Study of TB006 in Outpatient Patients With Mild to Moderate COVID-19

Phase 1

Withdrawn

• Conditions: Covid19
• Interventions: Drug: TB006; Other: Placebo

• Registration Number: NCT04801056
• Lead Sponsor: TrueBinding, Inc.

Brief Summary

TB006, a monoclonal antibody, is an anti-inflammatory and anti-fibrotic agent that reduces the severity of underlying diseases in COVID-19 patients. The primary objective of TB006 treatment is to decrease the potential acute severe deterioration in outpatient COVID-19 patients with underlying diseases, such as diabetes, hypertension, and cancer. TB006 has been developed to treat the ambulatory patients with diagnosed mild to moderate COVID-19 who are considered at low risk for severe disease or hospitalization.

Detailed Description

TB006, a monoclonal antibody, is an anti-inflammatory and anti-fibrotic agent that reduces the severity of underlying diseases in COVID-19 patients. The primary objective of TB006 treatment is to decrease the potential acute severe deterioration in outpatient COVID-19 patients with underlying diseases, such as diabetes, hypertension, and cancer. TB006 has been developed to treat the ambulatory patients with diagnosed mild to moderate COVID-19 who are considered at low risk for severe disease or hospitalization.

In the single ascending dose study, the dosages of 5 mg/kg \~ 50 mg/kg will be investigated in patients with mild to moderate COVID-19, and will be administered to patients over 60 minutes after dilution in 0.9% Sodium Chloride Injection, USP (normal saline) to a final volume of 250 mL. The primary objective of the SAD study is to evaluate the safety and tolerability of single ascending doses of TB006 vs placebo administered via i.v. infusion in outpatient patients with mild-to-moderate COVID-19 and to determine the dose recommended for Phase Ib study.

Study Timeline

• Study First Submitted: 2021-03-11
• Study First Submitted QC: 2021-03-15
• Study First Posted: 2021-03-16
• Study Start: 2021-06-01
• Primary Completion: 2021-09-01
• Study Completion: 2021-09-01
• Status Verified: 2022-05
• Last Update Submitted: 2022-05-11
• Last Update Posted: 2022-05-18

Recruitment & Eligibility

• Status: WITHDRAWN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

Inclusion Criteria

1. Willing and able to provide written informed consent prior to performing study procedures (or legally authorized representative able to provide consent on the patient's behalf).

2. Age ≥ 18 years

3. A positive Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) infection confirmed by polymerase chain reaction (PCR) test or an equivalent test ≤ 3 days before randomization

4. Patients with mild to moderate COVID-19 experiencing any of the following symptoms:

   • Mild (without shortness of breath or dyspnea): Fever, cough, sore throat, malaise, headache, muscle pain, gastrointestinal symptoms
   • Moderate: Any symptom of mild illness, shortness of breath with excursion, clinically suggestive of moderate illness with COVID-19, such as respiratory rate ≥ 20 breaths per minute, saturation of oxygen (SpO2) > 93% on room air at sea level, heart rate ≥ 90 beats per minute

5. At low risk for progressing to severe COVID-19 and/or hospitalization.

6. Adequate organ function at screening as evidenced by:

   • Hemoglobin > 10.9 g/dL
   • Absolute neutrophil count (ANC) > 1.0 × 10^9/L
   • Platelets > 125 × 10^9/L
   • Alanine Aminotransferase (ALT) or aspartate aminotransferase (AST) < 1.25 × upper limit of normal (ULN)
   • Creatinine clearance > 90 mL/min using the Cockcroft-Gault formula for patients ≥ 18 years of age [Cockcroft 1976]

7. Normal electrocardiogram with QTcF of ≤ 450 ms

Exclusion Criteria

1. Participation in any other clinical trial of an experimental treatment for COVID-19

2. Clinical signs indicative of Severe or Critical Illness Severity

   • SEVERE:

   • Any symptom of severe, systematic illness, including moderate illness, shortness of breath, or respiratory distress

   • Clinically suggestive of severe illness with COVID-19, such as respiratory rate ≥ 30 breaths per minute, heart rate ≥ 125 per minute, saturation of oxygen (SpO2) ≤ 93% on room air at sea level, or PaO2/FiO2 < 300

   • CRITICAL ILLNESS (one of the following):

   • Respiratory failure defined based on resource utilization requiring at least one of the following:

     1. Endotracheal intubation and mechanical ventilation, oxygen delivered by high483 flow nasal cannula (heated, humidified, oxygen delivered via reinforced nasal cannula at flow rates > 20 L/min with fraction of delivered oxygen ≥ 0.5)
     2. Noninvasive positive pressure ventilation, ECMO, or clinical diagnosis of respiratory failure (i.e., clinical need for one of the preceding therapies, but preceding therapies not able to be administered in setting of resource limitation)

   • Shock (defined by systolic blood pressure < 90 mm Hg, or diastolic blood pressure < 60 mm Hg or requiring vasopressors)

   • Multi-organ dysfunction/failure

3. Have a history of a positive SARS-CoV-2 serology test

4. Evidence of shock (defined by systolic blood pressure < 90 mm Hg, or diastolic blood pressure < 60 mm Hg or requiring vasopressors)

5. Patients who are hospitalized due to COVID-19

6. Patients who required oxygen therapy due to COVID-19

7. Patients who required mechanical ventilation or anticipated impending need for mechanical ventilation

8. Receiving V-V ECMO ≥ 5 days, or any duration of V-A ECMO

9. Have a history of convalescent COVID-19 plasma treatment

10. Women who are pregnant or breastfeeding

11. Male or female of childbearing potential who has plans to become pregnant during the study period and for six months after the clinical study or who is not willing to take appropriate contraceptive measures (e.g., concomitant use of a spermicidal agent, barrier contraceptive, or/and intrauterine contraceptive)

12. Viral disease (HIV, HBV, HCV, etc.) other than COVID-19 that are not adequately controlled or require administration of other antiviral agents or medications that could potentially interact with TB006

13. Patients with a history or current evidence of any concomitant condition, therapy, or laboratory abnormality that, in the opinion of the investigator, might confound the results of the trial, interfere with the patient's participation and compliance

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
TB006	TB006	During the SAD study, subjects will receive a single dose of TB006 (at the dosage level of 10 \~ 50 mg/kg) administered via i.v. infusion for 60 mins. In addition, a sentinel cohort of 5 mg/kg will be open for enrollment and double-blinded randomization first, with 2 patients randomized to active/TB006 arm, to assess preliminary safety and tolerability of study drug, and to determine cohort expansion and dose escalation. Upon the completion of sentinel cohort and all subjects are safe and well tolerate study treatment, regular dose escalation will start.
Placebo	Placebo	During the SAD study, subjects will receive a single dose of the placebo administered via i.v. infusion for 60 mins. In addition, the corresponding sentinel placebo group will include 1 patient to placebo arm. Upon the completion of sentinel cohort and all subjects are safe and well tolerate study treatment, regular dose escalation will start.

Primary Outcome Measures

Name	Time	Method
Treatment emergent adverse events	Baseline to Day 85	Evaluated as per DAIDS v2.1

Secondary Outcome Measures

Name	Time	Method
Pharmacokinetic parameters of TB006: AUC(0-last)	Day 1 to Day 85	- Area under the plasma concentration curve over time (hr\*µg/mL)
Pharmacokinetic parameters of TB006: Cmax	Day 1 to Day 85	- Maximum concentration of TB006 (µg/mL)
Pharmacokinetic parameters of TB006: Tmax	Day 1 to Day 85	- The amount of time that TB006 is present at the maximum concentration (hours)
Pharmacokinetic parameters of TB006: T1/2	Day 1 to Day 85	- Half life of TB006 (hours)
Immunogenicity	Day 1 to Day 85	- Anti-drug antibodies (ADA)
Preliminary Efficacy: Viral shedding change	Day 1 to Day 28	Change from baseline in viral shedding from Day 1 to Day 28, as measured by RT-qPCR
Preliminary Efficacy: Viral shedding change at each visit	Baseline to Day 28	Change from baseline in viral shedding at each visit through Day 28, as measured by RT-qPCR
Preliminary Efficacy: Time to viral shedding clearance	Baseline to Day 85	Measure the time to viral shedding clearance
Preliminary Efficacy: Proportion of treated patients with ≥ 1 COVID-19 related medically-attended visit through Day 28	Baseline to Day 28	Proportion of treated patients with ≥ 1 COVID-19 related medically-attended visit through Day 28
Preliminary Efficacy: Total number of COVID-19 related medically-attended visits	Baseline to Day 28	Number of COVID-19 related medically-attended visits during study
Preliminary Efficacy: Proportion of treated patients admitted to a hospital due to COVID-19	Baseline to Day 28	Proportion of patients admitted to a hospital by Day 28
Preliminary Efficacy: Time to sustained clinical recovery from baseline	Baseline to Day 85	Time to sustained clinical recovery from baseline to end of follow-up visits
Preliminary Efficacy: Clinical improvement from baseline at each visit through Day 28 (in patients with or without underlying comorbidities	Baseline to Day 28	Measured by change in score according to the World Health Organization (WHO) ordinal scale, ranging from 0 (uninfected) to 8 (dead)