Resource Use in the Randomized Master Protocol for Immune Modulators for Treating COVID-19 (ACTIV-1 IM): A Secondary Data Analysis

Background: COVID-19 pneumonia requires considerable health care resources. Research Question: Does a single dose of infliximab or abatacept, in addition to remdesivir and steroids, decreased resource use among patients hospitalized with COVID-19 pneumonia? Study Design and Methods: The Randomized Master Protocol for Immune Modulators for Treating COVID-19 (ACTIV-1 IM) was a randomized, placebo-controlled trial examining the potential benefit in time to recovery and mortality of the immunomodulators infliximab, abatacept, and cenicriviroc. This observational study performed a secondary analysis of the participants receiving infliximab, abatacept, and common placebo to examine resource use. Hospital days, ICU days, days with supplemental oxygen, days with high-flow nasal cannula or noninvasive ventilation, ventilator days, and days of extracorporeal membrane oxygenation each were examined. Proportional odds models were used to compare days alive and free of resource use over 28 days between infliximab and placebo groups and between abatacept and placebo groups. Results: In this study, infliximab infusion, compared with placebo, was associated with greater odds of being alive and free of all interventions tested. Abatacept use was associated only with greater odds of days alive and free of hospitalization and supplemental oxygen. Interpretation: Infliximab and abatacept use were associated with decreased use of health care resources over 28 days compared with placebo, but the absolute differences were small. Clinical Trial Registry: ClinicalTrials.gov; No.: NCT04593940; URL: www.clinicaltrials.gov