Control Group |
REGN 10933 and REGN 10987 also known as Casirivimab and imdevimab respectively |
Active Comparator in Phase III:
Casirivimab, 600 mg, and imdevimab, 600 mg, to be administered together as a single infusion as a one-time dose of 1200 mg at Study Entry/Day 0.
5.1.2 Administration
Casirivimab and Imdevimab:
Prior to administration, attach a polyvinyl chloride (PVC), polyethylene (PE)-lined PVC, or polyurethane (PU) infusion set containing a sterile, in-line or add-on 0.2 micron polyethersulfone (PES) filter and prime the infusion set per institutional procedures.
Casirivimab with imdevimab will be administered together as a single IV infusion. The rate of infusion is dependent upon the infusion bag size. For a 50 mL bag, the maximum infusion rate is 180 mL/hour. For a 100 mL, 150 mL, or 250 mL bag, the maximum infusion rate is 310 mL/hr. After the infusion is complete, flush with a sufficient volume of 0.9% Sodium Chloride Injection, USP to ensure full dose administration.
Administer the casirivimab and imdevimab solution immediately after preparation. If immediate administration is not possible, store the diluted casirivimab and imdevimab infusion in the refrigerator between 2°C to 8°C for no more than 36 hours or at room temperature up to 25°C for no more than 4 hours, including the infusion time. If refrigerated, allow the infusion solution to equilibrate to room temperature for approximately 30 minutes prior to administration.
Participants will be monitored for one hour after completion of infusion.
|
one-time dose of 1200 mg at Study Entry/Day 0 |
REGN10933
The REGN10933 recombinant monoclonal antibody (IgG1 isotype) is a covalent heterotetramer consisting of 2 disulphide-linked human gamma heavy chains, each covalently linked through a disulphide bond to a human kappa light chain. Based on the primary structure (excluding N-linked glycosylation), REGN10933 possesses a molecular weight of 145.23 kDa (C6454H9976N1704O2024S44), taking into account the formation of 16 disulphide bonds. There is a single N-linked glycosylation site (Asn300) on each heavy chain, located within the constant region in the Fc domain of the molecule.
The complementarity-determining regions (CDRs) within the heavy chain and light chain variable domains of REGN10933 combine to form the binding sites for its target, the receptor binding domain of SARS-CoV-2 S protein.
REGN10933 FDS consists of 120 mg/mL purified protein in an aqueous buffered solution, containing 10 mM L-histidine, pH 6.0, 8% (w/v) sucrose and 0.1% (w/v) polysorbate 80. REGN10933 DP is supplied as liquid solutions for IV and SC administrations. The DPs are preservative-free and nonpyrogenic.
Chemical formula from primary structure: C6454H9976N1704O2024S44
REGN10987
The REGN10987 recombinant monoclonal antibody (IgG1 isotype) is a covalent heterotetramer consisting of 2 disulphide-linked human gamma heavy chains, each covalently linked through a disulphide bond to a human lambda light chain. Based on the primary structure (excluding N-linked glycosylation), REGN10987 possesses a molecular weight of 144.14 kDa (C6396H9882N1694O2018S42), taking into account the formation of 16 disulphide bonds. There is a single N-linked glycosylation site (Asn300) on each heavy chain, located within the constant region in the Fc domain of the molecule. The complementarity-determining regions (CDRs) within the heavy chain and light chain variable domains of REGN10987 combine to form the binding sites for its target, the receptor binding domain of SARS-CoV-2 S protein.
REGN10987 FDS consists of 120 mg/mL purified protein in an aqueous buffered solution, containing 10 mM L-histidine, pH 6.0, 8% (w/v) sucrose and 0.1% (w/v) polysorbate 80. REGN10987 DP is supplied as liquid solutions for IV and SC administrations. The DPs are preservative-free and nonpyrogenic.
Chemical formula from primary structure: C6396H9882N1694O2018S42
Mechanism of Action:
The Regeneron combination therapy, REGN-COV2, has favorable properties with potential to translate into therapeutic benefit to patients with confirmed COVID-19 and prophylactic benefit to protect against infection or disease with SARS-CoV-2. REGN-COV2 is a combination of 2 fully human IgG1 mAbs (REGN10933+REGN10987) that bind non-overlapping epitopes on the RBD of the SARS-CoV-2 S protein, an exogenous protein, and neutralize virus infectivity by blocking binding to ACE2. REGN10933 and REGN10987 are intended to be utilized as a combination treatment and should not be used individually as monotherapy. For viral targets, a combination of antibodies that bind to nonoverlapping epitopes may minimize the likelihood of loss of antiviral activity due to naturally circulating viral variants or development of escape mutants under drug pressure. Regeneron has significant experience with prior development programs for fully human mAbs against exogenous targets, including atoltivimab, odesivimab, and maftivimab (also known as REGN-EB3, Ebola); REGN3048 and REGN3051 (MERS-CoV); REGN2222 (respiratory syncytial virus, RSV); REGN5713, REGN5714, and REGN 5715 (Bet v1 birch tree allergen); and REGN1908 and REGN1909 (fel d 1 cat dander allergen).
The manufacturing processes for REGN10933 and REGN10987 are identical and use growth of a suspension culture of recombinant Chinese hamster ovary (CHO) cells to express REGN10933 or REGN10987 under an inducible promoter. Upon addition of doxycycline hyclate, the recombinant product is produced and secreted into the culture medium from which it is isolated an |
800 |
Active-Treatment of Control Group |
Experimental Group |
SAB 185 Anti SARS CoV2 Human Immunoglobulin Intravenous Tc Bovine Derived |
Participants may be randomized to receive either SAB-185 (3,840 Units/kg)/ Active Comparator (casirivimab and imdevimab) or SAB-185 (10,240 Units/kg)/ Active Comparator (casirivimab and imdevimab).
SAB-185/ Active Comparator (casirivimab and imdevimab) is to be administered as an intravenous infusion. Two doses of SAB-185 will be studied in this study. Each dose is considered separately, as its own agent group. Participants may be randomized to receive either SAB-185 (3,840 Units/kg)/ Active Comparator (casirivimab and imdevimab) or SAB-185 (10,240 Units/kg)/ Active Comparator (casirivimab and imdevimab).
SAB-185, 3,840 Units/kg
Investigational Agent: SAB-185, 3,840 Units/kg, to be administered intravenously (IV) for one dose at study Entry/Day 0.
OR
Active Comparator (casirivimab and imdevimab), for Phase III participants only.
SAB-185, 10,240 Units/kg
Investigational Agent: SAB-185, 10,240 Units/kg, to be administered IV for one dose at study Entry/Day 0.
OR
Active Comparator (casirivimab and imdevimab), for Phase III participants only.
Composition:
SAB-185 is a clear, colourless sterile liquid for intravenous use formulated in 10 mM glutamic acid monosodium salt, 262 mM D-sorbitol, 0.05 mg/mL Tween 80, pH 5.5 and is stored at 2-8ºC
|
Two doses of SAB-185 will be studied in this study. |
SAB-185 is a transchromosomic (Tc) bovine-derived human polyclonal antibody preparation
consisting of purified human IgG molecules targeted against SARS-CoV-2 spike glycoprotein.
The product is in development for use as a therapeutic agent for the treatment of COVID-19 disease caused by SARS-CoV-2. Each IgG molecule consists of two heavy chains and two light chains linked with disulphide bonds. The entire IgG molecule has a molecular weight of approximately 150 kilodaltons as evidenced by size-exclusion high performance liquid chromatography (SEC HPLC) analysis. Each heavy chain has a molecular weight of approximately 50 kilodaltons, and each light chain has a molecular weight of approximately 25 kilodaltons as measured by sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS PAGE) under reducing conditions.
The drug product contains a high level of neutralizing antibodies against SARS-CoV-2 viruses. SAB-185 contains less than 2% of chimeric IgG, which contains human IgG heavy chain and bovine light chain. Other impurities in SAB-185 include bovine plasma proteins, such as bovine serum albumin (BSA), and bovine IgG, each of which are below a level of 100 parts per million (ppm). It is expected that the IgG antibodies in SAB-185 will have a 28-day half-life and distribution in humans similar to that of SAB-301, an anti-Middle East Respiratory Syndrome Coronavirus [MERS-CoV] Tc bovine hIgG, as previously evaluated in a Phase 1 clinical trial and typical for human IgG antibodies.
Mechanism of Action:
SAB-185 is a transchromosomic (Tc) bovine-derived human polyclonal antibody preparation consisting of purified human immunoglobulin (hIgG) molecules targeted against SARS-CoV-2 spike protein. The product is in development for use as a therapeutic agent for the treatment of Coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).
Transchromosomic (Tc) bovines may be useful in the production of fully-human polyclonal IgG antibodies to fight SARS-CoV-2 infection. The genome of Tc bovines contains a human artificial chromosome (HAC), which comprises the entire human Ig gene repertoire (human Ig heavy chain [IgH] and human kappa light chain) that reside on two different human chromosomes (i.e., the IgH locus from human chromosome 14 and the immunoglobulin kappa locus from human chromosome 2). This system in the Tc bovine uses the genetic information in the HAC provided by the immunoglobulin gene repertoires to generate diverse fully human polyclonal antibodies (pAbs). The collected plasma with Tc pAbs are passed through an affinity chromatography column, first using an anti-human IgG kappa affinity column, which captures Tc pAbs and removes residual non-hIgG and bovine plasma proteins.
Through this process, SAB has generated a number of useful human pAbs that can be used as therapy for infectious agents, like SARS-CoV-2. Antibody products developed through this method have demonstrated in vivo efficacy against a range of viral infections, including, Middle Eastern Respiratory Syndrome virus (MERS-CoV), Ebola, Zika, and influenza in a variety of animal models including rodents, ferrets, and non-human primates. For SARS-CoV-2, SAB has developed SAB-185, which will use an antigen production system that is non-mammalian and non-egg based that has been shown to be safe and used in previous clinical trials of SAB-301 and SAB-136. Enzyme linked immunosorbent assay indicates that SAB-185 neutralizes not only the RBD but also the full-length spike protein. Specifically, SAB-185 is a human polyclonal antibody preparation consisting of purified human immunoglobulin (hIgG) molecules targeted against SARS-CoV-2 spike protein. This full human pAbs (hIgG/hIgκ) was produced in Tc bovines after vaccination with suitable viral antigens. This vaccination schedule was conducted with a pDNA vaccine that expressed wild-type SARS-CoV-2 spike protein, followed by additional immunizati |
800 |
|