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Evaluating the Effect of NT-I7, a Long Acting Interleukin-7, to Increase Lymphocyte Counts and Enhance Immune Clearance of SARS-CoV-2 (COVID-19)

Primary Purpose

COVID-19, SARS-CoV-2

Status
Withdrawn
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
NT-I7
Placebo
Blood for research purposes
Blood for pharmacokinetic samples
Nasopharyngeal, oropharyngeal, or saliva swab
Blood for anti-drug antibody (ADA)
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for COVID-19 focused on measuring COVID-19, SARS-CoV-2

Eligibility Criteria

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

Inclusion Criteria:

  • Tested PCR positive for SARS-CoV-2by nasopharyngeal swab, oropharyngeal swab, or saliva.
  • Mild COVID-19, defined as WHO Ordinal Scale <4 .
  • Respiratory rate < 20 bpm, HR < 90 bpm, and SpO2 > 93% on room air at sea level.
  • Absolute lymphocyte count (ALC) < 1500 cells/mm3 at the time of screening.
  • AST/ALT ≤ 3.0 x ULN, total bilirubin ≤ 1.5 x ULN (except if due to Gilbert's syndrome).

    -≥ 18 years of age.

  • First day of treatment must be no more than 10 days from onset of COVID-19 symptoms.
  • Must be willing to be closely monitored in the hospital or in an alternate setting (e.g. clinical trial unit) for at least the first 7 days (±2 days allowed) following NT-I7/placebo injection.
  • Individuals of reproductive potential must agree to either abstinence or use of at least one study-approved form of contraception when engaging in sexual activities that can result in pregnancy from the time of screening through 60 days for female and 120 days for male after study agent administration. Acceptable forms of contraception for this study are male or female condoms, diaphragms or cervical caps with a spermicide, or non-hormonal intrauterine devices.
  • Patients with factors or concomitant illness associated with higher risk of mortality due to COVID-19 (such as older age, hypertension, diabetes, and/or COPD) are eligible.
  • Able to understand and willing to sign an IRB approved written informed consent document.

Exclusion Criteria:

  • Receiving any other investigational agents which may affect patient's lymphocyte counts. Note: There is no evidence that chloroquine or hydroxychloroquine could affect lymphocyte counts. Thus, chloroquine or hydroxychloroquine use is not an exclusion criteria for this study. Additionally, it is permissible for potential participants to have received investigational or off-label agents for COVID-19 prior to or during study participation.
  • Pregnant or breastfeeding women are excluded from this study because NT-I7 has not been evaluated regarding its potential for teratogenic or abortifacients effects. There is a potential risk for adverse events in nursing infants secondary to treatment of the mother with the study drug; therefore, breastfeeding should be discontinued if the mother is treated with NT-I7.
  • Transferred from ICU to the floor.
  • Requiring dialysis.
  • Shortness of breath or known hypoxia (defined as PaO2/FiO2 ≤ 300 mmHg), or signs of serious lower airway disease.
  • Evidence of ARDS, SIRS/shock, or cardiac failure.
  • Elevated inflammatory markers such as CRP > 2 x ULN, LDH > 2 x ULN, D-dimer > 2 x ULN, ferritin > ULN, or IL-6 > ULN (when available).
  • Any established diagnosis of autoimmune disease requiring systemic treatment EXCEPT for vitiligo or endocrine disease (such as diabetes, thyroid disease, and adrenal disease) controlled by replacement therapy.
  • Receipt of live attenuated vaccine within 30 days before the study treatment. Examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, chicken pox, yellow fever, rabies, Bacillus Calmette-Guérin (BCG), Zoster, and typhoid vaccine. Seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed; however, intranasal influenza vaccines (e.g. FluMist) are live attenuated vaccines and are not allowed.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm Type

    Experimental

    Experimental

    Placebo Comparator

    Arm Label

    NT-I7 (Phase I)

    NT-I7 (Pilot)

    Placebo (Pilot)

    Arm Description

    In the phase I study, 3 dose levels of NT-I7 are planned. Dosing will be staggered such that there will be a minimum of 72 hours between the dosing of one participant and the dosing of the next participant NT-I7 will be given by intramuscular injection on Day 0 Participants will also be given standard of care treatment for COVID-19

    NT-I7 (dose determined by Phase I portion of study) will be given by intramuscular injection on Day 0 Participants will also be given standard of care treatment for COVID-19

    Placebo will be given by intramuscular injection on Day 0 Participants will also be given standard of care treatment for COVID-19

    Outcomes

    Primary Outcome Measures

    Safe and tolerable dose of NT-I7 (Phase I only)
    The safe tolerated dose is defined as the dose level immediately below the dose level at which 1 patient of a cohort of 3 patients experiences dose-limiting toxicity within 14 days after administration of NT-I7 Dose limiting toxicities (DLT) are defined as: A serious adverse event that is at least possibly related to NT-I7 A grade 3 or higher adverse event that is at least possibly related to NT-I7 (excluding injection site swelling, irritation or discomfort) A clinically significant lab abnormality that is at least possibly related to NT-I7
    Percent change in absolute lymphocyte count (ALC)

    Secondary Outcome Measures

    Percent change in absolute lymphocyte count (ALC)
    Change in SARS-CoV-2 viral load
    -Using PCR from nasopharyngeal swab, oropharyngeal swab or saliva
    Change in SARS-CoV-2 viral load
    -Using PCR from nasopharyngeal swab, oropharyngeal swab or saliva
    COVID-19 Symptom severity as measured by WHO Ordinal Scale for clinical improvement
    Time to resolution of COVID-19 symptoms
    Incidence of treatment-emergent adverse events
    -A treatment emergent adverse event (TEAE) is defined as any event that begins or worsens on or after date of first dose of study treatment.
    Number of participants by PCR result status (positive or negative)
    -If quantitative PCR is not available
    Number of participants by PCR result status (positive or negative)
    -If quantitative PCR is not available

    Full Information

    First Posted
    July 30, 2020
    Last Updated
    July 29, 2021
    Sponsor
    Washington University School of Medicine
    Collaborators
    NeoImmune Tech
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    1. Study Identification

    Unique Protocol Identification Number
    NCT04498325
    Brief Title
    Evaluating the Effect of NT-I7, a Long Acting Interleukin-7, to Increase Lymphocyte Counts and Enhance Immune Clearance of SARS-CoV-2 (COVID-19)
    Official Title
    A Phase I and Pilot Study Evaluating the Effect of NT-I7, a Long Acting Interleukin-7, to Increase Lymphocyte Counts and Enhance Immune Clearance of SARS-CoV-2
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2021
    Overall Recruitment Status
    Withdrawn
    Why Stopped
    Principal investigator is leaving the institution.
    Study Start Date
    July 31, 2021 (Anticipated)
    Primary Completion Date
    April 30, 2022 (Anticipated)
    Study Completion Date
    April 30, 2022 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Washington University School of Medicine
    Collaborators
    NeoImmune Tech

    4. Oversight

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

    5. Study Description

    Brief Summary
    Lymphopenia is common in patients with COVID-19 and is associated with worse clinical outcomes. NT-I7 is a long-acting human interleukin-7 (IL-7) that has been shown to increase absolute lymphocyte count (ALC) and CD4+ and CD8+ T cell counts with a well-tolerated safety profile in humans. In this study, patients who have tested positive for SARS-CoV-2 by PCR testing without severe disease and with ALC <1500 cells/mm3 will be enrolled.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    COVID-19, SARS-CoV-2
    Keywords
    COVID-19, SARS-CoV-2

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 1
    Interventional Study Model
    Parallel Assignment
    Model Description
    The study will open as a phase I study to test three different dose levels of NT-I7. Once a safe tolerated dose is established, the pilot portion of the study will be activated wherein participants will be randomized on a 1:1 basis to receive a single injection of NT-I7 (at the safe tolerated dose) or placebo.
    Masking
    ParticipantCare ProviderInvestigator
    Masking Description
    The clinicians, participants, and clinical research coordinators will be blinded
    Allocation
    Randomized
    Enrollment
    0 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    NT-I7 (Phase I)
    Arm Type
    Experimental
    Arm Description
    In the phase I study, 3 dose levels of NT-I7 are planned. Dosing will be staggered such that there will be a minimum of 72 hours between the dosing of one participant and the dosing of the next participant NT-I7 will be given by intramuscular injection on Day 0 Participants will also be given standard of care treatment for COVID-19
    Arm Title
    NT-I7 (Pilot)
    Arm Type
    Experimental
    Arm Description
    NT-I7 (dose determined by Phase I portion of study) will be given by intramuscular injection on Day 0 Participants will also be given standard of care treatment for COVID-19
    Arm Title
    Placebo (Pilot)
    Arm Type
    Placebo Comparator
    Arm Description
    Placebo will be given by intramuscular injection on Day 0 Participants will also be given standard of care treatment for COVID-19
    Intervention Type
    Drug
    Intervention Name(s)
    NT-I7
    Intervention Description
    Supplied by study
    Intervention Type
    Drug
    Intervention Name(s)
    Placebo
    Intervention Description
    Supplied by study
    Intervention Type
    Procedure
    Intervention Name(s)
    Blood for research purposes
    Intervention Description
    Prior to injection (Day 0), Day 7, and Day 14
    Intervention Type
    Procedure
    Intervention Name(s)
    Blood for pharmacokinetic samples
    Intervention Description
    -Phase I only: 1-2 hours prior to dosing, 6 hours after dosing, 24 hours after dosing, Day 7, Day 14, and Day 21
    Intervention Type
    Procedure
    Intervention Name(s)
    Nasopharyngeal, oropharyngeal, or saliva swab
    Intervention Description
    -Prior to study treatment, Day 4(optional), Day 7, and Day 14
    Intervention Type
    Procedure
    Intervention Name(s)
    Blood for anti-drug antibody (ADA)
    Intervention Description
    Baseline, Day 7, Day 14, Day 21, Day 60, and Day 90. Participants with ADA positivity on Day 90 will be monitored every 90 days until antibody level returns to baseline
    Primary Outcome Measure Information:
    Title
    Safe and tolerable dose of NT-I7 (Phase I only)
    Description
    The safe tolerated dose is defined as the dose level immediately below the dose level at which 1 patient of a cohort of 3 patients experiences dose-limiting toxicity within 14 days after administration of NT-I7 Dose limiting toxicities (DLT) are defined as: A serious adverse event that is at least possibly related to NT-I7 A grade 3 or higher adverse event that is at least possibly related to NT-I7 (excluding injection site swelling, irritation or discomfort) A clinically significant lab abnormality that is at least possibly related to NT-I7
    Time Frame
    Completion of DLT assessment window of Phase I portion of study (estimated to be 8 months)
    Title
    Percent change in absolute lymphocyte count (ALC)
    Time Frame
    From baseline to Day 14
    Secondary Outcome Measure Information:
    Title
    Percent change in absolute lymphocyte count (ALC)
    Time Frame
    From baseline through Day 21
    Title
    Change in SARS-CoV-2 viral load
    Description
    -Using PCR from nasopharyngeal swab, oropharyngeal swab or saliva
    Time Frame
    From baseline to Day 7
    Title
    Change in SARS-CoV-2 viral load
    Description
    -Using PCR from nasopharyngeal swab, oropharyngeal swab or saliva
    Time Frame
    From baseline to Day 14
    Title
    COVID-19 Symptom severity as measured by WHO Ordinal Scale for clinical improvement
    Time Frame
    From baseline, day 7, day 14, and day 21
    Title
    Time to resolution of COVID-19 symptoms
    Time Frame
    From baseline through Day 21
    Title
    Incidence of treatment-emergent adverse events
    Description
    -A treatment emergent adverse event (TEAE) is defined as any event that begins or worsens on or after date of first dose of study treatment.
    Time Frame
    From baseline through Day 21
    Title
    Number of participants by PCR result status (positive or negative)
    Description
    -If quantitative PCR is not available
    Time Frame
    -From baseline to Day 7
    Title
    Number of participants by PCR result status (positive or negative)
    Description
    -If quantitative PCR is not available
    Time Frame
    From baseline to Day 14

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Tested PCR positive for SARS-CoV-2by nasopharyngeal swab, oropharyngeal swab, or saliva. Mild COVID-19, defined as WHO Ordinal Scale <4 . Respiratory rate < 20 bpm, HR < 90 bpm, and SpO2 > 93% on room air at sea level. Absolute lymphocyte count (ALC) < 1500 cells/mm3 at the time of screening. AST/ALT ≤ 3.0 x ULN, total bilirubin ≤ 1.5 x ULN (except if due to Gilbert's syndrome). -≥ 18 years of age. First day of treatment must be no more than 10 days from onset of COVID-19 symptoms. Must be willing to be closely monitored in the hospital or in an alternate setting (e.g. clinical trial unit) for at least the first 7 days (±2 days allowed) following NT-I7/placebo injection. Individuals of reproductive potential must agree to either abstinence or use of at least one study-approved form of contraception when engaging in sexual activities that can result in pregnancy from the time of screening through 60 days for female and 120 days for male after study agent administration. Acceptable forms of contraception for this study are male or female condoms, diaphragms or cervical caps with a spermicide, or non-hormonal intrauterine devices. Patients with factors or concomitant illness associated with higher risk of mortality due to COVID-19 (such as older age, hypertension, diabetes, and/or COPD) are eligible. Able to understand and willing to sign an IRB approved written informed consent document. Exclusion Criteria: Receiving any other investigational agents which may affect patient's lymphocyte counts. Note: There is no evidence that chloroquine or hydroxychloroquine could affect lymphocyte counts. Thus, chloroquine or hydroxychloroquine use is not an exclusion criteria for this study. Additionally, it is permissible for potential participants to have received investigational or off-label agents for COVID-19 prior to or during study participation. Pregnant or breastfeeding women are excluded from this study because NT-I7 has not been evaluated regarding its potential for teratogenic or abortifacients effects. There is a potential risk for adverse events in nursing infants secondary to treatment of the mother with the study drug; therefore, breastfeeding should be discontinued if the mother is treated with NT-I7. Transferred from ICU to the floor. Requiring dialysis. Shortness of breath or known hypoxia (defined as PaO2/FiO2 ≤ 300 mmHg), or signs of serious lower airway disease. Evidence of ARDS, SIRS/shock, or cardiac failure. Elevated inflammatory markers such as CRP > 2 x ULN, LDH > 2 x ULN, D-dimer > 2 x ULN, ferritin > ULN, or IL-6 > ULN (when available). Any established diagnosis of autoimmune disease requiring systemic treatment EXCEPT for vitiligo or endocrine disease (such as diabetes, thyroid disease, and adrenal disease) controlled by replacement therapy. Receipt of live attenuated vaccine within 30 days before the study treatment. Examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, chicken pox, yellow fever, rabies, Bacillus Calmette-Guérin (BCG), Zoster, and typhoid vaccine. Seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed; however, intranasal influenza vaccines (e.g. FluMist) are live attenuated vaccines and are not allowed.
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Jian Campian, M.D., Ph.D.
    Organizational Affiliation
    Washington University School of Medicine
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No
    Links:
    URL
    http://www.siteman.wustl.edu
    Description
    Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

    Learn more about this trial

    Evaluating the Effect of NT-I7, a Long Acting Interleukin-7, to Increase Lymphocyte Counts and Enhance Immune Clearance of SARS-CoV-2 (COVID-19)

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