Evaluation of Acebilustat, a Selective Inhibitor of Leukotriene B4 Biosynthesis, for Treatment of Outpatients With Mild-Moderate Coronavirus Disease 2019: A Randomized, Double-Blind, Placebo-Controlled Phase 2 Trial

• Published in: Clinical infectious diseases 2023-07, Vol.77 (2), p.186-193
• Main Authors: Levitt, Joseph E, Hedlin, Haley, Duong, Sophie, Lu, Di, Lee, Justin, Bunning, Bryan, Elkarra, Nadia, Pinsky, Benjamin A, Heffernan, Eileen, Springman, Eric, Moss, Richard B, Bonilla, Hector F, Parsonnet, Julie, Zamanian, Roham T, Langguth, Jamison J, Bollyky, Jenna, Khosla, Chaitan, Nicolls, Mark R, Desai, Manisha, Rogers, Angela J
• Format: Article
• Language: English
• Subjects: COVID-19; Double-Blind Method; Humans; Leukotriene B4; Outpatients; SARS-CoV-2; Treatment Outcome
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciad187

Abstract Background The vast majority of coronavirus disease 2019 (COVID-19) disease occurs in outpatients where treatment is limited to antivirals for high-risk subgroups. Acebilustat, a leukotriene B4 inhibitor, has potential to reduce inflammation and symptom duration. Methods In a single-center trial spanning Delta and Omicron variants, outpatients were randomized to 100 mg/d of oral acebilustat or placebo for 28 days. Patients reported daily symptoms via electronic query through day 28 with phone follow-up on day 120 and collected nasal swab samples on days 1–10. The primary outcome was sustained symptom resolution to day 28. Secondary 28-day outcomes included time to first symptom resolution, area under the curve (AUC) for longitudinal daily symptom scores, duration of viral shedding through day 10, and symptoms on day 120. Results Sixty participants were randomized to each study arm. At enrollment, the median duration was 4 days (interquartile range, 3–5 days), and the median number of symptoms was 9 (7–11). Most patients (90%) were vaccinated, with 73% having neutralizing antibodies. A minority of participants (44%; 35% in the acebilustat arm and 53% in placebo) had sustained symptom resolution at day 28 (hazard ratio, 0.6 [95% confidence interval, .34–1.04]; P = .07 favoring placebo). There was no difference in the mean AUC for symptom scores over 28 days (difference in mean AUC, 9.4 [95% confidence interval, −42.1 to 60.9]; P = .72). Acebilustat did not affect viral shedding or symptoms at day 120. Conclusions Sustained symptoms through day 28 were common in this low-risk population. Despite this, leukotriene B4 antagonism with acebilustat did not shorten symptom duration in outpatients with COVID-19. Clinical Trials Registration. NCT04662060. Acebilustat, a leukotriene B4 inhibitor, did not improve symptom resolution in outpatients with coronavirus disease 2019. Most remained symptomatic at day 28 despite a highly vaccinated cohort. Longitudinal symptom severity may quantify disease burden more reliably than symptom duration alone. Graphical Abstract Graphical Abstract