PHASE 3 TRIAL SHOWS REGEN-COV? (CASIRIVIMAB WITH IMDEVIMAB) ANTIBODY COCKTAIL REDUCED HOSPITALIZATION OR DEATH BY 70% IN NON-HOSPITALIZED COVID-19 PATIENTS

TABLE 1: Key Results from Phase 3 Outpatient Trial1-3 | ||||
1,200 mg IV | Placebo | 2,400 mg IV | Placebo | |
n=736 | n=748 | n=1,355 | n=1,341 | |
Patients with??1 COVID-19-related hospitalization or death through day 29 | ||||
Risk reduction | 70% (p=0.0024) | 71% (p<0.0001) | ||
# of patients with events | 7 (1.0%) | 24 (3.2%) | 18 (1.3%) | 62 (4.6%) |
Time to COVID-19 symptom resolution | ||||
Median (days) | 10 | 14 | 10 | 14 |
Median reduction (days) | 4 (p<0.0001) | 4 (p<0.0001) |
1. | Based on the modified Full Analysis Set population, which includes all randomized patients with a positive SARS-CoV-2 RT-qPCR test from nasopharyngeal swabs at randomization and ?1 risk factor for severe COVID-19. |
2. | The formal hierarchical analysis first evaluated the 2,400 mg dose vs. concurrent placebo and then evaluated the 1,200 mg dose vs. concurrent placebo. |
3. | Based on Phase 1/2 analyses showing that the 8,000 mg and 2,400 mg doses were indistinguishable, the Phase 3 protocol was amended to compare the 2,400 mg and 1,200 mg doses vs. placebo, and the 8,000 mg data were converted to a descriptive analysis. |
TABLE 2: Pseudovirus Neutralization Data for SARS-CoV-2 Variant Substitutions with casirivimab and imdevimab Together | ||
Lineage with Spike Protein Substitution | Key Substitutions Tested | Fold Reduction in Susceptibility |
B.1.1.7 (UK?origin) | N501Ya | no changec |
B.1.351 (South Africa?origin) | K417N, E484K, N501Yb | no changec |
P.1 (Brazil?origin) | K417T + E484K | no changec |
B.1.427/B.1.429 (California?origin) | L452R | no changec |
B.1.526 (New York?origin)d | E484K | no changec |
a. | Pseudovirus expressing the entire variant spike protein was tested. The following changes from wild-type spike protein are found in the variant: del69-70, del145, N501Y, A570D, D614G, P681H, T716I, S982A, D1118H. |
b. | Pseudovirus expressing the entire variant spike protein was tested. The following changes from wild-type spike protein are found in the variant: D80Y, D215Y, del241-243, K417N, E484K, N501Y, D614G, A701V. |
c. | No change: < 2-fold reduction in susceptibility. |
d. | Not all isolates of the?New York?lineage harbor the E484K substitution (as of February 2021). |
- REGEN-COV has not been approved, but has been authorized for emergency use by FDA
- This use is authorized only for the duration of the declaration that circumstances exist justifying the authorization of the emergency use under section 564(b)(1) of the Act, 21 U.S.C. ? 360bbb-3(b)(1), unless the authorization is terminated or revoked sooner
- Healthcare providers should review the?Fact Sheet for Healthcare Providers?for information on the authorized use of REGEN-COV and mandatory requirements of the EUA and must comply with the requirements of the EUA. The?FDA Letter of Authorization?is available for reference,?as well as the?Dear Healthcare Provider Letter?and?Patient Fact Sheet
- REGEN-COV (casirivimab with imdevimab) is not authorized for use in patients
- who are hospitalized due to COVID-19, OR
- who require oxygen therapy due to COVID-19, OR
- who require an increase in baseline oxygen flow rate due to COVID-19 in those on chronic oxygen therapy due to underlying non-COVID-19 related comorbidity
- Benefit of treatment with REGEN-COV has not been observed in patients hospitalized due to COVID-19. Monoclonal antibodies, such as REGEN-COV, may be associated with worse clinical outcomes when administered to hospitalized patients with COVID-19 requiring high flow oxygen or mechanical ventilation.
- Have a body mass index (BMI) =35
- Have chronic kidney disease
- Have diabetes
- Have immunosuppressive disease
- Are currently receiving immunosuppressive treatment
- Are =65 years of age
- Are =55 years of age AND have
- cardiovascular disease, OR
- hypertension, OR
- chronic obstructive pulmonary disease/other chronic respiratory disease.
- Are 12 ? 17 years of age AND have
- BMI =85th percentile for their age and gender based on?CDC?growth charts,?https://www.cdc.gov/growthcharts/clinical_charts.htm,OR
- sickle cell disease, OR
- congenital or acquired heart disease, OR
- neurodevelopmental disorders (e.g., cerebral palsy), OR
- a medical-related technological dependence, for example, tracheostomy, gastrostomy, or positive pressure ventilation (not related to COVID-19), OR
- asthma, reactive airway or other chronic respiratory disease that requires daily medication for control.
- Hypersensitivity Including Anaphylaxis and Infusion-Related Reactions:?There is a potential for serious hypersensitivity reaction, including anaphylaxis, with administration of REGEN-COV. If signs or symptoms of a clinically significant hypersensitivity reaction or anaphylaxis occur, immediately discontinue administration and initiate appropriate medications and/or supportive therapy. Infusion-related reactions have been observed with administration of REGEN-COV.
- Signs and symptoms of infusion related reactions may include?fever, difficulty breathing, reduced oxygen saturation, chills, nausea, arrythmia (e.g., atrial fibrillation, tachycardia, bradycardia), chest pain or discomfort, weakness, altered mental status, headache, bronchospasm, hypotension, hypertension, angioedema, throat irritation, rash including urticaria, pruritus, myalgia, dizziness, fatigue and diaphoresis. If an infusion-related reaction occurs, consider slowing or stopping the infusion and administer appropriate medications and/or supportive care.
- Clinical Worsening After REGEN-COV Administration: Clinical worsening of COVID-19 after administration of REGEN-COV has been reported and may include signs or symptoms of fever, hypoxia or increased respiratory difficulty, arrythmia (e.g., atrial fibrillation, tachycardia, bradycardia), fatigue, and altered mental status. Some of these events required hospitalization. It is not known if these events were related to REGEN-COV use or were due to progression of COVID-19.
- Limitations of Benefit and Potential for Risk in Patients with Severe COVID-19:?Benefit of treatment with REGEN-COV has not been observed in patients hospitalized due to COVID-19. Monoclonal antibodies, such as REGEN-COV, may be associated with worse clinical outcomes when administered to hospitalized patients with COVID-19 requiring high-flow oxygen or mechanical ventilation. Therefore, REGEN-COV is not authorized for use in patients who are hospitalized due to COVID-19, OR who require oxygen therapy due to COVID-19, OR who require an increase in baseline oxygen flow rate due to COVID-19 in those on chronic oxygen therapy due to underlying non-COVID-19 related comorbidity.
- Serious adverse events (SAEs) were reported in 4 (1.6%) patients in REGEN-COV 2,400 mg group, 2 (0.8%) patients in REGEN-COV 8,000 mg group and 6 (2.3%) patients in the placebo group. None of the SAEs were considered to be related to study drug. SAEs that were reported as Grade 3 or 4 adverse events were pneumonia, hyperglycemia, nausea and vomiting (2,400 mg REGEN-COV), intestinal obstruction and dyspnea (8,000 mg REGEN-COV) and COVID-19, pneumonia and hypoxia (placebo).?REGEN-COV is?not authorized at the 8,000 mg dose (4,000 mg casirivimab and 4,000 mg imdevimab).
- One anaphylactic reaction was reported in the clinical program. The event began within 1 hour of completion of the infusion, and required treatment including epinephrine. The event resolved. Infusion-related reactions, of Grade 2 or higher severity, were reported in 4 subjects (1.5%) in the 8,000 mg (4,000 mg casirivimab and 4,000 mg imdevimab) arm. These infusion-related reactions events were moderate in severity; and include pyrexia, chills, urticaria, pruritus, abdominal pain, and flushing. One infusion-related reaction (nausea) was reported in the placebo arm and none were reported in the 2,400 mg (1,200 mg casirivimab and 1,200 mg imdevimab) arm. In two subjects receiving the 8,000 mg dose of REGEN-COV, the infusion-related reactions (urticaria, pruritus, flushing, pyrexia, shortness of breath, chest tightness, nausea, vomiting) resulted in permanent discontinuation of the infusion. All events resolved.
- Pregnancy:?There is currently limited clinical experience in the use of REGEN-COV in COVID-19 patients who are pregnant. REGEN-COV therapy should be used during pregnancy only if the potential benefit justifies the potential risk for the mother and the fetus.
- Lactation:?There is currently no clinical experience in use of REGEN-COV in COVID-19 patients who are breastfeeding. The development and health benefits of breastfeeding should be considered along with the mother's clinical need for REGEN-COV and any potential adverse effects on the breastfed child from REGEN-COV or from the underlying maternal condition.