Background: Coronavirus disease 2019 (COVID-19) pneumonia requires considerable healthcare resources.
Research objective: Examine if a single dose of infliximab or abatacept, in addition to remdesivir and steroids, decreased resource utilization among participants hospitalized with COVID-19 pneumonia.
Study design and methods: Accelerating COVID-19 Therapeutic Interventions and Vaccines Immunomodulator (ACTIV-1 IM) master protocol was a randomized, placebo-controlled trial examining the potential benefit in time to recovery and mortality of immunomodulators infliximab, abatacept, and cenicriviroc. This observational study performs a secondary analysis of the infliximab, abatacept, and common placebo participants to examine resource utilization. Hospital days, intensive care unit days, days with supplemental oxygen, days with high flow nasal cannula or non-invasive ventilation, ventilator days, and days of extracorporeal membrane oxygenation were each 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: Infliximab infusion, compared to 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 healthcare resources over 28 days compared to placebo, but the absolute differences were small.
Clinical trial registration: www.clinicaltrials.gov (NCT04593940).
Keywords: COVID-19; abatacept; hospitalization; infliximab; resource utilization; supplemental oxygen; ventilator.