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Effect of Crizanlizumab, a P-Selectin Inhibitor, in COVID-19

Leucker et al., JACC: Basic to Translational Science, doi:10.1016/j.jacbts.2021.09.013, NCT04435184
Dec 2021  
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Progression, WHO ≥ 8 68% Improvement Relative Risk Progression, WHO ≥ 6 9% Time to discharge -35% Crizanlizumab  Leucker et al.  LATE TREATMENT  DB RCT Is late treatment with crizanlizumab beneficial for COVID-19? Double-blind RCT 42 patients in the USA (July - November 2020) Lower progression (p=0.48) and discharge (p=0.16), not sig. c19early.org Leucker et al., JACC: Basic to Transla.., Dec 2021 Favorscrizanlizumab Favorscontrol 0 0.5 1 1.5 2+
RCT 54 hospitalized COVID-19 patients showing crizanlizumab treatment reduced soluble P-selectin levels, increased D-dimer levels, and decreased prothrombin fragment 1.2 compared to placebo. There were no significant differences in inflammatory markers, clinical outcomes, or adverse events between groups. The authors hypothesize that crizanlizumab may induce endogenous thrombolysis in COVID-19.
risk of progression, 67.7% lower, RR 0.32, p = 0.48, treatment 0 of 22 (0.0%), control 1 of 20 (5.0%), NNT 20, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm), WHO status ≥ 8, day 14.
risk of progression, 9.1% lower, RR 0.91, p = 1.00, treatment 1 of 22 (4.5%), control 1 of 20 (5.0%), NNT 220, WHO status ≥ 6, day 14.
time to discharge, 35.4% higher, relative time 1.35, p = 0.16, treatment mean 6.5 (±4.1) n=22, control mean 4.8 (±3.5) n=20, randomization to discharge.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Leucker et al., 31 Dec 2021, Double Blind Randomized Controlled Trial, placebo-controlled, USA, peer-reviewed, 13 authors, study period 15 July, 2020 - 27 November, 2020, trial NCT04435184 (history).
This PaperCrizanlizumabAll
Effect of Crizanlizumab, a P-Selectin Inhibitor, in COVID-19
MD Thorsten M Leucker, MS William O Osburn, MS Paula Reventun, BA Kimberley Smith, PHD Brian Claggett, PHD Bridget-Anne Kirwan, PHD Sophie De Brouwer, MD Marlene S Williams, MD, JD Gary Gerstenblith, MD David N Hager, MD Michael B Streiff, MD Scott D Solomon, MD Charles J Lowenstein
JACC: Basic to Translational Science, doi:10.1016/j.jacbts.2021.09.013
Severe COVID-19 is characterized by vascular inflammation and thrombosis, including elevations of P-selectin, a marker released by activated endothelial cells that mediates vascular inflammation. We tested the effect of crizanlizumab, an antibody to P-selectin, on biomarkers of inflammation and thrombosis in patients with COVID-19 in a randomized, placebocontrolled, double-blind clinical trial. Crizanlizumab decreased soluble Pselectin levels in patients with COVID-19. Crizanlizumab increased D-dimer and decreased prothrombin fragment 1.2 in patients with COVID-19. Crizanlizumab may induce endogenous thrombolysis in the setting of COVID-19.
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Late treatment
is less effective
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