ABSTRACT
Background Evidence suggests that early, robust type 1 interferon responses to SARS-CoV-2 are critical determinants for COVID-19 disease outcomes, accelerating viral clearance and limiting viral shedding. Accordingly, we undertook a ring prophylaxis study to determine whether pegylated IFN{beta}-1 could reduce SARS-CoV-2 household transmission. Methods A household cluster randomized controlled study of IFN{beta}-1 administered to non-hospitalized, symptomatic COVID-19 index cases and treatment-eligible household contacts aged 18-70 years compared to standard care, was conducted. Following randomization participants received IFN{beta}-1 on days 1, 6, and 11 or standard care. Viral shedding was determined by sequential salivary polymerase chain reaction measurements until day 29 in both study arms. A post-hoc at risk population was defined as households where the index case was positive at the start of the study and there was at least one treatment eligible contact in a household who tested negative for SARS-CoV-2. Frequentist and Bayesian analyses were undertaken to determine the effects of treatment on (i) reducing viral shedding in index cases and (ii) reducing viral transmission to post-exposure household contacts. Results In total, 1172 participants in 341 households underwent randomization, with 607 assigned to receive IFN{beta}-1 and 565 to standard care. Based on intention to treat and per protocol analyses, IFN{beta}-1 treatment was ineffective. However, in the at risk population, the relative risk of infection was reduced by 23% in treated individuals and that there was a 95% probability that IFN{beta}-1 reduced household transmission. Conclusion Ring prophylaxis with IFN{beta}-1 reduces the probability of SARS-CoV-2 transmission within a household.
Subject(s)
COVID-19ABSTRACT
Summary Background The global pandemic of COVID-19 cases caused by infection with SARS-CoV-2 is ongoing. We describe here the clinical course of COVID-19 in a cohort of confirmed cases in Wuhan, China, treated with the repurposed potential experimental therapeutics IFN-2b, arbidol or a combination of IFN-2b plus arbidol. Methods 77 adults with confirmed COVID-19 were treated with either nebulized IFN-2b (5mU,b.i.d.), arbidol (200mg dispersible tablet, t.i.d.) or a combination of IFN-2b plus arbidol. Serial SARS-CoV-2 testing along with hematological measurements, including cell counts and blood biochemistry, serum cytokine levels, temperature and blood oxygen saturation levels were recorded for each patient during their hospital stay. Findings Treatment with IFN-2b with or without arbidol significantly reduced the duration of detectable virus in the upper respiratory tract and in parallel reduced duration of elevated blood levels for the inflammatory markers IL-6 and CRP. Interpretation IFN-2b should be investigated as therapy in COVID-19 cases.