Is it safe and beneficial to administer a second immunomodulator in patients with moderate COVID-19? How do we identify which patients are likely to progress to severe disease?
At the recent IDWeek 2022 conference, Emily Ko, MD, PhD, described her work to identify effective COVID-19 treatments for patients who fall somewhere in between mild and severe infection.
Ko explained that we know immunomodulators help patients with severe disease, but there is a research gap in the efficacy of immunomodulators for moderate COVID-19 infection. “I think the question, from a physician standpoint,” said Ko, “is really who is most likely to benefit.”
Ko and her team chose to examine the immunomodulators abatacept and infliximab “because of the unique mechanisms of action that had not been previously studied.” They were investigated alongside standard-of-care, including remdesivir and corticosteroids.
Is there a benefit for administering an early second immunomodulator in patients with moderate COVID-19? “Our results suggest that there is,” said Ko.
Some of these patients get better on their own, so the intervention is unnecessary. Ko is working on a risk-benefit analysis to understand which patients are likely to progress to severe disease and could potentially benefit from an early second immunomodulator.
The trial, “ACTIV-1,” was part of the Accelerating Therapeutics Interventions and Vaccines program. The initiative was developed at the beginning of the pandemic to encourage collaboration between public and private sectors, with oversight from the National Center for Advancing Translational sciences.
When asked about anything that surprised her during the course of this study, Ko said she was struck by how the trial participants were so willing to help. “Patients were just so thankful and willing to join us in trying to find new therapies, and I would always tell them, ‘We don’t know if this works, we’re just trying to find something that does.’”
Despite Ko’s disclaimer, “Universally, they said, ‘I want this to help somebody else,’ which was really refreshing, and I don’t think I’d encountered that in clinical trials work before.”
Ko’s talk, “Administration of abatacept or infliximab reduces mortality in hospitalized patients with COVID pneumonia,” was delivered at th IDWeek 2022 conference, held October 19-23 in Washington, D.C.