New drug could treat patients hospitalised with COVID-19 pneumonia: Lancet study

A newly identified drug may be used to effectively treat some patients hospitalised with COVID-19 pneumonia, according to a study published in The Lancet Respiratory Medicine journal. The team, including researchers from the University of Birmingham and the University of Oxford, UK, tested namilumab — an antibody already in late-stage trials to treat rheumatoid arthritis — in patients hospitalised with COVID-19 pneumonia.

The patients were receiving ‘usual’ care, as well as having high levels in their blood of a marker of inflammation known as C reactive protein (CRP).

CRP levels rise when there is inflammation in the body, and elevated levels of CRP have been found to be a potential early marker to predict risk for severity of COVID-19, the researchers said.

“Our research has provided important proof-of-concept evidence that namilumab reduces inflammation in hospitalised patients with COVID-19 pneumonia,” said Ben Fisher, co-chief investigator of the trial at the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust (UHB).

“However, our sample size is too small for a definitive assessment of clinical outcomes and further studies are required for this, as well as to understand better the population that may benefit most,” Fisher said.

Namilumab targets a ‘cytokine’ which is naturally secreted by immune cells in the body, but in uncontrolled levels is believed to be a key driver of the excessive and dangerous lung inflammation seen in COVID-19 patients.

The trial carried out between June 2020 and February 2021 involved patients aged over 16 with COVID-19 pneumonia either being treated on a ward or Intensive Care Unit (ICU) at nine hospitals across the UK.

The study involved 54 patients receiving ‘usual care’ — treatment with steroids and oxygen or ventilation — and 57 patients given usual care as well as a single intravenous dose of 150mg of namilumab. As well as COVID-19 pneumonia, all study participants had CRP levels greater than 40mg/l.

The researchers compared the probability of the reduction of levels of CRP in patients. Compared to usual care alone, the researchers found that there was a 97 per cent probability of CRP being reduced over time in those given namilumab when compared with usual care alone.

The patients were monitored, and after 28 days the study also showed there were fewer deaths and more discharges from hospital or ICU in those who had been given namilumab compared to those receiving usual care alone. By day 28, 78 per cent of the patients receiving namilumab were discharged from hospital or ICU, compared to 61 per cent given usual care.

In the namilumab group, 11 per cent were still in hospital by day 28, compared to 20 per cent in the usual care group, according to the researchers. Of those in the namilumab group, 11 per cent patients died compared to 19 per cent who died in the usual care group by day 28, they said.

The team calculated the differences between the two groups in overall probability of those being discharged from ICU or a ward at 28 days. Of those on a ward, the probability of discharge at day 28 was 64 per cent in the usual care group, compared to 77 per cent in the namilumab cohort.

Of those in ICU, probability of discharge at day 28 was 47 per cent in the usual care group, compared to 66 per cent in the namilumab cohort, according to the study.

The researchers noted that the study results may not generalise to hospitalised patients without evidence of pneumonia or raised CRP or patients not requiring hospitalisation. It is important, therefore, that namilumab is now prioritised for further COVID-19 research in a much larger phase 3 clinical trial, they added.