A Prospective, Multi-Center, Randomized, Placebo-Controlled, Double-Blinded Study to Evaluate the Efficacy, Safety and Tolerability of IMU-838 as Addition to Investigator's Choice of Standard of Care Therapy, in Patients With Coronavirus Disease 19
试验速览
- 阶段
- 2 期
- 状态
- 已完成
- 发起方
- Immunic AG
- 入组人数
- 234
- 试验地点
- 4
- 主要终点
- Proportion of Patients Without Any Need for INV Until EoS
研究概览
简要总结
At present there is no approved drug treatment for Covid-19. In this study we plan to investigate if an experimental drug called IMU-838 (vidofludimus calcium) can improve your symptoms, prevent worsening that would initiate further treatments such as ventilation, and can lower your virus number if given in addition to your doctor's choice of standard therapy. We will also test if IMU-838 has any side effects and measure the level of IMU 838 in your blood.
Experimental drug means that it is not yet authorized for marketing in your country. To date approximately 600 individuals have received IMU-838 (or a drug similar to IMU-838 that contains the same active substance as IMU-838) in research studies.
详细描述
The trial consists of a Phase 2 proof-of-concept phase (Part 1) with the option to extend enrollment (without interruption) to Phase 3 (Expansion Phase, Part 2).
This trial is a multicenter, double-blind, placebo-controlled, randomized, parallel-group trial to evaluate the safety and efficacy of IMU-838 as addition to investigator's choice of SoC treatment in patients with COVID-19. Eligible patients will be centrally randomized 1:1 to twice-daily (BID) oral 22.5 mg IMU-838 (45 mg/day + SoC) or placebo (+ SoC). Randomization will be stratified by age (< or >=65 years) and antiviral therapy (no antivirals, Hydroxychloroquine and Chloroquine, all other antivirals).
Adaptive sequential trial design and overall trial design
The trial uses an adaptive sequential design. An IDMC will review unblinded data and provide the Sponsor with recommendations regarding modifications of sample size and trial conduct.
A 1st interim analysis (IA1) will be performed after approximately 200 patients have completed the trial (either as scheduled or prematurely), while enrollment continues. If no activity of IMU 838 is observed by the IDMC in this IA, further patient enrollment will be stopped, and a final analysis of Part 1 will be performed (FA1). It is expected that the final analysis of Part 1 will include approximately 230 patients. If the IA1 results indicate activity of IMU-838 in COVID-19, the trial may be extended to Part 2 with a revised sample size derived by the IDMC based on IA1 results and with possible other trial adjustments. If the trial is extended into Part 2, a 2nd IA (IA2) is planned after approximately two-thirds of patients (based on the overall global sample size [Part 1 and Part 2 combined]) have been enrolled to potentially adjust sample size and other trial features if needed. The final analysis of the trial (FA2) will then be done after all patients have completed Part 2.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Participant, Investigator)
盲法说明
Trial participants, the investigator and all other personnel directly involved in the conduct of the trial will be blinded to treatment assignments.
To maintain the blind, IMU-838 and placebo tablets will have identical appearance, shape and color, and will have identical labeling and packaging. To minimize the potential for bias, treatment randomization information will be kept confidential by the responsible personnel and will not be released to investigators, other trial center personnel, or the Sponsor's designee(s).
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Male or female patients at least 18 years old (may be extended to include also children 12 years or older after the 1st interim analysis)
- •Admitted to the hospital or other medical in-patient treatment facility for treatment of COVID-19 The hospitalization needs to be for medical reasons (treatment of COVID-19 disease) and cannot be for social reasons or due to housing insecurity.
- •For US sites only: If the investigator would commonly hospitalize the patient but for healthcare resource reasons decides to treat the patient in a specially designed out-patient setting, then such patients are also allowed to enter the trial (please note that in this case the patient would be counted as clinical status category 3). The investigator then must assure that the patient has at least a twice daily assessment by qualified trial personnel and all laboratory assessments can be adequately performed as per protocol. The Sponsor reserves the right to discontinue this option via administrative letter if such assurances cannot be met by any site.
- •SARS-CoV-2 infection confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) test in a nasopharyngeal, oropharyngeal or respiratory sample at ≤4 days before randomization
- •Moderate COVID-19 disease defined as fulfilling clinical status category 3 or 4 on the WHO 9-point ordinal scale [21]:
- •Category 3: Hospitalized (see note above for US only), virus-positive, no oxygen therapy with the following conditions:
- •The hospitalization needs to be for medical reasons (treatment of COVID-19 disease) and cannot be for social reasons or due to housing insecurity
- •Category 4: Hospitalized, virus-positive, oxygen by mask or nasal prongs (excluding high-flow oxygen therapy) with the following conditions:
- •Peripheral capillary oxyhemoglobin saturation (SpO2) >92% at maximum of 6 liters oxygen flow per minute
- •Stable respiratory rate ≤30 breaths/min at maximum of 6 liters oxygen flow per minute
- •Presence of at least 1 symptom characteristic for COVID-19 disease i.e., fever, cough or respiratory distress
- •Willingness and ability to comply with the protocol
- •Written informed consent given prior to any trial-related procedure
- •For women of childbearing potential: Application of a highly effective method of birth control (failure rate less than 1% per year when used consistently and correctly) together with a barrier method between trial consent and 30 days after the last intake of the IMP.
- •Highly effective forms of birth control are those with a failure rate less than 1% per year and include:
- •oral, intravaginal, or transdermal combined (estrogen and progestogen containing) hormonal contraceptives associated with inhibition of ovulation
- •oral, injectable, or implantable progestogen-only hormonal contraceptives associated with inhibition of ovulation
- •intrauterine device or intrauterine hormone-releasing system
- •bilateral tubal occlusion
- •vasectomized partner (i.e., the patient's male partner underwent effective surgical sterilization before the female patient entered the clinical trial and is the sole sexual partner of the female patient during the clinical trial)
- •sexual abstinence (acceptable only if it is the patient's usual form of birth control/lifestyle choice; periodic abstinence [e.g., calendar, ovulation, symptothermal, postovulation methods] and withdrawal are no acceptable methods of contraception)
- •Barrier methods of contraception include:
- •Occlusive cap (diaphragm or cervical/vault caps) with spermicidal gel/film/cream/suppository
- •Male patients must agree not to father a child or to donate sperm starting at Screening, throughout the clinical trial and for 30 days after the last intake of the IMP. Male patients must also
- •abstain from sexual intercourse with a female partner (acceptable only if it is the patient's usual form of birth control/lifestyle choice), or
- •use adequate barrier contraception during treatment with the IMP and until at least 30 days after the last intake of the IMP, and
- •if they have a female partner of childbearing potential, the partner should use a highly effective contraceptive method as outlined in inclusion criterion 8
- •if they have a pregnant partner, they must use condoms while taking the IMP to avoid exposure of the fetus to the IMP
排除标准
- •Underlying disease-related exclusion criteria
- •Involvement in the trial is not in the patient's best interest according to the investigator's decision, including the presence of any condition that would, in the assessment of the investigator, not allow the protocol to be followed safely Note: The investigator should particularly consider exclusion of patients at increased risk for serious or fatal AEs in case of worsening of the pulmonary perfusion. This includes, but is not limited to, pre-existing pulmonary hypertension, severe chronic respiratory disease, severely increased risk for thromboembolic complications and moderate to severe left ventricular ejection fraction (LVEF) dysfunction. In addition, other known risk factors of highest risk of mortality in COVID-19 patients should be considered.
- •Presence of respiratory failure, shock, and/or combined failure of other organs that requires ICU monitoring in the near foreseeable future
- •Critical patients whose expected survival time <48-72 hours
- •Presence of the following laboratory values at screening:
- •White blood cell count (WBC) <1.0 x 109/L
- •Platelet count <100,000/mm³ (<100 x 109/L)
- •Total bilirubin>2 x ULN
- •Alanine aminotransferase (ALT) or gamma glutamyl transferase (GGT) >5 x ULN
- •Participation in any other interventional clinical trial
- •Hospitalization primarily for other reasons than COVID-19 (including primarily for concomitant conditions during ongoing SARS-CoV-2 infection)
- •Anticipated transport to a different hospital or institution, in particular when such transport is anticipated for pending ECMO or RRT treatment
- •Clinical suspicion of a bacterial superinfection at Screening IMP-related exclusion criteria
- •Patients who cannot take drugs orally
- •Allergic or hypersensitive to the IMP or any of the ingredients
- •Use of the following concomitant medications is prohibited from Screening to end of treatment with IMP in this trial (up to Day 14) if not indicated otherwise in this protocol:
- •Concurrent use of any mycophenolate mofetil or of methotrexate exceeding 17.5 mg weekly
- •Any medication known to significantly increase urinary elimination of uric acid, in particular lesinurad (Zurampic™) as well as uricosuric drugs such as probenecid
- •Current treatments for any malignancy, in particular irinotecan, paclitaxel, tretinoin, bosutinib, sorafenib, enasidenib, erlotinib, regorafenib, pazopanib and nilotinib
- •Any drug significantly restricting water diuresis, in particular vasopressin and vasopressin analogs
- •Use of rosuvastatin at daily doses higher than 10 mg
- •Arbidol and Colchicine
- •Any use of other DHODH inhibitors, including teriflunomide (Aubagio™) or leflunomide (Arava™)
- •Chloroquine and Hydroxychloroquine during the entire trial unless taken for indicated use before entering the trial
- •Use of any investigational product within 8 weeks or 5x the respective half-life before the date of informed consent, whichever is longer, and throughout the duration of the trial General exclusion criteria
- •Patients who have a "do not intubate" or "do not resuscitate" order (unless the patient waives in writing this order and will allow intubation for the duration of the trial period)
- •Patients with end-stage liver disease (Child Pugh C score)
- •History or presence of serious or acute heart disease such as uncontrolled cardiac dysrhythmia or arrhythmia, uncontrolled angina pectoris, cardiomyopathy, or uncontrolled congestive heart failure (New York Heart Association [NYHA] class 3 or 4) Note: NYHA class 3: Cardiac disease resulting in marked limitation of physical activity. Patients are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea, or anginal pain. NYHA class 4: Cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.
- •Legal incapacity, limited legal capacity, or any other condition that makes the patient unable to provide consent for the trial
- •Pregnant or breastfeeding
- •An employee of an investigator or Sponsor or an immediate relative of an investigator or Sponsor
- •Patients institutionalized due to judicial order
研究组 & 干预措施
IMU-838
twice-daily (BID) oral 22.5 mg IMU-838 (45 mg/day + SoC)
干预措施: IMU-838 (Drug)
Placebo
twice-daily (BID) oral placebo (+ SoC)
干预措施: Placebo (Other)
结局指标
主要结局
Proportion of Patients Without Any Need for INV Until EoS
时间窗: Throughout the Study (Day 0 to Day 28)
Number of Participants Stratified as those With and Without the Need for INV Until End-of-study (EoS). For this outcome a worst case approach was used in which patients who were lost to follow-up or who discontinued the trial on or before Day 13 due to any other reason than death and discontinued with a last observed WHO clinical status no lower than that at Screening, and patients who died were considered as patients requiring INV.
次要结局
- Days to INV, RRT and ECMO(Throughout the Study (Day 0 to Day 28))
- Probability of ICU Admission(Throughout the Study (Day 0 to Day 28))
- Immunoglobulin (Ig)A and/or IgG Antibodies Against SARS-CoV-2(Day 6, 14 and 28)
- Cumulative Dose(Day 0 to day 14)
- Time to Clinical Recovery(Throughout the Study (Day 0 to EoS [Day 27 up to Day 42]))
- Plasma Levels of IMU-838(on Days 0, 1, 2, 3, 6, 14, and 28)
- Correlation of Trough Levels (Quartiles) to Selected Clinical Outcomes(Trough levels at Day 14; Clinical outcome: Day 0 to EoS (EoS = Day 27 up to Day 42))
- Number of Participants With Adverse Events (AEs) and Serious AEs(Throughout the Study (Day 0 to Day 28))
- Vital Signs: Height(at Baseline)
- Vital Signs: Weight(at Baseline)
- Vital Signs: Body Temperature (ºC)(at Baseline)
- Albumin Concentration at Various Time Points(Throughout the Study (Day 0 to Day 28))
- Hematocrit Ratio at Various Time Points(Throughout the Study (Day 0 to Day 28))
- Urine Creatinine at Various Time Points(Throughout the Study (Day 0 to Day 28))
- Temperature(Throughout the Study (Day 0 to Day 28))
- D-dimer(Throughout the Study (Day 0 to Day 28))
- Lactate Dehydrogenase (LDH)(Throughout the Study (Day 0 to Day 28))
- C-reactive Protein(Throughout the Study (Day 0 to Day 28))
- Procalcitonin(Throughout the Study (Day 0 to Day 28))
- Troponin I(Throughout the Study (Day 0 to Day 28))
- Correlation of Time to Clinical Improvement With Quartiles of D-Dimer Blood Levels at Day 6(D-Dimer levels at Day 6; Clinical outcome: Day 0 to EoS (EoS = Day 27 up to Day 42))
- Changing in Log 10 Copies in Spontaneous Sputum and Nasopharyngeal Swab Samples at Various Time Points(Throughout the Study (Day 0 to Day 28))
- Mean Viral Load - log10 Copies in Spontaneous Sputum and Nasopharyngeal Swab Samples(Throughout the Study (Day 0 to Day 28))
- Number of Participants With 2 Consecutive Negative SARS-CoV-2 Reverse Transcriptase Polymerase Chain Reaction Tests at Least 24 Hours Apart(Throughout the Study (Day 0 to Day 28))
- Rate of Conversion to a Negative SARS-CoV-2 (Qualitative) Test(on Day 28)
- Days in ICU Department(Throughout the Study (Day 0 to Day 28 ))
- All Cause Mortality (ITT Approach)(Throughout the Study (Day 0 to Day 28 ))
- Time to Clinical Improvement(Throughout the Study (Day 0 to Day 28))
- Days of Hospitalization(Throughout the Study (Day 0 to Day 28))
- Patients Free of Renal-replacement Therapy (RRT)* Until EoS(Throughout the Study (Day 0 to Day 28 ))
- Patients Required ECMO Until EoS(Throughout the Study (Day 0 to Day 28 ))
- Patients Free of INV Until Day 14*(Throughout the Study (Day 0 to Day 14 ))
- Patients Free of RRT(Day 0 to Day 14)
- Number of Patients Free of ECMO(Day 0 to Day 14)
- Patients With Improvement of at Least 2 Points (From Randomization) on the 9-category WHO Ordinal scale1(on Days 6, 14, and 28)
- Patients With Auxiliary Oxygen Therapy (Including All Types of Oxygen Therapy)(on Days 6, 14, and 28)
- Patients With Clinical Recovery(Throughout the Study (Day 0 to Day 28 ))
- Patients With Clinical Improvement or Live Discharge From Hospital Without Oxygen Supplementation(Throughout the Study (Day 0 to Day 28 ))
- Percentage of Participants With WHO Status<=2(on Days 6, 14, and 28)
- Duration of INV(Throughout the Study (Day 0 to Day 28 ))
- Days on ECMO(Throughout the Study (Day 0 to Day 28))
- Days on RRT(Throughout the Study (Day 0 to Day 28))
- Days of Auxiliary Oxygen Therapy(Throughout the Study (Day 0 to Day 28))
- Participants With ICU Admission(on Days 6, 14, and 28)
- Time to Conversion to a Negative SARS-CoV-2 (Qualitative) Test(Throughout the Study (Day 0 to Day 28))
- Interleukin (IL)-17(Day 0, 6, 14 and Day 28)
- Interleukin (IL)-1ß(Day 0, 6, 14 and Day 28)
- Interleukin (IL)-6(Day 0, 6, 14 and 28)
- Interferon Gamma (IFNγ)(Day 0, 6, 14 and 28)
- Tumor Necrosis Factor Alpha(Day 0, 6, 14 and 28)
- Probability of Death(Throughout the Study (Day 0 to Day 28))
- Days to INV(Throughout the Study (Day 0 to Day 28))
- Days to RRT(Throughout the Study (Day 0 to Day 28))
- Days to ECMO(Throughout the Study (Day 0 to Day 28))