This study evaluated the efficacy, safety, pharmacokinetics, and pharmacodynamics of ravulizumab administered in adult participants with coronavirus disease 2019 (COVID-19) severe pneumonia, acute lung injury, or acute respiratory distress syndrome. Participants were randomly assigned to receive ravulizumab in addition to best supportive care (BSC) (2/3 of the participants) or BSC alone (1/3 of the participants). BSC consisted of medical treatment and/or medical interventions per routine hospital practice.
Biological: Ravulizumab
Weight-based doses of ravulizumab were administered intravenously on Days 1, 5, 10, and 15.
Other Name: Array
Other: BSC
Participants received medications, therapies, and interventions per standard hospital treatment protocols.
Inclusion Criteria:
1. Males or female participants ≥ 18 years of age and ≥ 40 kilograms at the time of
providing informed consent.
2. Confirmed diagnosis of severe acute respiratory syndrome coronavirus 2 infection (for
example, via polymerase chain reaction and/or antibody test) presenting as severe
COVID-19 requiring hospitalization.
3. Severe pneumonia, acute lung injury, or acute respiratory distress syndrome confirmed
by computed tomography or X-ray at Screening or within the 3 days prior to Screening,
as part of the participant's routine clinical care.
4. Respiratory distress requiring mechanical ventilation, which can be either invasive
(requiring endotracheal intubation) or noninvasive (with continuous positive airway
pressure or bilevel positive airway pressure).
5. Female participants of childbearing potential and male participants with female
partners of childbearing potential must follow protocol specified contraception
guidance for avoiding pregnancy for 8 months after treatment with the study drug.
Exclusion Criteria:
1. Participant was not expected to survive for more than 24 hours.
2. Participant was on invasive mechanical ventilation with intubation for more than 48
hours prior to Screening.
3. Severe pre-existing cardiac disease (that is, New York Heart Association Class 3 or
Class 4, acute coronary syndrome or persistent ventricular tachyarrhythmias).
4. Participant had an unresolved Neisseria meningitidis infection.
5. Used the following medications and therapies:
- Current treatment with a complement inhibitor or
- Intravenous immunoglobulin within 4 weeks prior to randomization on Day 1
6. Treatment with investigational therapy in a clinical study within 30 days before
randomization, or within 5 half-lives of that investigational therapy, whichever was
greater. Exceptions:
- Investigational therapies were allowed if received as part of BSC through an
expanded access protocol or emergency approval for the treatment of COVID-19.
- Investigational antiviral therapies (such as remdesivir) were allowed even if
received as part of a clinical study.
7. Female participants who were breastfeeding or who have a positive pregnancy test
result at Screening.
8. History of hypersensitivity to any ingredient contained in the study drug, including
hypersensitivity to murine proteins.
9. Participant who was not currently vaccinated against Neisseria meningitidis, unless
the participant agrees to receive prophylactic treatment with appropriate antibiotics
for at least 8 months after the last infusion of study drug or until at least 2 weeks
after the participant receives vaccination against Neisseria meningitidis.
Central Arkansas Veterans Healthcare System
Little Rock, Arkansas, United States
LAC/USC Health Center
Los Angeles, California, United States
UC Irvine Medical Center
Orange, California, United States
MedStar Georgetown University Hospital
Washington, District of Columbia, United States
University of Florida
Jacksonville, Florida, United States
Mayo Clinic Florida
Jacksonville, Florida, United States
Rush University Medical Center
Chicago, Illinois, United States
Norton Healthcare
Louisville, Kentucky, United States
Baltimore VA Medical Center
Baltimore, Maryland, United States
Massachusetts General Hospital
Boston, Massachusetts, United States
Brigham and Women's Hospital
Boston, Massachusetts, United States
Boston Medical Center
Boston, Massachusetts, United States
Henry Ford Hospital
Detroit, Michigan, United States
Mayo Clinic Health System
Mankato, Minnesota, United States
Mayo Clinic
Rochester, Minnesota, United States
Washington University School of Medicine
Saint Louis, Missouri, United States
NYU Langone Health Center
New York, New York, United States
Icahn School of Medicine at Mount Sinai
New York, New York, United States
Westchester Medical Center
Valhalla, New York, United States
Medical University of South Carolina
Charleston, South Carolina, United States
Baptist Memorial Hospital
Memphis, Tennessee, United States
Houston Methodist Hospital
Houston, Texas, United States
Mayo Clinic Health System in Eau Claire
Eau Claire, Wisconsin, United States
Mayo Clinic Health System
La Crosse, Wisconsin, United States
Hôpital Raymond Poincaré
Garches, Hauts De Seine, France
Hôpital Henri Mondor
Créteil, Val De Marne, France
Hôpital Bicêtre
Le Kremlin-Bicêtre cedex, Val De Marne, France
Medical Hospital, Tokyo Medical and Dental University
Bunkyō-Ku, Tokyo-To, Japan
Jikei University Hospital
Minato-Ku, Tokyo, Japan
Tokyo Medical University Hospital
Shinjuku-Ku, Tokyo, Japan
Hospital Universitari de Bellvitge
L'Hospitalet De Llobregat, Barcelona, Spain
Hospital Universitari Vall d'Hebron
Barcelona, Spain
Hospital Clinic de Barcelona
Barcelona, Spain
Hospital Universitario Ramon y Cajal
Madrid, Spain
King's College Hospital
London, Greater London, United Kingdom
Hammersmith Hospital
London, Greater London, United Kingdom
Royal Liverpool University Hospital
Liverpool, Merseyside, United Kingdom
Queen Elizabeth Hospital
Birmingham, West Midlands, United Kingdom
St James's University Hospital
Leeds, West Yorkshire, United Kingdom