvarur 610 005, India
| | - Balasubramanian Ganesh
- National Institute of Epidemiology, Indian Council of Medical Research, Ayappakkam, Chennai 600 077, India
| | - Narcisse Joseph
- Department of Medical Microbiology, Universiti Putra Malaysia, Kuala Lumpur, Malaysia
| | - Hemalatha Babu
- Division of Microbiology and Immunology, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory National Primate Research Center, Emory Vaccine Center, Atlanta, GA 30329, USA
| | - Sakthivel Govindaraj
- Division of Microbiology and Immunology, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory National Primate Research Center, Emory Vaccine Center, Atlanta, GA 30329, USA
| | - Marie Larsson
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, Sweden
| | - Shree L. Kandasamy
- Bond Life Sciences Center, Department of Veterinary Pathobiology, University of Missouri, Columbia, MO 65211, USA
| | - Sampath Palani
- State Public Health Laboratory, Directorate of Public Health and Preventive Medicine, DMS Campus, Teynampet, Chennai, Tamil Nadu 600 006, India
| | - Kamalendra Singh
- Bond Life Sciences Center, Department of Veterinary Pathobiology, University of Missouri, Columbia, MO 65211, USA
| | - Siddappa N. Byrareddy
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68131, USA
| | - Vijayakumar Velu
- Division of Microbiology and Immunology, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory National Primate Research Center, Emory Vaccine Center, Atlanta, GA 30329, USA
| | - Esaki M. Shankar
- Infection and Inflammation, Department of Biotechnology, Central University of Tamil Nadu, Thiruvarur 610 005, India
| | - Sivadoss Raju
- State Public Health Laboratory, Directorate of Public Health and Preventive Medicine, DMS Campus, Teynampet, Chennai, Tamil Nadu 600 006, India
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