Eiger Announces First COVID-19 Patients Dosed with Peginterferon Lambda

Eiger BioPharmaceuticals announced the first patients have been dosed in a Phase 2 study of peginterferon lambda (Lambda) in outpatients with mild COVID-19 at the Stanford University School of Medicine.

Approximately 120 patients will be randomized 1:1 to a single subcutaneous dose of Lambda or normal saline placebo to evaluate the efficacy of Lambda in reducing the duration of viral shedding of SARS-CoV-2 virus and in reducing duration of symptoms and hospitalization in patients with mild COVID-19. Patients will be followed for 28 days.

The Stanford study is co-led by Upinder Singh, MD, Professor of Medicine and Infectious Diseases and Geographic Medicine and Microbiology and Immunology and Prasanna Jagannathan, MD, Assistant Professor of Medicine and Infectious Diseases.

Lambda interferon plays a key role in the targeted innate immune response against viral pathogens that infect the respiratory tract. Upon infection of airway epithelial cells, type III IFNs, like lambda interferon, are produced first and act as the initial line of defense to limit virus spread at the epithelial barrier without triggering inflammation. The study will investigate the hypothesis that Lambda may be most effective in patients who have confirmed infection with mild symptoms in order to reduce duration and severity of COVID-19.

"SARS-CoV-2 induces very weak expression of interferons in infected cells," said Colin Hislop, MD, Senior Vice President of Clinical and Development Operations. "Absence of interferon production likely hampers the early innate immune response to SARS-CoV-2 infection and suggests stimulation of antiviral immunity with exogenous lambda interferon might be successful for treating SARS-CoV-2 infection." 

The Stanford study is one of six international, investigator sponsored studies evaluating Lambda in COVID-19. Other sites include Soroka University (Israel), Mount Sinai Hospital (New York), Massachusetts General Hospital (Boston), Johns Hopkins University (Baltimore), and University of Toronto (Toronto). Eiger has been involved in protocol development, regulatory interactions and is providing Lambda clinical drug supply. Collectively, up to 400 patients are expected be enrolled and dosed across international sites. These studies will assess Lambda's ability to reduce COVID-19 replication and limit virus transmission.

Lambda is a well-characterized, late-stage, first-in-class, type III interferon (IFN) that stimulates immune responses that are critical for the development of host protection during viral infections.  Lambda targets type III IFN receptors which are distinct from the type I IFN receptors targeted by IFN alfa. Binding leads to activation of JAK-STAT signaling pathway and upregulation of numerous IFN-stimulated genes (ISGs). IFN lambda receptors are largely restricted to cells and tissues of epithelial origin, including respiratory epithelial cells.

IFN lambdas are critical for maintaining a balanced antiviral response in the respiratory tract. They are induced at lower viral burden before type I IFNs to limit the initial infection by inducing viral resistance to cells and helping them deal with the virus load. IFN lambda lacks the strong pro-inflammatory effects of type I IFNs and are tissue-protective and anti-inflammatory. Administration of IFN lambda has been shown to suppress viral replication while stopping the 'cytokine storm' from developing.

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