Nitric Oxide Gas Inhalation Therapy for Mild/Moderate COVID19 Infection

Phase 2

Withdrawn

• Conditions: Pneumonia, Viral; Coronavirus Infections; Dyspnea
• Interventions: Drug: Nitric Oxide

• Registration Number: NCT04290858
• Lead Sponsor: Xijing Hospital

Brief Summary

The scientific community is in search for novel therapies that can help to face the ongoing epidemics of novel Coronavirus (COVID-19) originated in China in December 2019. At present, there are no proven interventions to prevent progression of the disease. Some preliminary data on SARS pneumonia suggest that inhaled Nitric Oxide (NO) could have beneficial effects on COVID-19 due to the genomic similarities between this two coronaviruses. In this study we will test whether inhaled NO therapy prevents progression in patients with mild to moderate COVID-19 disease.

Detailed Description

To date, no targeted therapeutic treatments for the ongoing COVID-19 outbreak have been identified. Antiviral combined with adjuvant therapies are currently under investigation. The clinical spectrum of the infection is wide, ranging from mild signs of upper respiratory tract infection to severe pneumonia and death.

In the patients who progress, the time period from symptoms onset to development of dyspnea is reported to be between 5 to 10 days, and that one to severe respiratory distress syndrome from 10 to 14 days. Globally, 15 to 18% of patients deteriorates to the need of mechanical ventilation, despite the use of non-invasive ventilatory support in the earliest phases of the disease. Probability of progress to end stage disease is unpredictable, with the majority of these patients dying from multi-organ failure. Preventing progression in spontaneously breathing patients with mild to moderate disease would translate in improved morbility and mortality and in a lower use of limited healthcare resources.

In 2004, during the SARS-coronavirus (SARS-CoV) outbreak, a pilot study showed that low dose ( max 30 ppm) inhaled NO for 3 days was able to shorten the time of ventilatory support. At the same time, NO donor compound S-nitroso-N-acetylpenicillamine increased survival rate in an in-vitro model of SARS-CoV infected eukaryotic cells.Based on the genetic similarities between the two viruses, similar effects of NO on COVID-19 can be hypothesized. While further in-vitro testing is recommended, we proposed a randomized clinical trial to test the effectiveness of inhaled NO in preventing the progression of COVID-19 related disease, when administered at an early stage.

Study Timeline

• Study First Submitted: 2020-02-27
• Study First Submitted QC: 2020-02-28
• Status Verified: 2020-03
• Study Start: 2020-03-01
• Study First Posted: 2020-03-02
• Last Update Submitted: 2020-03-22
• Last Update Posted: 2020-03-24
• Primary Completion: 2021-03-01
• Study Completion: 2022-02-01

Recruitment & Eligibility

• Status: WITHDRAWN
• Sex: All
• Target Recruitment: Not specified

Inclusion Criteria

1. Laboratory confirmed COVID19 infection defined with a positive RT-PCR from any specimen.

2. Hospital admission with at least one of the following:

   • fever ≥ 36.6 °C from axillary site; or ≥ 37.2°C from oral site; or ≥ 37.6°C from tympanic or rectal site.
   • Respiratory rate ≥ 24 bpm
   • cough

3. Spontaneous breathing with or without hypoxia of any degree. Gas exchange and ventilation maybe assisted by any continuous continuous airway pressure (CPAP), or any system of Non Invasive Ventilation (NIV), with Positive End-Expiratory Pressure (PEEP) ≤ 10 cmH2O.

4. ≤ 8 days since onset of the symptoms

Exclusion Criteria

1. Pregnancy, or positive pregnancy test in a predose examination
2. Open tracheostomy
3. Therapy with high flow nasal cannula
4. Clinical controindication, as deemed by the attending physician

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Nitric Oxide inhalation	Nitric Oxide	Nitric Oxide will be delivered through a non invasive CPAP system (with minimal pressure support to decrease discomfort due to the facial mask) or through a non-rebreathing mask system.

Primary Outcome Measures

Name	Time	Method
Reduction in the incidence of intubation and mechanical ventilation	28 days	The primary outcome will be the proportion of patients with mild COVID2019 who deteriorate to a severe form of the disease requiring intubation and mechanical ventilation. Patients with indication to intubation and mechanical ventilation but concomitant DNI (Do Not Intubate) or not intubated for any other reason external to the clinical judgment of the attending physician will be considered as meeting the criteria for the primary endpoint.

Secondary Outcome Measures

Name	Time	Method
Negative conversion of COVID-19 RT-PCR from upper respiratory tract	7 days	Proportion of patients with a negative conversion of RT-PCR from an oropharyngeal or a nasopahryngeal swab
Mortality	28 days	Mortality from all causes
Time to clinical recovery	28 days	Time from initiation of the study to discharge or to normalization of fever (defined as \<36.6°C from axillary site, or \< 37.2°C from oral site or \< 37.8°C from rectal or tympanic site), respiratory rate (\< 24 bpm while breathing room air) and alleviation of cough (defined as mild or absent in a patient reported scale of severe \>\>moderate\>\>mild\>\>absent).