Anti-Inflammatory Drugs Prevented COVID-19 Deaths, But Didn’t Help Recovery Time


Fewer hospitalized patients with COVID-19 pneumonia died when treated with standard care plus either infliximab or abatacept.

Common anti-inflammatory medications used to treat certain autoimmune diseases did not affect time to recovery in hospitalized patients with COVID-19 pneumonia, but did reduce the likelihood of death, according to new data published in JAMA.1

The study, conducted by researchers from the Washington University School of Medicine, was funded by the Biomedical Advanced Research and Development Authority, an organization within the United States Department of Health and Human Services. The study, called ACTIV-1 Immune Modulator, began in April 2020 as part of an initiative from the National Institutes of Health to develop a coordinated research response to the COVID-19 pandemic.

“One of the fundamental questions of early COVID-19 research was whether we could dampen the inflammatory process using existing anti-inflammatory drugs,” William G. Powderly, MD, the J. William Campbell Professor of Medicine at Washington University and principal investigator on the study, said in a statement.2 “We hope this study will be helpful in revising guidelines for best practices in treating patients hospitalized with COVID-19.”

Investigators conducted a randomized, double-masked, placebo-controlled study to investigate whether abatacept, cenicriviroc, or infliximab provided any benefit when added to standard of care for COVID-19 pneumonia. The study included 3 substudies from 95 hospitals at 85 clinical research sites in the United States and Latin America.

The study cohort included 1971 participants who were 18 years or older and were hospitalized with a SARS-CoV-2 infection, as well as evidence of pulmonary involvement. Participants were given an infusion of 10 mg abatacept, 5 mg infliximab, or a 28-day oral course of cenicriviroc with a 300-mg loading dose, followed by 150 mg twice per day.

The primary study outcome was time to recovery by day 28, which was evaluated using an 8-point ordinal scale. Recovery was defined as the first day a participant scored at least 6 on the scale.

Investigators found that the time to recovery from COVID-19 pneumonia was not significantly different between any of the medications compared to placebo. However, 2 of the drugs did show a reduced likelihood of death when used with standard-of-care. All-cause 28-day mortality was 11.0% for abatacept vs 15.1% for placebo, and 10.1% for infliximab vs 14.5% for placebo.

Study limitations include that the results are limited to COVID-19 variants represented at the time of study, unavailable data on vaccine participation, and challenges with adherence due to cenicriviroc being an oral medication.

“We’ve now shown that there are multiple potential options available for COVID treatment,” Powderly said. “But ideally, we as doctors don’t want to have to treat COVID pneumonia. We much prefer to prevent it, and vaccines are still the best way to prevent severe COVID-19.”

1. O’Halloran JA, Ko ER, Anstrom KJ, et al. Abatacept, Cenicriviroc, or Infliximab for Treatment of Adults Hospitalized With COVID-19 Pneumonia: A Randomized Clinical Trial. JAMA. Published online July 10, 2023. doi:10.1001/jama.2023.11043
2. Wiemers, M. Anti-inflammatory drugs did not speed COVID-19 recovery but prevented deaths. News Release. Washington University. July 10, 2023. Accessed July 14, 2023.
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