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Study to Evaluate the Efficacy and Safety of Tocilizumab Versus Corticosteroids in Hospitalised COVID-19 Patients With High Risk of Progression

Primary Purpose

COVID-19

Status
Unknown status
Phase
Phase 3
Locations
Malaysia
Study Type
Interventional
Intervention
Tocilizumab
Methylprednisolone
Sponsored by
University of Malaya
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for COVID-19 focused on measuring COVID-19

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

1) Hospitalised symptomatic COVID-19 patients 2( Presence of clinical and radiological signs of progressive disease, AND laboratory evidence indicative of risk for cytokine storm complications.

All patients participating in this clinical trial must meet the following inclusion criteria:

  1. Hospitalised symptomatic COVID-19 patients
  2. Presence of clinical and radiological signs of progressive disease, AND laboratory evidence indicative of risk for cytokine storm complications:

    Clinical:

    Dyspnoea OR RR>20 breaths/min AND O2 sat <93% on RA OR increasing need for O2 supplementation to maintain O2 sat >95% on RA

    WITH

    Radiological:

    CXR or CT indicative of pneumonia OR worsening findings over time

    AND

    Laboratory:

    CRP levels >60 OR an increase of CRP >20 over 12 hours WITH an increasing ferritin level OR declining lymphocyte counts

  3. Age > 18 years and able to give consent

Exclusion Criteria:

Patients will be excluded if any of the following conditions apply:

  1. Known sensitivity/allergy to TCZ or other monoclonal antibodies
  2. AST/ALT>5 times UNL, platelet counts <50,000 or neutrophil counts <500
  3. Active TB
  4. Pregnant
  5. Receipt of mechanical ventilation
  6. Has received other immunomodulatory drugs (including TCZ) in the past for the treatment of other conditions
  7. Individuals, in the opinion of the investigator, where progression to death is imminent and inevitable in the next 24 hours irrespective of treatment provision or who have signed a DNR.
  8. Participating in other clinical trials (subject to approval)
  9. Any serious medical condition or abnormal clinical laboratory tests which in the judgement of the investigator may compromise patient safety should he/she participate in the study.

Sites / Locations

  • University Malaya Medical Centre

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Tocilizumab

Methylprednisolone

Arm Description

Tocilizumab is given at 8 mg/kg (body weight) once and administered as an intravenous infusion within no less than 60 minutes.

Reconstituted methylprednisolone is infused over 30 minutes and administered at a dose of 120mg/day for 3 days

Outcomes

Primary Outcome Measures

The proportion of patients requiring mechanical ventilation
Mean days of ventilation

Secondary Outcome Measures

The proportion of patients requiring ICU admission
Overall 28-day survival
Change in symptom severity assessed by the World Health Organization (WHO) Coronavirus Disease 2019 (COVID19) ordinal scale measured daily up to 7 days from baseline
Duration of hospital and ICU stay

Full Information

First Posted
April 8, 2020
Last Updated
April 11, 2020
Sponsor
University of Malaya
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1. Study Identification

Unique Protocol Identification Number
NCT04345445
Brief Title
Study to Evaluate the Efficacy and Safety of Tocilizumab Versus Corticosteroids in Hospitalised COVID-19 Patients With High Risk of Progression
Official Title
An Open-label, Randomized, Cross-over Interventional Study to Evaluate the Efficacy and Safety of Tocilizumab Versus Corticosteroids in Hospitalised COVID-19 Patients With High Risk of Progression
Study Type
Interventional

2. Study Status

Record Verification Date
April 2020
Overall Recruitment Status
Unknown status
Study Start Date
April 15, 2020 (Anticipated)
Primary Completion Date
October 31, 2020 (Anticipated)
Study Completion Date
October 31, 2020 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Malaya

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study aims to compare the efficacy and safety of Methylprednisolone versus Tocilizumab in improving clinical outcomes and reducing the need for ventilator support in COVID-19 patients with moderate COVID-19 disease at risk for complications of cytokine storm. Approximately 310 participants hospitalized with COVID-19 in UMMC, Hospital Sungai Buloh, Hospital Kuala Lumpur and Hospital Tuanku Jaafar will be enrolled into this study. Eligible participants will be selected based on a set of clinical, laboratory and radiological parameters indicative of early stages of CRS and lung function decline prior to being randomized at a ratio of 1:1 to receive either Tocilizumab or Methylprednisolone. Participants will be monitored daily for clinical and laboratory parameters, and at 48 hours, switched to the alternate study arm should they manifest signs and symptoms indicative of decompensation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
COVID-19
Keywords
COVID-19

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
310 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Tocilizumab
Arm Type
Experimental
Arm Description
Tocilizumab is given at 8 mg/kg (body weight) once and administered as an intravenous infusion within no less than 60 minutes.
Arm Title
Methylprednisolone
Arm Type
Active Comparator
Arm Description
Reconstituted methylprednisolone is infused over 30 minutes and administered at a dose of 120mg/day for 3 days
Intervention Type
Drug
Intervention Name(s)
Tocilizumab
Intervention Description
IV infusion
Intervention Type
Drug
Intervention Name(s)
Methylprednisolone
Intervention Description
IV infusion
Primary Outcome Measure Information:
Title
The proportion of patients requiring mechanical ventilation
Time Frame
Through study completion, and average of 6 months
Title
Mean days of ventilation
Time Frame
Through study completion, and average of 6 months
Secondary Outcome Measure Information:
Title
The proportion of patients requiring ICU admission
Time Frame
Through study completion, and average of 6 months
Title
Overall 28-day survival
Time Frame
28 day from baseline
Title
Change in symptom severity assessed by the World Health Organization (WHO) Coronavirus Disease 2019 (COVID19) ordinal scale measured daily up to 7 days from baseline
Time Frame
7 days from baseline
Title
Duration of hospital and ICU stay
Time Frame
Through study completion, and average of 6 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: 1) Hospitalised symptomatic COVID-19 patients 2( Presence of clinical and radiological signs of progressive disease, AND laboratory evidence indicative of risk for cytokine storm complications. All patients participating in this clinical trial must meet the following inclusion criteria: Hospitalised symptomatic COVID-19 patients Presence of clinical and radiological signs of progressive disease, AND laboratory evidence indicative of risk for cytokine storm complications: Clinical: Dyspnoea OR RR>20 breaths/min AND O2 sat <93% on RA OR increasing need for O2 supplementation to maintain O2 sat >95% on RA WITH Radiological: CXR or CT indicative of pneumonia OR worsening findings over time AND Laboratory: CRP levels >60 OR an increase of CRP >20 over 12 hours WITH an increasing ferritin level OR declining lymphocyte counts Age > 18 years and able to give consent Exclusion Criteria: Patients will be excluded if any of the following conditions apply: Known sensitivity/allergy to TCZ or other monoclonal antibodies AST/ALT>5 times UNL, platelet counts <50,000 or neutrophil counts <500 Active TB Pregnant Receipt of mechanical ventilation Has received other immunomodulatory drugs (including TCZ) in the past for the treatment of other conditions Individuals, in the opinion of the investigator, where progression to death is imminent and inevitable in the next 24 hours irrespective of treatment provision or who have signed a DNR. Participating in other clinical trials (subject to approval) Any serious medical condition or abnormal clinical laboratory tests which in the judgement of the investigator may compromise patient safety should he/she participate in the study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Adeeba Kamarulzaman, MBBS
Phone
+603-79492050
Email
adeeba@um.edu.my
First Name & Middle Initial & Last Name or Official Title & Degree
Reena Rajasuriar, PhD
Email
reena@um.edu.my
Facility Information:
Facility Name
University Malaya Medical Centre
City
Kuala Lumpur
ZIP/Postal Code
59100
Country
Malaysia
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Reena Rajasuriar, PhD
Email
reena@um.edu.my
First Name & Middle Initial & Last Name & Degree
Adeeba Kamarulzaman, MBBS
First Name & Middle Initial & Last Name & Degree
Sharifah Faridah Syed Omar, MBBS
First Name & Middle Initial & Last Name & Degree
Reena Rajasuriar, PhD
First Name & Middle Initial & Last Name & Degree
Suresh Kumar Chidambaram, MBBS
First Name & Middle Initial & Last Name & Degree
Tiang Koi Ng, MBBS
First Name & Middle Initial & Last Name & Degree
Chee Loon Leong, MBBS

12. IPD Sharing Statement

Plan to Share IPD
Undecided

Learn more about this trial

Study to Evaluate the Efficacy and Safety of Tocilizumab Versus Corticosteroids in Hospitalised COVID-19 Patients With High Risk of Progression

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