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This appendix has been provided by the authors to give readers additional information about their work.
Supplement to: Dougan M, Nirula A, Azizad M, et al. Bamlanivimab plus etesevimab in mild or moderate Covid-19.
N Engl J Med. DOI: 10.1056/NEJMoa2102685
Supplementary Appendix
Table of contents
BLAZE-1 Investigators pg 2
Support staff pg 3
Supplementary Methods pg 12
Symptom Questionnaire pg 30
1
BLAZE-1 Investigators
Faisal Amin - Central Valley Research, Modesto, CA
Robert L Gottlieb - Baylor University Medical Center, Dallas, TX, Baylor Scott and White Medical
Center – Irving, Irving, TX, Baylor Scott and White All Saints Medical Center, Fort Worth, TX, and
Baylor Scott and White Medical Center – Round Rock, Round Rock, TX
2
Adam Schwartz - Kaiser Permanente, San Diego, CA
Support Staff
Keri Sullivan
Kathryn Hall
Sub Investigators
Monica Brown
Thomas Johnson
Tayler Flores RN
Justin Palarca RN
Chase Miller
3
Las Vegas Medical Research Center, 8530 W Sunset Rd Ste 300, Las Vegas, NV, USA (Dr. Bharat
Mocherla)
Sub investigators
Dana Forte
Del Gardner
Beth Moreno
CRCs
Erlie Lopez
Nicole Martini
Kelly Beck
Jesse Hawkins
Valarie Maldonado
Lorna Duff
Tina Martinez
Joanna Bachowska
Sandra Barcena
RA
Damon Murray
Pharmacy
Jane Filus
James Fajardo
Theresa Reyes
Joanna Salvador
Baylor University Medical Center and Baylor Scott and White Research Institute, 3410 Worth St, Suite
250, Dallas, TX, USA (Dr. Gottlieb)
Marcus Holmes, DO
Solomon Bassett
4
Emily Brock
Giselle Carino
Laura Clariday
Tanqunisha Coleman
Allyson Davis
Allyson Fowlks
Nazia Iram
Felecia Jones
Tina Jones
Kiara Leonard
Katalin Martits‐Chalangari, MD
Shannon Perez
Noelia Ramirez
Madison Ryan
Samantha Villa
Baylor Scott and White All Saints Medical Center, Fort Worth, TX, USA (Dr. Gottlieb)
Bryan Youree, MD
Nathan Albright, DO
Asifa Ashraf, MD
Abhishek Avirineni, MD
5
Dipesh Bista, MD
Andrew Darwin, DO
Shovendra Gautam, MD
Ezmina Lalani, DO
Sherly Mathew, MD
Cheryl McDonald, MD
Diana Moise, MD
Jack Ni, DO
Whitney Nwagbara, MD
Ijeoma Nwelue, MD
Aaron Oubre, MD
Huma Paika, MD
Vivek Ramarathnam, MD
Nida Rasheed, MD
Jacelyn Baldridge
Sharon Brown
Theresa Cheyne
Sandra Garcia
Kristina Perez
Felicity Vaughan
Decolia Washington
Natalia Wiemann
Baylor Scott and White Medical Center – Irving, Irving, TX, USA (Dr. Gottlieb)
Steven Davis, MD
6
Blake Johnson, MD
Alyssa Boudreau
Krizia Duque
Brittany Garcia
Jon Thammavong
Mary Wallace
Baylor Scott and White Medical Center – Round Rock, Round Rock, TX, USA (Dr. Gottlieb) and Baylor
Scott and White Research Institute, Dallas, TX, USA (Dr. Gottlieb)
MaryAnn Tran MD
William Tobleman MD
Theresa Quezada
Carmen Sutton
Department of Medicine, Women’s Guild Lung Institute, Cedars-Sinai Medical Center, 8700 Beverly
Blvd, Los Angeles, CA (Dr. Chen)
Anders Berg, MD
Emad Bayoumi, MD
Antonina Caudill
Gregg Clapham
Jeremy Falk, MD
David Frishberg, MD
Billy Gellepis
7
Lisa Herrera
Niree Hindoyan
Carissa Huynh
Harneet Jawanda
Elizabeth Kissell
Yuri Matusov, MD
Shaunt Mehdikhani
Tanyalak Parimon, MD
Ethan Pascual
Victor Tapson, MD
Sam Torbati, MD
Tanzira Zaman, MD
Timothy Wynter
Sub-Investigators
Joel Ebuh, MD
Dennisse Galdamez
CRCs
Britney Greer
Deisy Espinoza
Patient Advocate
Herman Davis
Meredith Benfield
Tara Shetley
Carita Barefoot
Polly Turner
8
Clinical Trials of SWLA, Lake Charles, LA (Dr. Morris)
Janet Bourque
Melissa Comeaux
David Guillory
Brandi Ingalls
Codie Lee
Sam Liprie
Summer Moss
Page Prather
Kira Rice
Kevin Hanson MD
Javier Nazar MD
Ema Burcheci, RN
Sophia Bixler, RN
Mitchell Kennedy
Bryan McKay
Jack O’Donnell
Hillary Thoreson, RN
Hilda Yousefi
Krista Gross
Jennifer Norton
9
Suvi Gross
Maria Carrillo
Shalynn Fields
Benjamin Karsai
Syed Mehdi
Chioma B Ejiogu, NP
Coty Coffee
Stephen Epner
Tracy Everett
Kimberly Forbes
Sybil Hosek
Matthew Itterra
Kody Keckler
Karen Kroc
Mark Mycyk
Robert Needleman
Heather Prescaro
Monina Quindipan
Daniel Pineda
Karel Reyes
Kristin Mounce, NP
Tara Simon, NP
Stepahanie Alford, RN
Kathleen Kioussopoulos, RN
Tricia Kunz, RN
10
Kelly Underwood, RN
Chanda Beckner
11
Supplementary Methods
Inclusion Criteria
Participants were eligible to be included in the study only if all of the following criteria
apply:
Age
Disease Characteristics
- Not hospitalized
- Have one or more mild or moderate COVID-19 symptoms (FDA May 2020, Available
at: https://www.fda.gov/regulatory-information/search-fda-guidance-
documents/covid-19-developing-drugs-and-biological-products-treatment-or-
prevention)
i. Fever
ii. Cough
iv. Malaise
v. Headache
12
viii. Shortness of breath with exertion
- Must have sample collection for first positive SARS-CoV-2 viral infection
Sex
agreements and guidance is provided in Section 10.4, Appendix 4, PYAB Protocol (k).
Study Procedures
Informed Consent
and/or assent as described in Section 10.1.3 of PYAB Protocol (k) which includes
compliance with the requirements and restrictions listed in the informed consent
- Are ≥18 years of age and satisfy at least one of the following at the time of screening
• Have a BMI ≥ 35
13
• Have type 1 or type 2 diabetes
o cardiovascular disease, OR
o hypertension, OR
Note: BMI is rounded to the nearest whole number, for example, 34.5 is rounded to 35.
- Are 12-17 years of age (inclusive) AND satisfy at least one of the following at the
time of screening
• Have a BMI ≥85th percentile for their age and gender based on CDC
to COVID-19)
14
• Have chronic kidney disease
Exclusion Criteria
Participants were excluded from the study if any of the following criteria apply:
Medical Conditions
- SpO2 ≤ 93% on room air at sea level or PaO2/FiO2 < 300, respiratory rate ≥30 per
ventilation
- Have known allergies to any of the components used in the formulation of the
interventions
randomization
(besides COVID-19) that in the opinion of the investigator could constitute a risk
- Have any co-morbidity requiring surgery within <7 days, or that is considered life
- Have any serious concomitant systemic disease, condition or disorder that, in the
Other Exclusions
15
- Have a history of a positive SARS-CoV-2 serology test
- Have a history of a positive SARS-CoV-2 test prior to the one serving as eligibility for
this study
- Are concurrently enrolled in any other type of medical research judged not to be
- Are investigator site personnel directly affiliated with this study, and
All participants were centrally randomized to study intervention using an interactive web
response system and stratified by duration since symptom onset to randomization (≤8 days
versus >8 days), and age at the time of screening (<18 years of age versus ≥18 years of age).
Eligible participants were randomized using a 1:1 allocation ratio. In this double-blind study,
neither participants, investigators, nor the sponsor study team were aware of treatment
assignments prior to the final data base lock at the conclusion of the study arm. If an
16
investigator, site personnel performing assessments, or participant is unblinded while the
infusion is ongoing, the participant was discontinued from the study intervention and the
infusion stopped.
SARS-CoV-2 was detected from nasopharyngeal swabs collected in sterile, viral transport
media using the materials, extraction method, and RT-PCR protocol described in the “Lilly
SARS-CoV-2 Assay EUA Summary” published on the US Food and Drug Administration website
“N2” target different sequences of the SARS-CoV-2 nucleocapsid N gene and are co-amplified
with a human internal control target, RNase P, for 45 cycles of PCR. Primer and probe
sequences are available in the “Lilly SARS-CoV-2 Assay EUA Summary” and were obtained
RT-PCR results were interpreted as follows; a clinical sample was “positive” for detection of
SARS-CoV-2 if either or both SARS-CoV-2 specific N1 and N2 targets showed clear and
unambiguous amplification and a cycle threshold (Ct) determined. A clinical sample was
“negative” for detection of SARS-CoV-2 if neither the N1 nor N2 target showed amplification,
and the internal human control, RNase P, showed clear and unambiguous amplification. A
clinical sample was “invalid” if all three targets showed no amplification. Viral presence or
absence and any quantitative determination was not scored for “invalid” samples. All
assignment.
17
Determination of Viral Clearance and Time to Viral Clearance
For qualitative endpoints in the trial (viral clearance yes/no, time to viral clearance) the
2 clearance was defined as 2 consecutive negative RT-PCR tests for the SARS-CoV-2 virus as
previously described. The date of viral clearance was defined as the earliest date of the 2
consecutive negative tests. Additionally, a normalization step was included for any sample
For quantitative endpoints in the trial (change from baseline, area under the response viral
load curve [AUC]), the viral load will be derived based on cycle threshold (Ct) values with the
following considerations; (i) two Ct values will be provided on 2 different genes: N1 and N2.
N1 will be used as the primary measure, N2 will only be used when the Ct value for N1 is not
available (ii) Ct values range between 0 and 45 (iii) Negative CoV-2 tests will be associated
with a Ct value of 45 (iv) The (log base 10) viral load will be calculated from the Ct value (45-
Hierarchical Testing
A hierarchical multiple comparisons procedure, to control type I error in the primary endpoint
analysis, was implemented. All primary and key secondary endpoints within a dose were
tested in a sequential manner at a 1-sided 0.025 significance level. The following is a list of
the primary and key secondary outcomes tested for each dose:
18
• Primary (Test 1) - proportion of participants who experience COVID-19 related
hospitalization (defined as ≥24 hours of acute care) or death from any cause by Day
29 (primary objective)
• Key Secondary (Test 2) – change from baseline to Day 7 (±2 days) in viral load
• Key Secondary (Test 3) – proportion of participants with SARS-CoV-2 viral load greater
Day 29:
breath, feeling feverish, body aches and pain, sore throat, chills, and headache; and a
19
Supplementary Figures and Tables
Figure S1: Kaplan-Meier analysis of time to SARS-CoV-2 clearance among high-risk patients treated
with bamlanivimab + etesevimab versus placebo.
Data for patients at risk are displayed in the associated table and represent the number of patients at
risk (number of events) per treatment group.
20
Figure S2: Kaplan-Meier analysis of time to symptom improvement up to Day 11 among high-risk
patients treated with bamlanivimab + etesevimab versus placebo.
Data for patients at risk are displayed in the associated table and represent the number of patients at
risk (number of events) per treatment group.
21
Figure S3: Kaplan-Meier analysis of time to symptom resolution up to Day 11 among high-risk patients
treated with bamlanivimab + etesevimab versus placebo.
Data for patients at risk are displayed in the associated table and represent the number of patients at
risk (number of events) per treatment group.
22
Figure S4: Kaplan-Meier analysis of time to sustained symptom resolution up to Day 29 among high-
risk patients treated with bamlanivimab + etesevimab versus placebo.
Data for patients at risk are displayed in the associated table and represent the number of patients at
risk (number of events) per treatment group.
23
Figure S5: Kaplan-Meier analysis of time to sustained complete symptom resolution up to Day 29
among high-risk patients treated with bamlanivimab + etesevimab versus placebo.
Data for patients at risk are displayed in the associated table and represent the number of patients at
risk (number of events) per treatment group.
24
Table S1: Patient mortality reported over the course of the trial.
Days from
Study Day (since
Patient Treatment Age BMI Sex Comorbidity Symptom Onset (to
Randomization)
Randomization)
1 Placebo 39 49 M Hypertension 1 day Day 20
2 Placebo 73 29 M Hyperlipidaemia 4 days Day 13
3 Placebo 54 40 F Anxiety 4 days Day 36
4 Placebo 77 34 F Dementia 3 days Day 16
Cardiac pacemaker
5 Placebo 75 22 M 7 days Day 24
insertion
Cardiac failure
6 Placebo 62 32 M 2 days Day 24
congestive
7 Placebo 62 23 M Hypertension 4 days Day 25
8 Placebo 65 40 M Hypertension 4 days Day 36
Coronary artery
9 Placebo 59 61 M 7 days Day 3
disease
10 Placebo 62 39 M Oedema 3 days Day 19
25
Table S2: Symptom resolution at Days 2-11 among high-risk patients treated with bamlanivimab +
etesevimab versus placebo.
Bamlanivimab
+ Etesevimab
(N=518)
Symptom resolution at Day 2 vs Placebo,
-0.7 (-5.5, 4.0)
Δ (95% CI)
Symptom resolution at Day 3 vs Placebo,
5.9 (0.6, 11.3)
Δ (95% CI)
Symptom resolution at Day 4 vs Placebo,
5.8 (0.0, 11.7)
Δ (95% CI)
Symptom resolution at Day 5 vs Placebo,
8.7 (2.5, 14.8)
Δ (95% CI)
Symptom resolution at Day 6 vs Placebo,
9.4 (3.1, 15.7)
Δ (95% CI)
Symptom resolution at Day 7 vs Placebo,
8.6 (2.6, 14.6)
Δ (95% CI)
Symptom resolution at Day 8 vs Placebo,
12.2 (5.5, 18.9)
Δ (95% CI)
Symptom resolution at Day 9 vs Placebo,
7.3 (0.7, 13.9)
Δ (95% CI)
Symptom resolution at Day 10 vs Placebo,
10.7 (4.2, 17.2)
Δ (95% CI)
Symptom resolution at Day 11 vs Placebo,
9.1 (3.0, 15.2)
Δ (95% CI)
N, number of subjects; CI, confidence interval
26
Table S3: Patient demographics and baseline clinical characteristics.
(next page)
27
Bamlanivimab
Placebo + Etesevimab Total
(N=517) (N=518) (N=1035)
Age (median years) 56 57 56
Age Group 517 518 1035
>=12 and <18 7 (1.4) 4 (0.8) 11 (1.1)
>=18 and <35 69 (13.3) 73 (14.1) 142 (13.7)
>=35 and <45 77 (14.9) 83 (16.0) 160 (15.5)
>=45 and <55 94 (18.2) 66 (12.7) 160 (15.5)
>=55 and <65 115 (22.2) 124 (23.9) 239 (23.1)
>=65 155 (30.0) 168 (32.4) 323 (31.2)
Race ‡, n*a 513 512 1025
n (%)*a
American Indian or Alaska Native 1 (0.2) 2 (0.4) 3 (0.3)
Asian 22 (4.3) 16 (3.1) 38 (3.7)
Black or African American 39 (7.6) 44 (8.6) 83 (8.1)
Native Hawaiian or Other Pacific 2 (0.4) 0 2 (0.2)
Islander
White 447 (87.1) 449 (87.7) 896 (87.4)
Of multiple race decent 2 (0.4) 1 (0.2) 3 (0.3)
Missing 4 6 10
Ethnicity ‡, n 516 517 1033
Hispanic or LatinX, n (%)*a 155 (30.0) 149 (28.8) 304 (29.4)
Height (median, cm) 170.0 169.0 169.5
Weight (median, kg) 95.40 95.63 95.40
Body-mass index § (median) 33.90 34.14 34.09
Days since COVID-19 symptom
onset to randomization;
28
0 3 (42.9) 0 3 (27.3)
1 3 (42.9) 4 (100.0) 7 (63.6)
2 1 (14.3) 0 1 (9.1)
29
Questionnaire obtained by: Study ID Subject Number Visit/Cycle Number Signature of Individual Completing Form
J2W-MC-PYAB
1. Assessment Date:
(DD/MMM/YYYY)
2. Cough ○ Yes
○ Mild
○ Moderate
○ Severe
○ No (Absent)
5. Fatigue ○ Yes
○ Mild
○ Moderate
○ Severe
○ No (Absent)
200528001-Symptom_Assessment-1-English-US-Source #EI253352
Study ID Subject Number Visit/Cycle Number Page 2 of 2
J2W-MC-PYAB
8. Chills ○ Yes
○ Mild
○ Moderate
○ Severe
○ No (Absent)
13. Overall, how bad are your symptoms TODAY (check one)? ○ No symptoms
○ Mild
○ Moderate
○ Severe
○ Very severe
14. Overall, how is your general physical health TODAY (check one)? ○ Poor
○ Fair
○ Good
○ Very good
○ Excellent
15. Have you returned to your usual (pre-COVID) health today (check one)? ○ Yes
○ No
200528001-Symptom_Assessment-1-English-US-Source #EI253352