Interferon-α Nasal Spray Prophylaxis Reduces COVID-19 in Cancer Patients: A Randomized, Double-Blinded,
Michelle K Yong1,2,3,4, Karin Thursky1,2,4,5, Megan Crane1,4
1Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Background:
We evaluated whether a daily nasal spray of interferon-alpha (IFN-α) would reduce the incidence of COVID-19 or community-acquired respiratory viral infections in adult cancer patients.
Methods:
In this multicenter, randomized, double-blinded, placebo-controlled trial, participants were randomized 1:1 to receive daily 40 000 IU IFN-α nasal spray or normal saline placebo. Participants who developed influenza-like symptoms self-collected nasal swabs for PCR testing of SARS-CoV-2, influenza A/B, respiratory syncytial virus, parainfluenza, adenovirus, seasonal coronavirus, picornavirus, human metapneumovirus, and/or SARS-CoV-2 rapid antigen testing. Co-primary endpoints were incidence of COVID-19 and/or other respiratory viruses ≤90 days of randomization.
Results:
Four hundred and thirty-three participants were randomized to IFN-α (n = 217) or placebo (n = 216). The incidence of COVID-19 was lower in the IFN-α group versus placebo (8.3% vs 14.4%), indicating a 40% reduced risk of infection (relative risk [RR]: .60; 95% credible interval [CrI]: .33-.97). Other respiratory viral infection incidence was 5.1% and 5.1% in both groups (RR: 1.12; .43-2.34). In the per-protocol cohort (n = 389), the incidence of COVID-19 in IFN-α and placebo groups was 7.7% and 16.0% (RR: .50; .26-.84) with other respiratory virus incidence of 4.6% and 5.7%, respectively. Subgroup analysis demonstrated lower COVID-19 in the IFN-α group for ages <65 years (RR: .48; .20-.92), female sex (RR: .44; .19-.85), and COVID-19 vaccinated (RR: .50; .26-.82), but no difference by underlying malignancy. No differences were observed in secondary endpoints of severity, hospitalization, and mortality. IFN-α was well tolerated and safe.
Conclusions:
IFN-α nasal spray prophylaxis reduced the incidence of COVID-19 among adult cancer patients.
Clinical Trials Registration:
ClinicalTrials.gov identifier: NCT04534725 (ANZCTR: ACTRN12620000843954).
Insights
A daily nasal spray of interferon-alpha (IFN-α) significantly reduced COVID-19 incidence in adult cancer patients. This prophylaxis was safe and well-tolerated, offering a potential new strategy for infection prevention in this vulnerable population.
Area of Science:
- Infectious Diseases
- Oncology
- Virology
Background:
- Adult cancer patients are at increased risk for severe COVID-19 and other respiratory viral infections.
- Interferon-alpha (IFN-α) has known antiviral properties.
- Evaluating prophylactic nasal IFN-α is crucial for protecting immunocompromised individuals.
Purpose of the Study:
- To determine if daily nasal interferon-alpha (IFN-α) spray reduces COVID-19 incidence in adult cancer patients.
- To assess the efficacy of IFN-α nasal spray against other community-acquired respiratory viral infections.
- To evaluate the safety and tolerability of nasal IFN-α prophylaxis.
Main Methods:
- A multicenter, randomized, double-blinded, placebo-controlled trial.
- Participants received daily 40,000 IU IFN-α nasal spray or placebo.
- PCR and rapid antigen testing were used for viral detection in symptomatic individuals.
Main Results:
- IFN-α nasal spray reduced COVID-19 incidence by 40% (RR: .60; 95% CrI: .33-.97).
- No significant difference in other respiratory viral infection rates was observed between groups.
- Subgroup analyses showed greater benefit in younger (<65 years), female, and vaccinated patients.
Conclusions:
- Nasal interferon-alpha (IFN-α) prophylaxis effectively reduced COVID-19 incidence in adult cancer patients.
- The treatment was safe and well-tolerated, with no increased risk of severe outcomes.
- IFN-α nasal spray represents a promising preventative measure for high-risk cancer populations.
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