COVID-19 Update #69 for 2/19/2021

COVID-19 Vaccines
 
The World Health Organization (WHO) has endorsed the AstraZeneca COVID-19 vaccine and recommends two doses, given eight to 12 weeks apart.
 
Researchers from Pfizer, BioNTech and the University of Texas evaluated the ability of COVID-19 antibodies from 20 serum samples obtained from 15 participants in the pivotal Phase III BNT162b2 trial (NCT04368728) to neutralize the South African SARS-CoV-2 variant (B.1.351 lineage). The serum samples neutralized the original SARS-CoV-2 virus and all mutant viruses tested at titers of 1:40 or greater. The serum samples were about two-thirds weaker in neutralizing the B.1.351 lineage. The researchers concluded that it was unknown how this reduction would affect immunity.
 
Researches from Moderna and National Institute of Allergy and Infectious Diseases evaluated the ability of COVID-19 antibodies from participants in a Phase I mRNA-1273 trial (NCT04283461), to neutralize pseudovirus designed to mimic the original virus, the United Kingdom SARS-CoV-2 variant (B.1.1.7 lineage) and the South African SARS-CoV-2 variant (B.1.351 lineage). There was no decrease in neutralization of the B.1.1.7 lineage compared to neutralization of the original SARS-CoV-2 virus, but a decrease was seen with the B.1.351 lineage. The researchers concluded that it was unknown how this reduction would affect immunity.
 
COVID-19 Anti-inflammatories
 
The 15,000 patient RECOVERY trial (NCT04381936) has several arms testing lopinavir-ritonavir, dexamethasone, hydroxychloroquine, azithromycin, tocilizumab, convalescent plasma, immunoglobulin (IVIG) and the monoclonal antibody combination REGN-COV2. British researchers reported that mortality was 29% in 2,022 patients that received tocilizumab, compared to 33% that received usual care in COVID-19 patients who required oxygen and had evidence of inflammation. 82% of patients in the trial received dexamethasone. Treatment with tocilizumab also resulted in being discharged alive at 28 days (54% vs 47%). The researchers concluded that adding tocilizumab to dexamethasone reduced the risk of death in COVID-19 patients with hypoxia and significant inflammation.
 
COVID-19 Antivirals
 
In an update, the American College of Physician recommend that remdesivir should not be initiated in hospitalized COVID-19 patients receiving mechanical ventilation or extracorporeal membrane oxygenation (ECMO) because the infection has likely progressed to the inflammatory stage of the disease. ACP recommends consideration of remdesivir for five days in hospitalized patients that do not require ventilation or ECMO. Remdesivir may be given for up to ten days 10 days in patients that progress to mechanical ventilation or ECMO that had already started the drug.
 
Vitamin D has been suggested as having immunomodulatory and anti-inflammatory properties, so Brazilian researchers evaluated, whether a single dose would have a beneficial effect on patients with COVID-19. 

• In a 237 patient Brazilian trial (NCT04449718), treatment with a single dose of vitamin D3 200 000 IU did not reduce length of stay, mortality, ICU admission or mechanical ventilation compared to placebo in patients with COVID-19.​
  

Vidofludimus (IMU-838) is a dihydroorotate dehydrogenase (DHODH) inhibitor being developed by Immunic Therapeutics for the treatment of multiple sclerosis, inflammatory bowel disease and sclerosing cholangitis. DHODH inhibitors have host-based antiviral effects that are independent to specific virus proteins and their structure. Since the anti-viral properties may be applicable to many viruses, Immunics is evaluating vidofludimus as a treatment for COVID-19.

• Immunic announced interim data from 204 patients enrolled in the 28-day, 204 patient, Phase II CALVID-1 trial (NCT04379271), where treatment with vidofludimus did not reduce the need for invasive ventilation compared to placebo in hospitalized patients with moderate COVID-19. Investigators report the rate of ventilation was only 1%, which was lower than seen earlier in the pandemic. Clinical recovery and time to clinical improvement were improved with vidofludimus. Immics plans to announce the full results of the CALVID-1 trial in 2Q21.