Intravenous Aviptadil for Critical COVID-19 With Respiratory Failure

Phase 2

Completed

Conditions: Corona Virus Infection
Critical COVID-19 With Respiratory Failure
Acute Lung Injury
Acute Respiratory Distress Syndrome (ARDS)

Interventions: Drug: Aviptadil by intravenous infusion + standard of care
Drug: Normal Saline Infusion + standard of care

Registration Number: NCT04311697

Lead Sponsor: APR Applied Pharma Research s.a.

Brief Summary: Novel Corona Virus (SARS-CoV-2) is known to cause Respiratory Failure, which is the hallmark of Acute COVID-19, as defined by the new NIH/FDA classification. Approximately 50% of those who develop Critical COVID-19 die, despite intensive care and mechanical ventilation. Patients with Critical COVID-19 and respiratory failure, currently treated with high flow nasal oxygen, non-invasive ventilation or mechanical ventilation will be treated with ZYESAMI (aviptadil), a synthetic form of Human Vasoactive Intestinal Polypeptide (VIP) plus maximal intensive care vs. placebo + maximal intensive care. Patients will be randomized to intravenous Aviptadil will receive escalating doses from 50 -150 pmol/kg/hr over 12 hours.

Detailed Description: Acute Lung Injury, which triggers Critical COVID-19 is a known lethal complication of Corona Virus (SARS-CoV-2) infection. Conventional medical therapy, including intensive care and respiratory support is associated with an 80% mortality. Aviptadil, a synthetic form of Human Vasoactive Intestinal Polypeptide (VIP) has been awarded FDA Orphan Drug Designation for the treatment of ARDS and admitted to the FDA CoronaVirus Technology Accelerator Program.

VIP binds to VPAC1 receptors on the pulmonary Alveolar Type II (ATII) cell. ATII cells comprise only 5% of lung epithelial cells but are critical for oxygen transfer, surfactant production, and maintenance of Alveolar Type 1 cells. 70% of VIP binds to this receptor. The Type II cell is also the cell selectively attacked by the SARS-CoV-2 virus via the ACE2 surface receptor.

Nonclinical studies demonstrate that VIP is highly concentrated in the lung and specifically bound to the ATII cell, where it prevents NMDA-induced caspase-3 activation in the lung, inhibits IL6 and TNFa production, protects against HCl-induced pulmonary edema, and upregulates surfactant production, These and other effects have been observed in numerous animal model systems of lung injury in mice, rats, guinea pigs, sheep, swine, and dogs. In these models, Aviptadil restores barrier function at the endothelial/alveolar interface and thereby protects the lung and other organs from failure.

Aviptadil ihas a demonstrated 20 year history of safety in phase 2 trials for Sarcoid, Pulmonary Fibrosis, Bronchospasm, and a phase I trial in ARDS. In that phase I trial, 8 patients with severe ARDS on mechanical ventilation were treated with ascending doses of VIP. Seven of the 8 patients were successfully extubated and were alive at the five day timepoint. Six left the hospital and one died of an unrelated cardiac event.

Five phase 2 trials of aviptadil have been conducted under European regulatory authority. Numerous healthy volunteer studies have shown that i.v. infusion of Aviptadil is well tolerated with few adverse effects including alterations in blood pressure, heart rate, or ECG. In addition to published studies of human use, Aviptadil has been used on a compounded basis in certain ICUs for many years in the belief that it preserves life and restores function in pulmonary hypertension, ARDS, and Acute Lung Injury (ALI).

In this study, patients who are hospitalized for Critical COVID-19 infection with respiratory failure will be randomly allocated to Aviptadil administered by intravenous infusion in addition to maximal intensive care vs. maximal intensive care alone. Primary endpoints will be improvement in blood oxygenation and mortality.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 203

Inclusion Criteria

Critical COVID-19 with respiratory failure
Physician determination that patient is on maximal conventional medical therapy

Exclusion Criteria

Pregnancy (pregnant women may apply for open label treatment under compassionate care IND
Age <18 years
Mechanical ventilation for more than 7 days in primary cohort. Mechanical ventilation>21 days in the exploratory cohort
Mean Arterial Pressure < 65 mm Hg with use of pressor per ICU protocol
Irreversible condition (other than COVID-19) with projected fatal course
ECMO
Current or recent (within 30 d) enrollment in another investigational trial of anti-IL6 drug;
Active diagnosis of Acquired immune deficiency syndrome;
Transplant patients currently immunosuppressed;
Chemotherapy-induced neutropenia (granulocyte count <1000/mm3);
Cardiogenic shock; congestive heart failure - NYHA Class 3 or 4;
Recent myocardial infarction - within last 6 months and troponin > 0.5
Anuria (urine output < 50 ml/d) or other signs of multi-organ failure
Severe liver disease with portal hypertension;
Recent stroke or head trauma within last 12 months
Increased intracranial pressure, or other serious neurologic disorder;
Liquid Diarrhea more than 3x/day; defined as more than 3 non-bloody watery stools within a 24-hour period, requiring additional fluid and electrolyte supplementation

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Aviptadil IV in escalating doses + standard of care	Aviptadil by intravenous infusion + standard of care	Patients will be administered Aviptadil IV in escalating doses of 50 pmol, 100 pmol, 150 pmol/kg/hr
Placebo + standard of care	Normal Saline Infusion + standard of care	Patients will first be treated with placebo infusion + maximal intensive care

Primary Outcome Measures

Name	Time	Method
Resolution of Respiratory Failure (Alive and Free of Respiratory Failure)	Day 28	Participant is Alive and Free of Respiratory Failure (without subsequent relapse over 7 days) determined as no longer requiring acute care or more than low flow oxygen

Secondary Outcome Measures

Name	Time	Method
Oxygenation Index as Measured by PaO2:FiO2 Ratio	Day 7	oxygenation index (also known as Respiratory Distress Ratio) as measured by PaO2:FiO2 ratio (Respiratory Distress while on mechanical ventilation). RDR: PaO2:FiO2 represents an intermediate clinical endpoint that is known to be predictive of survival. RDR can only be measured in patients on mechanical ventilation because of its reliance on arterial blood gas measurements that are not routinely collected in non-intubated patients. A higher score indicates a better clinical outcome.
Number of Participants Alive at Day 60	Day 60	Survival probability on logistic regression through day 60
Number of Participants Achieving a Score of 6-8 on NIAID Ordinal Score Through Day 60	Day 60	Achievement of score 6-8 on NIAID Ordinal Scale through day 60 The NIAID score is the patient's status on the following 8-point scale:1)Death2)Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO),3)Hospitalized, on non-invasive ventilation or high flow oxygen devices4)Hospitalized, requiring supplemental oxygen5)Hospitalized, not requiring supplemental oxygen - requiring ongoing medical care (COVID-19 related or otherwise)6)Hospitalized, not requiring supplemental oxygen - no longer requires ongoing medical care7)Not hospitalized, limitation on activities and/or requiring home oxygen8)Not hospitalized, no limitations on activities-- a lower NIAID score is a worse outcome.

Trial Locations

Locations (10): St. Jude Medical Center
🇺🇸
Fullerton, California, United States
Hendrick Health
🇺🇸
Abilene, Texas, United States
Baptist Hospital of Miami
🇺🇸
Miami, Florida, United States
Heartland/Mosaic Health
🇺🇸
Saint Joseph, Missouri, United States
Miller School of Medicine / University of Miami Medical Center
🇺🇸
Miami, Florida, United States
University of California - Irvine
🇺🇸
Irvine, California, United States
Texas Health Hospital Frisco
🇺🇸
Frisco, Texas, United States
Houston Methodist Hospital
🇺🇸
Houston, Texas, United States
Texas Health Harris Methodist Hospital
🇺🇸
Fort Worth, Texas, United States
University of Louisville Hospital
🇺🇸
Louisville, Kentucky, United States