A Trial to Investigate Recovery From COVID-19 With C21 in Adult Subjects

Phase 3

Completed

• Conditions: COVID-19
• Interventions: Drug: C21; Drug: Placebo

• Registration Number: NCT04880642
• Lead Sponsor: Vicore Pharma AB

Brief Summary

This trial is a randomized, double-blind, placebo-controlled, parallel-group, 2-arm, multicenter trial to evaluate the efficacy and safety of C21 versus placebo as add-on to standard of care (SoC) in adult subjects with COVID-19.

The trial planned to enroll a total of maximum 300 randomized subjects, 150 per arm (oral C21 100 mg twice a day (BID) or placebo for 14 days) according to the 1:1 randomization.

Detailed Description

The trial consists of 3 consecutive periods: a screening period of up to 48 hours, a 2-week investigational medicinal product (IMP) treatment period and a follow-up period of up to 7 weeks after last IMP intake.

All subjects went through a series of efficacy, safety, and laboratory assessments. Safety laboratory tests and samples for future exploratory analysis were obtained at the screening visit.

The trial duration for an individual subject was not exceeded 9 weeks.

Study Timeline

• Study First Submitted: 2021-04-28
• Study First Submitted QC: 2021-05-10
• Study First Posted: 2021-05-11
• Study Start: 2021-09-16
• Primary Completion: 2022-04-25
• Study Completion: 2022-04-25
• Results First Submitted: 2023-08-23
• Status Verified: 2023-12
• Results First Submitted QC: 2023-12-11
• Last Update Submitted: 2023-12-11
• Results First Posted: 2023-12-14
• Last Update Posted: 2023-12-14

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 272

Inclusion Criteria

1. Age ≥18 years or the legal age of consent in the jurisdiction in which the trial was taking place at the time of signing the informed consent (Specific for India; Age ≥18 to ≤65 years at the time of signing the informed consent)

2. Hospitalized due to SARS-CoV-2 infection confirmed by a hospital-approved polymerase chain reaction (PCR) test, documented by either of the following:

   1. PCR positive in sample collected <72 hours prior to randomization (Visit 2); OR
   2. PCR positive in sample collected ≥72 hours and ≤7 days prior to randomization, documented inability to obtain a repeat sample AND progressive disease suggestive of ongoing SARS-CoV-2 infection

3. A score of 5 or 6 on the 8-point ordinal scale:

   1. Score 5: Hospitalized, requiring supplemental oxygen
   2. Score 6: Hospitalized, on non-invasive ventilation or high-flow oxygen device

4. Contraceptive use by men and women of childbearing potential consistent with local regulations regarding the methods of contraception for those participating in clinical studies and according to Appendix 3 in the Protocol (see Section 10.3)

5. Written informed consent, consistent with International Council for Harmonization Good Clinical Practice Revision 2 and local laws, obtained before the initiation of any trial-related procedure

6. Capable of giving signed informed consent as described in Appendix 1 in the Protocol (see Section 10.1.3) which includes compliance with the requirements and restrictions listed in the informed consent form and in this Protocol

   Country specific:

7. Specific for India: For subjects with an ordinal scale score of 5, moderate to severe COVID-19 disease confirmed by at an SpO2≤93 % or a respiratory rate≥24/min on room air. Note: If a subject was on supplemental oxygen with SpO2>93% and respiratory rate<24/min, but desaturation to ≤93 % or increase of respiratory rate to ≥24/min on lower supplemental oxygen or room air is documented during screening, the inclusion criterion was considered to be met.

Exclusion Criteria

1. Concurrent serious medical condition which in the opinion of the investigator constituted a risk or a contraindication for the participation in the trial or that could interfere with the trial objectives, conduct or evaluation

2. Known, active tuberculosis, active hepatitis B, C, or human immunodeficiency virus (HIV) infection (i.e., HIV with a CD4 count<500 cells/mm³).

3. Moderate or severe impairment of hepatic function (e.g., Child-Pugh class B or C where alterations in the score components were not due to another underlying disease (see Section 8.4.5 in the Protocol)).

4. Severe renal impairment (i.e., estimated glomerular filtration rate (eGFR)≤30 ml/min/1.73m2)

5. COVID-19 symptom onset >21 days prior to screening (Visit 1).

6. Hospitalized due to COVID-19 for >72 hours at screening (Visit 1).

7. Invasive mechanical ventilation or ECMO within 72 hours of screening (Visit 1).

8. Expected need for invasive mechanical ventilation or ECMO in <48 hours in the opinion of the investigator

9. Moderate to severe ARDS (e.g., same-day PaO2/FiO2 ≤200 mmHg; or SpO2/FiO2 ≤232 if arterial blood gas test is not available), if on non-invasive mechanical ventilation or high-flow oxygen.

10. Pregnant or breast-feeding female subjects

11. Any previous and concurrent experimental treatment for COVID-19 that was not considered local SoC.

12. Treatment with the medications listed below within 1 week prior to screening (Visit 1) or anticipated need for such medication during the participation in this trial:

    1. Strong Cytochrome P450 (CYP) 3A4 inducers.
    2. P-glycoprotein (P-gp) substrates with narrow therapeutic index.
    3. High dose Breast Cancer Resistance Protein (BCRP) sensitive substrates.
    4. Warfarin.
    5. Sulphasalazine or rosuvastatin.

13. Current or previous participation in any other clinical trial where the subject had received a dose of IMP within 1 month or 5 half-lives of the IMP, whichever was longest, prior to screening (Visit 1).

14. Positive pregnancy test (see Section 8.4.6 in the Protocol).

15. Abnormal laboratory value at screening (Visit 1) indicating a potential risk for the subject if enrolled in the trial as evaluated by the investigator

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
C21	C21	50 mg capsules, oral administration twice daily,for 14 days
Placebo	Placebo	placebo capsules, oral administration twice daily,for 14 days

Primary Outcome Measures

Name	Time	Method
All-cause Mortality up to Day 60	Day 1 to Day 60	Proportion of subjects in the mITT (all randomised, including 5 subjects not treated) with death up to Day 60 follow-up

Secondary Outcome Measures

Name	Time	Method
Proportion of Subjects Discharged From Hospital and Free of Supplemental Oxygen at Day 15	Day 15	Proportion of subjects discharged from hospital and free of supplemental oxygen at Day 15. Missing data imputed by MI, proportion given are average over the imputations.
Time to Sustained Hospital Discharge up to Day 60	Day 1 to Day 60	Time to sustained hospital discharge from Day 1 to Day 60: Time to sustained hospital discharge was defined as the time to the date of discharge from the initial hospitalization or re-hospitalization due to COVID-19 after which the subject was not re-hospitalized for COVID-19 related reasons.
Proportion of Subjects Free of Respiratory Failure, Defined as an 8-point Ordinal Scale Score ≤5, at Day 15	Day 15	Proportion of subjects free of respiratory failure, defined as an 8-point ordinal scale score ≤5, at Day 15. Missing data imputed by MI, proportion given are average over the imputations.
Supplemental Oxygen-free Days up to Day 29	Day 1 to Day 29, maximum 28 Days	Supplemental oxygen-free days from Day 1 up to Day 29, observed range 0 to 28 days. Subjects with deaths imputed as -1 day according to SAP and FDA guidance. Outcome was identical in both groups for both median and range

Trial Locations

Locations (60)

West Visayas State University Medical Center; 🇵🇭 Iloilo City, Philippines

Parkview Physicians Group - Infectious Diseases; 🇺🇸 Fort Wayne, Indiana, United States

Regional Clinical Hospital of Infectious Diseases; 🇺🇦 Kharkiv, Ukraine

St. Petersburg State Budgetary Healthcare Institution City Hospital Number 40 of the Kurortny District; 🇷🇺 Saint Petersburg, Russian Federation

Instituto Atena de Pesquisa Clínica; 🇧🇷 Natal, Rio Grande Do Norte, Brazil

Mediclinic Southern Africa; 🇿🇦 Tongaat, KwaZulu-Natal, South Africa

University of California Irvine Medical Center; 🇺🇸 Orange, California, United States

Northwestern Medicine Central DuPage Hospital; 🇺🇸 Winfield, Illinois, United States

Carilion Roanoke Memorial Hospital; 🇺🇸 Roanoke, Virginia, United States

Trinity Health; 🇺🇸 Minot, North Dakota, United States

Lehigh Valley Hospital - 17th Street; 🇺🇸 Allentown, Pennsylvania, United States

Hospital Italiano Rosario - Centro; 🇦🇷 Rosario, Santa Fe, Argentina

Instituto Médico Río Cuarto; 🇦🇷 Río Cuarto, Córdoba, Argentina

Nuevo Hospital San Roque; 🇦🇷 Córdoba, Argentina

Hospital Brasília; 🇧🇷 Brasília, Brazil

Hospital das Clínicas da Faculdade de Medicina de Botucatu; 🇧🇷 Botucatu, Brazil

Hospital de Clínicas de Porto Alegre; 🇧🇷 Porto Alegre, Brazil

Fundação Universidade de Caxias do Sul; 🇧🇷 Caxias Do Sul, Brazil

Centro de Pesquisas Clínicas de Natal; 🇧🇷 Natal, Brazil

Hospital Alemão Oswaldo Cruz - Paulista; 🇧🇷 São Paulo, Brazil

Fundación Santa Fe de Bogotá; 🇨🇴 Bogotá, Cundinamarca, Colombia

Fakultní Nemocnice u sv. Anny v Brně II. Interní Klinika kardiologická JIP,; 🇨🇿 Brno, South Moravian, Czechia

Clinica Somer; 🇨🇴 Rionegro, Antioquia, Colombia

Fakultní Nemocnice u sv. Anny v Brne Number 1; 🇨🇿 Brno, Czechia

Hospital Universitario San Ignacio; 🇨🇴 Bogotá, Cundinamarca, Colombia

Nemocnice Slaný; 🇨🇿 Slaný, Czechia

Masarykova nemocnice v Ústí nad Labem; 🇨🇿 Ústí Nad Labem, Czechia

Chettinad Hospital and Research Institute; 🇮🇳 Mahabalipuram, Chennai, India

Civil Hospital and B J Medical College; 🇮🇳 Ahmedabad, Gujarat, India

Malabar Medical College Hospital and Research Centre; 🇮🇳 Kozhikode, Kerala, India

Elite Mission Hospital; 🇮🇳 Thrissur, Kerala, India

Jawaharlal Nehru Institute of Medical Sciences; 🇮🇳 Imphal, Manipur, India

Noble Hospital; 🇮🇳 Pune, Maharashtra, India

Rajiv Gandhi Medical College; 🇮🇳 Thāne, Maharashtra, India

The Medical City; 🇵🇭 Iloilo City, Iloilo, Philippines

Southern Philippines Medical Center; 🇵🇭 Davao City, Philippines

Makati Medical Center; 🇵🇭 Makati, Philippines

Alexandrovskaya State Hospital; 🇷🇺 Saint Petersburg, Russian Federation

Lung Center of the Philippines; 🇵🇭 Quezon City, Philippines

Quirino Memorial Medical Center; 🇵🇭 Quezon City, Philippines

Pokrovskaya City Hospital; 🇷🇺 Saint Petersburg, Russian Federation

Clinical Infectious Disease Hospital 1 of the Moscow Department of Health; 🇷🇺 Moscow, Russian Federation

Nikolaevskaya State Hospital; 🇷🇺 Saint Petersburg, Russian Federation

TASK Eden; 🇿🇦 George, Western Cape, South Africa

Tygerberg Hospital; 🇿🇦 Tygerberg Hills, Western Cape, South Africa

Oleksandrivska Kyiv City Clinical Hospital; 🇺🇦 Kyiv, Ukraine

Hospital №1 of Zhytomyr City Council; 🇺🇦 Zhytomyr, Ukraine

Kyiv city clinical hospital number 12; 🇺🇦 Kiev, Ukraine

Rhythm Heart Institute; 🇮🇳 Vadodara, Gujarat, India

Chirayu Medical College and Hospital; 🇮🇳 Bhopal, Madhya Pradesh, India

Smt. Kashibai Navale Medical College and General Hospital; 🇮🇳 Pune, Gujarat, India

Hospital Italiano Rosario; 🇦🇷 Rosario, Santa Fe, Argentina

St. Luke's Medical Center - Global City; 🇵🇭 Taguig, Philippines

Zaporizhzhia Regional Clinical Hospital; 🇺🇦 Zaporizhia, Zaporizhzhia, Ukraine

Vinnytsia City Clinical Hospital №1; 🇺🇦 Vinnytsia, Ukraine

City Clinical Hospital №6 of the Dnipro City Council; 🇺🇦 Dnipropetrovs'k, Ukraine

City Clinical Hospital №13" Of Kharkiv City Council; 🇺🇦 Kharkiv, Ukraine

Government Medical College and Hospital; 🇮🇳 Nagpur, Maharashtra, India

Meditrina Institute of Medical Sciences; 🇮🇳 Nagpur, Maharashtra, India

Ruby Hall Clinic; 🇮🇳 Pune, Maharashtra, India