A randomised phase 2a study to investigate the effects of blocking interleukin-33 with tozorakimab in patients hospitalised with COVID-19: Accord-2

Tom Wilkinson, Anthony De Soyza, Miles Carroll, James D Chalmers, Michael G Crooks, Gareth Griffiths, Manu Shankar-Hari, Ling-Pei Ho, Alex Horsley, Chris Kell, Beatriz Lara, Biswa Mishra, Rachel Moate, Clive Page, Hitesh Pandya, Jason Raw, Fred Reid, Dinesh Saralaya, Ian C Scott, Salman SiddiquiAndy Ustianowski, Natalie van Zuydam, Ashley Woodcock, Dave Singh

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

BACKGROUND: Increased serum interleukin (IL)-33 predicts poor outcomes in patients hospitalised with coronavirus disease 2019 (COVID-19). We examined the efficacy and safety of tozorakimab, a monoclonal antibody that neutralises IL-33, in improving outcomes in ACCORD-2 (EudraCT: 2020-001736-95).

METHODS: ACCORD-2 was an open-label, phase 2a study in adults hospitalised with COVID-19. Patients were randomised 1:1 to tozorakimab 300 mg plus standard of care (SoC) or SoC alone. The primary end-point was time to clinical response (sustained clinical improvement of ≥2 points on the World Health Organization ordinal scale, discharge from hospital or fit for discharge) by day 29. Other end-points included death or respiratory failure, mortality and intensive care unit admission by day 29, and safety. Serum IL-33/soluble stimulated-2 (sST2) complex levels were measured by high-sensitivity immunoassay.

RESULTS: Efficacy analyses included 97 patients (tozorakimab+SoC, n=53; SoC, n=44). Median time to clinical response did not differ between the tozorakimab and SoC arms (8.0 and 9.5 days, respectively; HR 0.96, 80% CI 0.70-1.31; one-sided p=0.33). Tozorakimab was well tolerated and the OR for risk of death or respiratory failure with treatment versus SoC was 0.55 (80% CI 0.27-1.12; p=0.26), while the OR was 0.31 (80% CI 0.09-1.06) in patents with high baseline serum IL-33/sST2 complex levels.

CONCLUSIONS: Overall, ACCORD-2 results suggest that tozorakimab could be a novel therapy for patients hospitalised with COVID-19, warranting further investigation in confirmatory phase 3 studies.

Original languageEnglish
Article number00249-2023
JournalERJ Open Research
Volume9
Issue number5
DOIs
Publication statusPublished - 2 Oct 2023

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