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Study to Evaluate the Efficacy and Safety of Maraviroc in SARS-CoV-2 Infection (COVID-19). (MARACOVID)

Primary Purpose

COVID-19

Status
Terminated
Phase
Phase 2
Locations
Spain
Study Type
Interventional
Intervention
Maraviroc 300 mg
Standard care therapy
Sponsored by
Hospital Universitario Infanta Leonor
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for COVID-19 focused on measuring SARS-CoV-2, ARDS, Acute respiratory distress syndrome, maraviroc

Eligibility Criteria

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

Inclusion Criteria:

  • 1. Male or female adult ≥ 18 years of age at the time of giving informed consent.
  • 2. Subject is hospitalized.
  • 3. SARS-CoV-2 infection confirmed by PCR or other commercial or public health tests, in any biological sample obtained up to 4 days prior to randomization, or that meets locally accepted criteria for clinical diagnosis of COVID-19.
  • 4. Lung involvement confirmed by at least one of the following criteria:

    1. Radiological infiltrates on imaging test (conventional radiography, computed tomography (CT) or other)
    2. In the absence of radiological infiltrates, an SpO2 < 95% without oxygen supporting therapy (breathing ambient air), combined with cough, crackles on physical exam, or an LDH > 300 U/L with no other cause.
  • 5. Symptom onset ≤ 8 days prior to randomization.
  • 6. Understands and agrees to comply with planned study procedures.
  • 7. Women of childbearing potential must have a negative test for pregnancy (blood or urine) before their inclusion and agree to use an accepted method of contraception for the duration of the study.
  • 8. Subject (or legally authorized representative) provides written informed consent prior to initiation of any study procedures.

Exclusion Criteria:

  • 1. SpO2 ≤ 91% breathing ambient air and SpO2 < 95% with oxygen in nasal cannula at 2 lpm.
  • 2. Patient's attending physician considers the study is not the best medical option, or follow-up after discharge will be difficult.
  • 3. A patient who, in the investigator's opinion, is unlikely to survive > 48 hours from inclusion in the study.
  • 4. Patients with severe chronic kidney disease (ClCr < 30 ml/min/1.73 m2 or receiving renal replacement therapy in any of its modalities).
  • 5. Severe liver disease (Child-Pugh C, ALT > 5 times above upper limit of normal (LSN).
  • 6. COPD with FEV1 < 70.
  • 7. Known active neoplasia.
  • 8. HIV infection. Patients with known HIV infection, under follow-up, and immunovirological stability (CD4> 500 and undetectable viral load) for at least 6 months before inclusion in this study may be included.
  • 9. Hemoglobin < 9 gr/dL.
  • 10. Prolonged QT, defined as a QT interval > 460 ms. (or > 450 ms. in case of family history of sudden death or long QT syndrome or personal history of repeat syncope without an etiological diagnosis). This criterion will only apply if the standard treatment contains drugs with an effect on the duration (prolongation) of the QT interval.
  • 11.Significant cardiovascular disease, including:

    1. History of acute myocardial infarction, acute coronary syndrome (unstable angina, coronary by-pass surgery, angioplasty, or coronary stenting) ≤ 6 months prior to randomization
    2. Symptomatic heart failure (NYHA grade 2 or more) history, or current evidence of cardiac arrhythmia (except atrial fibrillation or flutter and paroxysmal supraventricular tachycardia) and/or conduction abnormalities (excluding branch blocks or Wenckebach grade I and II atrioventricular blocks).
  • 12. Known or suspected active autoimmune disease
  • 13. Pregnancy or breastfeeding, or positive pregnancy test at baseline or screening visit
  • 14. Patients who are expected to be transferred to another facility sooner than 72 hours after inclusion in the study.
  • 15. Patients who have received experimental treatment (off-label, compassionate use, or in clinical trials) within 30 days prior to the screening visit, except for treatment considered standard initiated on admission to hospital, up to 48 hours before inclusion in the study.
  • 16. Patients who have a history of allergic reactions to maraviroc or any of its components.

Sites / Locations

  • Hospital Clínic
  • Hospital Universitario Infanta Leonor

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Other

Arm Label

Test arm

Control arm

Arm Description

100 subjects will be randomly assigned to this arm. Patients in the test group will receive 300 mg of maraviroc BID for 14 days (added to standard care).

100 subjects will be randomized in this arm and will be treated according to the standard care. The Ministry of Health has issued detailed guidelines for the management of COVID-19. Local Institutional Guidelines and Protocols for supportive management will also be implemented.

Outcomes

Primary Outcome Measures

Proportion of patients developing severe ARDS.
A patient with a saturation of 90% or less despite the use of a reservoir mask without rebreathing with a flow of 7 liters per minute (FiO2 0.6 or higher), will be considered to have severe ARDS. These oximetric criteria have a close correlation with a PaO2 / FiO2 of 100 or less, which defines severe ARDS.

Secondary Outcome Measures

All-cause mortality.
Percentage of patients requiring tracheal intubation, use of Non-invasive Ventilation NIV or High Flow Nasal Cannula (HFNC) devices during the study period
Percentage of patients who progress to severe ARDS, death or ICU admission.
Differences in Time to Clinical Improvement
Defined as the time (in hours) from the start of the treatment under study to the normalization of temperature, normalization of respiratory rate and SpO2. Axillary temperature < 37.5ºC (oral < 37.2ºC) for 48 hours, without antipyretic treatment. Breathing rate < 24 rpm during the clinical evaluation and at least two consecutive daily evaluations (48 hours). SpO2 > 93% breathing ambient air during clinical assessment and at least two consecutive daily assessments (48 hours).
Change in clinical status of subject on a 7-point ordinal scale.
The ordinal scale of 7 categories of patient health status ranges from: Death. Hospitalized, with invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO). Hospitalized, with non-invasive ventilation or high flow oxygen devices. Hospitalized, requiring supplemental oxygen. Hospitalized, not requiring supplemental oxygen. Non-hospitalized, activity limitation. Non-hospitalized, no activity limitation.
Percentage of patients requiring immunosuppressive/immunomodulatory treatment as a rescue medication.
Proportion of patients developing adverse effects, serious adverse reactions, laboratory or physical examination findings, EKG abnormalities acquired during the trial, death and adverse events leading to early discontinuation of treatment.
Classification according to the WHO toxicity scale

Full Information

First Posted
June 18, 2020
Last Updated
February 24, 2022
Sponsor
Hospital Universitario Infanta Leonor
Collaborators
Hospital Clinic of Barcelona, ViiV Healthcare
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1. Study Identification

Unique Protocol Identification Number
NCT04441385
Brief Title
Study to Evaluate the Efficacy and Safety of Maraviroc in SARS-CoV-2 Infection (COVID-19).
Acronym
MARACOVID
Official Title
Bicentric, Phase 2, Randomized, Open-label Study to Evaluate the Efficacy and Safety of Maraviroc Associated With Standard Treatment in Hospitalized Patients With Pulmonary SARS-CoV-2 Infection (COVID-19).
Study Type
Interventional

2. Study Status

Record Verification Date
July 2020
Overall Recruitment Status
Terminated
Why Stopped
lack of viability
Study Start Date
June 26, 2020 (Actual)
Primary Completion Date
February 8, 2021 (Actual)
Study Completion Date
February 8, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Hospital Universitario Infanta Leonor
Collaborators
Hospital Clinic of Barcelona, ViiV Healthcare

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No

5. Study Description

Brief Summary
This is a bicentric, phase 2, randomized, open-label study to evaluate the efficacy and safety of maraviroc associated with standard treatment in hospitalized patients with pulmonary SARS-CoV-2 infection (COVID-19).
Detailed Description
This is a bicentric, phase 2, randomized, open-label study to evaluate the efficacy and safety of maraviroc associated with standard treatment in hospitalized patients with pulmonary SARS-CoV-2 infection (COVID-19), to prevent disease progression to severe Acute Respiratory Distress Syndrome (ARDS). Patients will be randomized to receive maraviroc (300 mg BID for 14 days) plus standard treatment, or standard treatment alone. 200 subjects will be enrolled and randomized 1:1 in this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
COVID-19
Keywords
SARS-CoV-2, ARDS, Acute respiratory distress syndrome, maraviroc

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
60 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Test arm
Arm Type
Experimental
Arm Description
100 subjects will be randomly assigned to this arm. Patients in the test group will receive 300 mg of maraviroc BID for 14 days (added to standard care).
Arm Title
Control arm
Arm Type
Other
Arm Description
100 subjects will be randomized in this arm and will be treated according to the standard care. The Ministry of Health has issued detailed guidelines for the management of COVID-19. Local Institutional Guidelines and Protocols for supportive management will also be implemented.
Intervention Type
Drug
Intervention Name(s)
Maraviroc 300 mg
Other Intervention Name(s)
Celsentri, Selzentry
Intervention Description
Patients will receive maraviroc 300 mg twice daily for 14 days
Intervention Type
Other
Intervention Name(s)
Standard care therapy
Intervention Description
Subjects randomized to control group will be on standard care treatment according to the Ministry of Health and Local Guidelines and Protocols.
Primary Outcome Measure Information:
Title
Proportion of patients developing severe ARDS.
Description
A patient with a saturation of 90% or less despite the use of a reservoir mask without rebreathing with a flow of 7 liters per minute (FiO2 0.6 or higher), will be considered to have severe ARDS. These oximetric criteria have a close correlation with a PaO2 / FiO2 of 100 or less, which defines severe ARDS.
Time Frame
28 days
Secondary Outcome Measure Information:
Title
All-cause mortality.
Time Frame
28 days
Title
Percentage of patients requiring tracheal intubation, use of Non-invasive Ventilation NIV or High Flow Nasal Cannula (HFNC) devices during the study period
Time Frame
28 days
Title
Percentage of patients who progress to severe ARDS, death or ICU admission.
Time Frame
28 days
Title
Differences in Time to Clinical Improvement
Description
Defined as the time (in hours) from the start of the treatment under study to the normalization of temperature, normalization of respiratory rate and SpO2. Axillary temperature < 37.5ºC (oral < 37.2ºC) for 48 hours, without antipyretic treatment. Breathing rate < 24 rpm during the clinical evaluation and at least two consecutive daily evaluations (48 hours). SpO2 > 93% breathing ambient air during clinical assessment and at least two consecutive daily assessments (48 hours).
Time Frame
28 days
Title
Change in clinical status of subject on a 7-point ordinal scale.
Description
The ordinal scale of 7 categories of patient health status ranges from: Death. Hospitalized, with invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO). Hospitalized, with non-invasive ventilation or high flow oxygen devices. Hospitalized, requiring supplemental oxygen. Hospitalized, not requiring supplemental oxygen. Non-hospitalized, activity limitation. Non-hospitalized, no activity limitation.
Time Frame
28 days
Title
Percentage of patients requiring immunosuppressive/immunomodulatory treatment as a rescue medication.
Time Frame
28 days
Title
Proportion of patients developing adverse effects, serious adverse reactions, laboratory or physical examination findings, EKG abnormalities acquired during the trial, death and adverse events leading to early discontinuation of treatment.
Description
Classification according to the WHO toxicity scale
Time Frame
28 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: 1. Male or female adult ≥ 18 years of age at the time of giving informed consent. 2. Subject is hospitalized. 3. SARS-CoV-2 infection confirmed by PCR or other commercial or public health tests, in any biological sample obtained up to 4 days prior to randomization, or that meets locally accepted criteria for clinical diagnosis of COVID-19. 4. Lung involvement confirmed by at least one of the following criteria: Radiological infiltrates on imaging test (conventional radiography, computed tomography (CT) or other) In the absence of radiological infiltrates, an SpO2 < 95% without oxygen supporting therapy (breathing ambient air), combined with cough, crackles on physical exam, or an LDH > 300 U/L with no other cause. 5. Symptom onset ≤ 8 days prior to randomization. 6. Understands and agrees to comply with planned study procedures. 7. Women of childbearing potential must have a negative test for pregnancy (blood or urine) before their inclusion and agree to use an accepted method of contraception for the duration of the study. 8. Subject (or legally authorized representative) provides written informed consent prior to initiation of any study procedures. Exclusion Criteria: 1. SpO2 ≤ 91% breathing ambient air and SpO2 < 95% with oxygen in nasal cannula at 2 lpm. 2. Patient's attending physician considers the study is not the best medical option, or follow-up after discharge will be difficult. 3. A patient who, in the investigator's opinion, is unlikely to survive > 48 hours from inclusion in the study. 4. Patients with severe chronic kidney disease (ClCr < 30 ml/min/1.73 m2 or receiving renal replacement therapy in any of its modalities). 5. Severe liver disease (Child-Pugh C, ALT > 5 times above upper limit of normal (LSN). 6. COPD with FEV1 < 70. 7. Known active neoplasia. 8. HIV infection. Patients with known HIV infection, under follow-up, and immunovirological stability (CD4> 500 and undetectable viral load) for at least 6 months before inclusion in this study may be included. 9. Hemoglobin < 9 gr/dL. 10. Prolonged QT, defined as a QT interval > 460 ms. (or > 450 ms. in case of family history of sudden death or long QT syndrome or personal history of repeat syncope without an etiological diagnosis). This criterion will only apply if the standard treatment contains drugs with an effect on the duration (prolongation) of the QT interval. 11.Significant cardiovascular disease, including: History of acute myocardial infarction, acute coronary syndrome (unstable angina, coronary by-pass surgery, angioplasty, or coronary stenting) ≤ 6 months prior to randomization Symptomatic heart failure (NYHA grade 2 or more) history, or current evidence of cardiac arrhythmia (except atrial fibrillation or flutter and paroxysmal supraventricular tachycardia) and/or conduction abnormalities (excluding branch blocks or Wenckebach grade I and II atrioventricular blocks). 12. Known or suspected active autoimmune disease 13. Pregnancy or breastfeeding, or positive pregnancy test at baseline or screening visit 14. Patients who are expected to be transferred to another facility sooner than 72 hours after inclusion in the study. 15. Patients who have received experimental treatment (off-label, compassionate use, or in clinical trials) within 30 days prior to the screening visit, except for treatment considered standard initiated on admission to hospital, up to 48 hours before inclusion in the study. 16. Patients who have a history of allergic reactions to maraviroc or any of its components.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Víctor Domínguez, MD
Organizational Affiliation
Hospital Universitario Infanta Leonor
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hospital Clínic
City
Barcelona
ZIP/Postal Code
08036
Country
Spain
Facility Name
Hospital Universitario Infanta Leonor
City
Madrid
ZIP/Postal Code
28031
Country
Spain

12. IPD Sharing Statement

Learn more about this trial

Study to Evaluate the Efficacy and Safety of Maraviroc in SARS-CoV-2 Infection (COVID-19).

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