Early pegylated interferon lambda treatment for COVID-19 reduces hospitalization, ED visits
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A single dose of pegylated interferon lambda used as early treatment in patients with COVID-19 was effective in lowering the total occurrences of hospitalization and ED visits, a study published in The New England Journal of Medicine found.
Pegylated interferon lambda (Eiger BioPharmaceuticals) has previously been examined in more than 20 clinical trials for diseases like hepatitis B, C and D and COVID-19. These trials have “provided a well-understood safety and side effect profile,” Gilmar Reis, MD, PhD, an assistant professor of medicine at the Pontifical Catholic University of Minas Gerais in Brazil, and colleagues wrote.
“Pegylated interferon lambda has broad-spectrum antiviral activity in numerous cell cultures, animal models and clinical settings,” they wrote.
Because SARS-CoV-2 induces a “weak expression” of naturally produced type III interferons in infected cells, the researchers suggested that a treatment with an external interferon lambda source may “stimulate antiviral immunity and treat early SARS-CoV-2 infection.”
Reis and colleagues conducted a randomized, controlled, phase 3 trial known as TOGETHER to determine how efficacious early pegylated interferon lambda treatment was at preventing adverse COVID-19-related clinical outcomes.
The researchers randomly assigned 1,949 participants to receive pegylated interferon lambda (n = 933) or placebo (n = 1,018) within 7 days after the onset of COVID-19 symptoms. The participants’ mean age was 43 years and 57.1% were women. Most participants (83%) were vaccinated to some degree against COVID-19. About 45% were infected with the delta variant of SARS-CoV-2, 41% were infected with the omicron variant and 12.5% were infected with the gamma variant.
Within 28 days of randomization, Reis and colleagues found that 2.7% of participants in the pegylated interferon lambda group experienced a hospitalization or ED visit lasting more than 6 hours compared with 5.6% in the placebo group, yielding a difference of 51% (RR = 0.49; 95% CI, 0.3-0.76).
Participants in the pegylated interferon lambda group also had shorter time to hospitalization for COVID-19 (HR = 0.57; 95% CI, 0.33-0.95) and fewer deaths (HR = 0.39; 95% CI, 0.05-1.95) compared with those in the placebo group.
“The risk of Covid-19-related hospitalization or death from any cause was 47% lower in the interferon group than in the placebo group,” the researchers wrote.
When the researchers restricted their analysis to patients who received treatment within 3 days of symptom onset, the effects of pegylated interferon lambda appeared to be stronger. Compared with participants in the placebo group, participants in the pegylated interferon lambda group had:
- a 65% lower incidence rate of COVID-19-related hospitalization;
- an 81% lower risk of COVID-19-related death; and
- an 89% risk reduction among unvaccinated participants.
Reis and colleagues noted that the results were consistent across dominant variants and “independent of vaccination status.”
In a press release, Jordan Feld, MD, MPH, the interim director at the Toronto Centre for Liver Disease, said the findings suggest that pegylated interferon lambda could be a promising treatment option for COVID-19.
“An important feature of this treatment is that it is not affected by changes or mutations in the virus, because it works by stimulating the body’s own response to viral infection,” he said. “This could be an important addition to our arsenal to fight COVID-19, especially for high-risk patients who may not be able to use currently available treatments because of side effects or drug interactions with medications they take.”
References:
- Reis G, et al. N Engl J Med. 2023;doi:10.1056/NEJMoa2209760.
- Single-dose treatment reduces risk of COVID-19 hospitalization by half for high-risk patients in a largely vaccinated population. https://www.uhn.ca/corporate/News/PressReleases/Pages/Single_dose_treatment_reduces_risk_of_COVID19_hospitalization_by_half_for_risk_patients.aspx. Published Feb. 8, 2023. Accessed Feb. 8, 2023.
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