Covid-19: Anti-TNF drug adalimumab to be trialled for patients in the community

A new trial launched at the University of Oxford will investigate whether the anti-tumour necrosis factor (TNF) drug adalimumab is effective for treating covid-19 patients in the community, including in care homes.

The AVID-CC trial will enrol up to 750 adult patients from community care settings throughout the UK, who will be randomly allocated to receive either adalimumab plus the standard of care, or just standard of care—as determined by the patient’s doctor.

The trial will test two dose levels of adalimumab—two or four injections (given at the same time in either the abdomen or thigh) on day 1.

Patients will be followed up for four months, including by an app in which they or their carers will be asked about symptoms they have.

The trial is funded through the Covid-19 Therapeutics Accelerator, an initiative launched by the Bill and Melinda Gates Foundation, Wellcome, and Mastercard. Pharmaceutical company Sandoz has supplied adalimumab.

Anti-TNF drugs have been used for decades to treat a range of inflammatory conditions. TNF switches on the body’s immune system to fight infections, but in some inflammatory diseases there is too much TNF and so blocking it helps control the disease.

A recent study using data from the Covid-19 Global Rheumatology Alliance physician reported registry and published in Annals of the Rheumatic Diseases, looked at people with rheumatic disease who were hospitalised with covid-19. They reported that anti-TNF treatment was associated with decreased odds of hospitalisation.1

Duncan Richards, professor of clinical therapeutics at the University of Oxford, said, “The observed potential of anti-TNF drugs has prompted us to conduct a study in patients in community care to see whether treatment with the anti-TNF drug adalimumab reduces the progression to severe or critical disease or death in patients with covid-19.”

The study will be delivered by Hospital at Home teams around the UK, where hospital based teams work in the community to deliver more complex treatment interventions.

Consultant geriatrician Adam Gordon, professor of care of older people at the University of Nottingham, said, “We have seen lots of examples, earlier in the pandemic, of older people in care homes being disadvantaged regarding access to treatments simply because of where they live. This study is an exciting opportunity to open up promising treatments to this most vulnerable, and underserved, group of people. It’s an important step forward as we investigate how to manage covid-19, and more generally in terms of bringing research to the frailest older people.”