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Anti-Granulocyte–Macrophage Colony–Stimulating Factor Monoclonal Antibody Gimsilumab for COVID-19 Pneumonia: A Randomized, Double-Blind, Placebo-controlled Trial
Criner, Gerard J. Lang, Frederick M. Gottlieb, Robert L. Mathews, Kusum S. Wang, Tisha S. Rice, Todd W. Madduri, Deepu Bellam, Shashi Jeanfreau, Robert Case, Amy H.
Criner, Gerard J.
Lang, Frederick M.
Gottlieb, Robert L.
Mathews, Kusum S.
Wang, Tisha S.
Rice, Todd W.
Madduri, Deepu
Bellam, Shashi
Jeanfreau, Robert
Case, Amy H.
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Journal article
Date
2022-06-01
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Thoracic Medicine and Surgery
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http://dx.doi.org/10.1164/rccm.202108-1859oc
Abstract
Rationale: GM-CSF (granulocyte–macrophage colony–stimulating factor) has emerged as a promising target against the hyperactive host immune response associated with coronavirus disease (COVID-19). Objectives: We sought to investigate the efficacy and safety of gimsilumab, an anti–GM-CSF monoclonal antibody, for the treatment of hospitalized patients with elevated inflammatory markers and hypoxemia secondary to COVID-19. Methods: We conducted a 24-week randomized, double-blind, placebo-controlled trial, BREATHE, at 21 locations in the United States. Patients were randomized 1:1 to receive two doses of intravenous gimsilumab or placebo 1 week apart. The primary endpoint was all-cause mortality rate at Day 43. Key secondary outcomes were ventilator-free survival rate, ventilator-free days, and time to hospital discharge. Enrollment was halted early for futility based on an interim analysis. Measurements and Main Results: Of the planned 270 patients, 225 were randomized and dosed; 44.9% of patients were Hispanic or Latino. The gimsilumab and placebo groups experienced an all-cause mortality rate at Day 43 of 28.3% and 23.2%, respectively (adjusted difference = 5% vs. placebo; 95% confidence interval [−6 to 17]; P = 0.377). Overall mortality rates at 24 weeks were similar across the treatment arms. The key secondary endpoints demonstrated no significant differences between groups. Despite the high background use of corticosteroids and anticoagulants, adverse events were generally balanced between treatment groups. Conclusions: Gimsilumab did not improve mortality or other key clinical outcomes in patients with COVID-19 pneumonia and evidence of systemic inflammation. The utility of anti–GM-CSF therapy for COVID-19 remains unclear.
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American Thoracic Society
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American Journal of Respiratory and Critical Care Medicine, Vol. 205, Iss. 11
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