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As part of the UK NIHR multi-arm, multi-stage CATALYST Trial, researchers at the University of Oxford will investigate whether administering the anti-inflammatory drug infliximab to patients with COVID-19 can prevent progression to respiratory failure or death.

Intensive care © Chaikom/Shutterstock

In some patients, COVID-19 can progress to severe respiratory failure requiring admission to an intensive care unit and mechanical ventilation of the lungs. This does not occur immediately but seems to progress over 7-10 days after first developing symptoms of the disease. 

The overall aim of the CATALYST Trial is to guide the selection of new drug interventions for large phase III trials in hospitalised patients with COVID-19 infection. It is hoped that by using drugs that target the most serious symptoms of the virus, the severity of the disease could be mitigated, leading to a reduction in the number of patients needing to be admitted to intensive care and ultimately, a reduction in virus-related deaths.

The University of Birmingham is leading the delivery of the trial in partnership with University Hospitals Birmingham and the Birmingham National Institute for Health Research Biomedical Research Centre. The trial is a collaboration with the NIHR Oxford Biomedical Research Centre and University College London NIHR Biomedical Research Centre.

The Oxford arm of the study, led by Professor Duncan Richards (Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences) and Dr Matt Rowland (Nuffield Department of Clinical Neurosciences), is funded by UK Research and Innovation with support from the arthritis therapy acceleration programme (A-TAP), University of Oxford Medical Sciences Division COVID fund, and Helena Charitable Foundation.

Infliximab (CT-P13), produced by Slough based Celltrion Healthcare UK, is an anti-tumour necrosis factor (TNF) therapy that is designed to attach to a protein involved in inflammation. It is currently used as a treatment for conditions including rheumatoid arthritis and inflammatory bowel syndrome under the trade name Remsima®. The Oxford researchers will explore exactly how this drug works to reduce inflammation caused by COVID-19 by taking blood and other samples from critically unwell patients.

The effect of the drug will be measured by the amount of oxygen required by patients  as well as assessment of other severity indicators of the disease (i.e organ failure). Drugs in the CATALYST Trial that show efficacy in these measures will be recommended for further testing within large ongoing national trials.

‘We hope that by using a treatment that is already used to treat inflammation in other autoimmune conditions we may be able to manage inflammation associated with COVID-19 early’, said Sir Marc Feldmann, Professor of Immunology at the University of Oxford.

‘The study will recruit across Birmingham and Oxford initially but we expect that other centres will join the study soon. We are collaborating closely with Birmingham on the plans for analysis of complex biomarkers. We believe these will provide important mechanistic insights into the drugs in the study and are an important aspect of the clinical and scientific value of this study.’ Professor Duncan Richards

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