Safety, Pharmacokinetics, and Predicted Neutralizing Activity of the SARS-CoV-2 Monoclonal Antibody Sipavibart: Results from Little DIPPER and the SUPERNOVA Substudy

Zhang et al., Infectious Diseases and Therapy, doi:10.1007/s40121-026-01423-3, NCT05872958, Sep 2026
Phase 1/2 studies of 564 participants evaluating the safety, pharmacokinetics, and immunobridging of sipavibart. In Little DIPPER, safety was considered acceptable, with AEs in 28.8% of sipavibart patients vs. 6.3% for placebo. In the SUPERNOVA substudy (n=468), AEs occurred in 26.1% of sipavibart patients vs. 20.9% of tixagevimab-cilgavimab patients. The primary immunobridging endpoint was met. However by the time of the final analysis variants carrying the F456L mutation - which show resistance to sipavibart - had emerged, limiting clinical utility.
Zhang et al., 7 Sep 2026, Randomized Controlled Trial, USA, peer-reviewed, 13 authors, study period 19 May, 2023 - 20 August, 2024, trial NCT05872958 (history). Contact: taylor.cohen@astrazeneca.com.
Abstract: ## ORIGINAL RESEARCH Safety, Pharmacokinetics, and Predicted Neutralizing Activity of the SARS-CoV-2 Monoclonal Antibody Sipavibart: Results from Little DIPPER and the SUPERNOVA Substudy Huixia Zhang · Lindsay Clegg · Sam Matthews · Yue Chang · Anastasia A. Aksyuk · Dave Francisco · Sambuddha Ghosh · Karina Soboleva · Aashima Puri · Mayur Ramesh · Michael Gibbs · Lee-Jah Chang · Taylor S. Cohen Received: March 27, 2026 / Accepted: July 21, 2026 © The Author(s) 2026 ABSTRACT Introduction : The rapid evolution of SARSCoV-2 has necessitated efforts to accelerate the clinical evaluation of neutralizing monoclonal antibodies. Little DIPPER and the SUPERNOVA substudy explored the feasibility of Prior Presentation: This work was partly presented in poster form at ESCMID, Barcelona, Spain, April 27-30, 2024 (LB026). Michael Gibbs affiliated with BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK at the time of these study. Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1007/ s40121- 026- 01423-3. - H. Zhang · L. Clegg Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Gaithersburg, MD, USA - S. Matthews Biometrics, Infectious Disease, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK - Y. Chang Biometrics, Infectious Disease, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA A. A. Aksyuk · D. Francisco Translational Medicine, Infectious Disease, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA immunobridging efficacy from tixagevimabcilgavimab to sipavibart using predicted neutralizing antibody (nAb) titers. Methods : The randomized, phase 1, Little DIPPER study evaluated the safety and pharmacokinetics of intramuscular (300 mg or 600 mg) and intravenous (300 mg, 600 mg, or 1200 mg) sipavibart in healthy participants. The randomized, phase 2, SUPERNOVA substudy evaluated the safety, predicted nAb activity, and pharmacokinetics of intravenous sipavibart 1200  mg and intramuscular tixagevimabcilgavimab 300 mg in immunocompetent and immunocompromised individuals. Predicted nAb titers at day 29 for sipavibart against SARSCoV-2 BA.2.86 and for tixagevimab-cilgavimab against SARS-CoV-2 Alpha were compared in a noninferiority analysis. S. Ghosh · K. Soboleva · M. Ramesh · L.-J. Chang · Present Address: T. S. Cohen ( * ) Infectious Disease, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA e-mail: taylor.cohen@astrazeneca.com A. Puri Global Patient Safety, Chief Medical Office, AstraZeneca, Gaithersburg, MD, USA M. Gibbs Clinical Development, Infectious Disease, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK Vol.:(0123456789) Results : In Little DIPPER, 96 participants received sipavibart ( n = 80) or placebo ( n = 16). Through day 91, adverse events (AEs) occurred in 23 participants (28.8%) who were administered sipavibart and one (6.3%) who was administered placebo. Sipavibart exhibited dose-proportional increases in serum exposure following intramuscular or intravenous administration. In the SUPERNOVA substudy, 468 participants received sipavibart ( n = 310) or tixagevimab-cilgavimab ( n = 158). Through day 29, AEs occurred in 81 participants (26.1%) who were administered sipavibart and 33 (20.9%) who were administered tixagevimab-cilgavimab. No serious hypersensitivity reactions occurred. The ratio of predicted nAb..
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Cohen are employees of and may hold stock and/or stock options in AstraZeneca. Sam Matthews was an employee of and received a salary from Exploristics Ltd, and was contracted to AstraZeneca at the time of the studies; and is currently an employee of and receives a salary from Cytel Inc, and is contracted to AstraZeneca. Michael Gibbs was an employee of and may have held stock and/or stock options in AstraZeneca at the time of the studies." }, { "group": { "label": "Declarations", "name": "EthicsHeading" }, "label": "Ethical Approval", "name": "Ethics", "order": 2, "value": "Both studies adhered to the ethical principles originating in the Declaration of Helsinki, International Council for Harmonisation Good Clinical Practice guidelines, and to AstraZeneca policy on Bioethics and Human Biological Samples. The protocols and other relevant documents were reviewed and approved by a central institutional review board (Little DIPPER: Advarra IRB, 6100 Merriweather Drive, Suite 600, Columbia, MD 21044, USA; SUPERNOVA substudy: WCG IRB, 212 Carnegie Center, Suite 301, Princeton, NJ 8540, USA). 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