TY - JOUR
T1 - Dipeptidyl peptidase-1 inhibition in patients hospitalised with COVID-19
T2 - a multicentre, double-blind, randomised, parallel-group, placebo-controlled trial
AU - Keir, Holly R
AU - Long, Merete B
AU - Abo-Leyah, Hani
AU - Giam, Yan Hui
AU - Vadiveloo, Thenmalar
AU - Pembridge, Thomas
AU - Hull, Rebecca C
AU - Delgado, Lilia
AU - Band, Margaret
AU - McLaren-Neil, Fiona
AU - Adamson, Simon
AU - Lahnsteiner, Eva
AU - Gilmour, Amy
AU - Hughes, Chloe
AU - New, Benjamin JM
AU - Connell, David
AU - Dowey, Rebecca
AU - Turton, Helena
AU - Richardson, Hollian
AU - Cassidy, Diane
AU - Cooper, Jamie
AU - Suntharalingam, Jay
AU - Diwakar, Lavanya
AU - Russell, Peter
AU - Underwood, Jonathan
AU - Hicks, Alexander
AU - Dosanjh, Davinder Ps
AU - Sage, Beth
AU - Dhasmana, Devesh
AU - Spears, Mark
AU - Thompson, AA Roger
AU - Brightling, Christopher
AU - Smith, Andrew
AU - Patel, Manish
AU - George, Jacob
AU - Condliffe, Alison M
AU - Shoemark, Amelia
AU - MacLennan, Graeme
AU - Chalmers, James D
AU - STOP-COVID19 Investigators
N1 - This study was funded by an investigator-initiated research grant from Insmed (Bridgewater, NJ, USA).
The authors acknowledge the funding and logistical support from the UK National Institute for Health and Care Research.
PY - 2022/9/5
Y1 - 2022/9/5
N2 - Background: Neutrophil serine proteases are involved in the pathogenesis of COVID-19 and increased serine protease activity has been reported in severe and fatal infection. We investigated whether brensocatib, an inhibitor of dipeptidyl peptidase-1 (DPP-1; an enzyme responsible for the activation of neutrophil serine proteases), would improve outcomes in patients hospitalised with COVID-19.Methods: In a multicentre, double-blind, randomised, parallel-group, placebo-controlled trial, across 14 hospitals in the UK, patients aged 16 years and older who were hospitalised with COVID-19 and had at least one risk factor for severe disease were randomly assigned 1:1, within 96 h of hospital admission, to once-daily brensocatib 25 mg or placebo orally for 28 days. Patients were randomly assigned via a central web-based randomisation system (TruST). Randomisation was stratified by site and age (65 years or ≥65 years), and within each stratum, blocks were of random sizes of two, four, or six patients. Participants in both groups continued to receive other therapies required to manage their condition. Participants, study staff, and investigators were masked to the study assignment. The primary outcome was the 7-point WHO ordinal scale for clinical status at day 29 after random assignment. The intention-to-treat population included all patients who were randomly assigned and met the enrolment criteria. The safety population included all participants who received at least one dose of study medication. This study was registered with the ISRCTN registry, ISRCTN30564012.Findings: Between June 5, 2020, and Jan 25, 2021, 406 patients were randomly assigned to brensocatib or placebo; 192 (47·3%) to the brensocatib group and 214 (52·7%) to the placebo group. Two participants were excluded after being randomly assigned in the brensocatib group (214 patients included in the placebo group and 190 included in the brensocatib group in the intention-to-treat population). Primary outcome data was unavailable for six patients (three in the brensocatib group and three in the placebo group). Patients in the brensocatib group had worse clinical status at day 29 after being randomly assigned than those in the placebo group (adjusted odds ratio 0·72 [95% CI 0·57-0·92]). Prespecified subgroup analyses of the primary outcome supported the primary results. 185 participants reported at least one adverse event; 99 (46%) in the placebo group and 86 (45%) in the brensocatib group. The most common adverse events were gastrointestinal disorders and infections. One death in the placebo group was judged as possibly related to study drug.Interpretation: Brensocatib treatment did not improve clinical status at day 29 in patients hospitalised with COVID-19.
AB - Background: Neutrophil serine proteases are involved in the pathogenesis of COVID-19 and increased serine protease activity has been reported in severe and fatal infection. We investigated whether brensocatib, an inhibitor of dipeptidyl peptidase-1 (DPP-1; an enzyme responsible for the activation of neutrophil serine proteases), would improve outcomes in patients hospitalised with COVID-19.Methods: In a multicentre, double-blind, randomised, parallel-group, placebo-controlled trial, across 14 hospitals in the UK, patients aged 16 years and older who were hospitalised with COVID-19 and had at least one risk factor for severe disease were randomly assigned 1:1, within 96 h of hospital admission, to once-daily brensocatib 25 mg or placebo orally for 28 days. Patients were randomly assigned via a central web-based randomisation system (TruST). Randomisation was stratified by site and age (65 years or ≥65 years), and within each stratum, blocks were of random sizes of two, four, or six patients. Participants in both groups continued to receive other therapies required to manage their condition. Participants, study staff, and investigators were masked to the study assignment. The primary outcome was the 7-point WHO ordinal scale for clinical status at day 29 after random assignment. The intention-to-treat population included all patients who were randomly assigned and met the enrolment criteria. The safety population included all participants who received at least one dose of study medication. This study was registered with the ISRCTN registry, ISRCTN30564012.Findings: Between June 5, 2020, and Jan 25, 2021, 406 patients were randomly assigned to brensocatib or placebo; 192 (47·3%) to the brensocatib group and 214 (52·7%) to the placebo group. Two participants were excluded after being randomly assigned in the brensocatib group (214 patients included in the placebo group and 190 included in the brensocatib group in the intention-to-treat population). Primary outcome data was unavailable for six patients (three in the brensocatib group and three in the placebo group). Patients in the brensocatib group had worse clinical status at day 29 after being randomly assigned than those in the placebo group (adjusted odds ratio 0·72 [95% CI 0·57-0·92]). Prespecified subgroup analyses of the primary outcome supported the primary results. 185 participants reported at least one adverse event; 99 (46%) in the placebo group and 86 (45%) in the brensocatib group. The most common adverse events were gastrointestinal disorders and infections. One death in the placebo group was judged as possibly related to study drug.Interpretation: Brensocatib treatment did not improve clinical status at day 29 in patients hospitalised with COVID-19.
KW - COVID-19
U2 - 10.1016/S2213-2600(22)00261-2
DO - 10.1016/S2213-2600(22)00261-2
M3 - Article
C2 - 36075243
SN - 2213-2600
VL - In Press
JO - The Lancet Respiratory Medicine
JF - The Lancet Respiratory Medicine
ER -
