Trial of Tocilizumab for Treatment of Severe COVID-19: ARCHITECTS
- Registration Number
- NCT04412772
- Lead Sponsor
- Queen's Medical Center
- Brief Summary
The overall objective is to evaluate the clinical efficacy and safety of tocilizumab relative to placebo among approximately 300 hospitalized adult patients who have severe COVID-19. The study will be a 2 arm double blinded comparison between tocilizumab 8 mg/kg and matching placebo IV. The dose may be repeated in 8-12 hours if clinical symptoms worsens, (e.g. increase in oxygen requirements). Participants will be followed for 28 days.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 300
- ii. Hospitalized with COVID-19 pneumonia, based on chest X-ray or CT scan AND iii. Evidence of hyperinflammation: IL-6>40pg/mL (if available) OR CRP >2 mg/dL OR ferritin >2000 ng/mL AND iv. One or more of the following: impending need for requiring invasive or non-invasive mechanical ventilation OR shock requiring vasopressor (without evidence of bacterial / fungal infection) OR need for extracorporeal membrane oxygenation (ECMO) OR severe, refractor ARDS (PaO2/FiO2<200 mmHg)
Known severe allergic reactions to tocilizumab or other monoclonal antibodies
- Active tuberculosis infection based on history
- Suspected active bacterial, fungal, viral, or other infection (besides COVID-19)
- In the opinion of the investigator, progression to death is imminent and inevitable within the next 24 hours, irrespective of the provision of treatments
- Have received oral anti-rejection or immunomodulatory drugs (including tocilizumab) with the past 6 months
- Participating in other drug clinical trials (participation in COVID-19 trials allowed)
- Self-reported pregnant or breastfeeding
- Any serious medical condition or abnormality of clinical laboratory tests that, in the investigator's judgment, precludes the patient's safe participation in and completion of the study
- Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 10 x upper limit of normal (ULN) detected within 24 hours at baseline
- Absolute neutrophil count (ANC) < 1000/mL at baseline
- Platelet count < 50,000/mL at baseline
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Tocilizumab (TCZ) Arm Tocilizumab Participants will receive 1 intravenous (IV) infusion of TCZ, dosed at 8 mg/kg, up to a maximum dose 800 mg. Up to 1 additional dose may be given if clinical symptoms worsen. Placebo Arm Placebo Participants will receive 1 IV infusion of placebo matched to TCZ. Up to 1 additional dose may be given if clinical symptoms worsen.
- Primary Outcome Measures
Name Time Method Clinical status (on a 7-point ordinal scale) at day 28 up to day 28 Clinical Status 7-point ordinal scale:
1. Not hospitalized, no limitations on activities
2. Not hospitalized, limitation on activities
3. Hospitalized, not requiring supplemental oxygen
4. Hospitalized, requiring supplemental oxygen
5. Hospitalized, on non-invasive ventilation or high flow oxygen devices
6. Hospitalized, on invasive mechanical ventilation or ECMO
7. Death
- Secondary Outcome Measures
Name Time Method Oxygenation up to day 28 vi. Duration of time on supplemental oxygen
Clinical improvement up to day 28 ii. Time to clinical improvement, defined as a National Early Warning Score (NEWS) of \< 2 maintained for 24 hours iii. Time to clinical improvement of at least 2 categories relative to baseline on a 7-category ordinal scale of clinical status
Mechanical Ventilation up to day 28 iv. Incidence of mechanical ventilation v. Ventilator-free days
Trial Locations
- Locations (1)
Queen's Medical Center
🇺🇸Honolulu, Hawaii, United States