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Losmapimod Safety and Efficacy in COVID-19 (LOSVID)

Primary Purpose

COVID-19

Status
Terminated
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Losmapimod oral tablet
Placebo oral tablet
Sponsored by
Fulcrum Therapeutics
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for COVID-19 focused on measuring COVID-19 pandemic, COVID-19 virus disease, COVID-19 virus infection, SARS-CoV-2 infection, coronavirus disease 2019, 2019 novel coronavirus disease, 2019 novel coronavirus infection

Eligibility Criteria

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

Inclusion Criteria:

  • Able and willing to provide written informed consent
  • Willing and able to comply with all study procedures
  • Age ≥50 years at time of screening
  • Confirmed infection with SARS-CoV-2 virus at or before the baseline visit by polymerase chain reaction (PCR) testing
  • ≤7 days to the time of randomization from the time of collection of the specimen that tested positive for the SARS-CoV-2 virus
  • Hospitalization at the time of the baseline visit
  • ≥90% oxygen saturation on room air and/or ≥94% oxygen saturation on oxygen administration at 2 L/min by nasal cannula at the baseline visit
  • Radiographic (X-ray or computed tomography scan, per local standard of care) and/or clinical evidence of pulmonary involvement consistent with COVID-19 at screening or baseline, per the judgment of the investigator
  • Clinical syndrome consistent with COVID-19 at screening, per the judgment of the investigator (CDC 2020)
  • CRP at screening >15 mg/L (i.e., >1.5 mg/dL) on local laboratory testing
  • Agrees to practice an approved method of birth control

Exclusion Criteria:

  • Inability to take oral medication at screening or baseline visit
  • Evidence at screening or baseline of critical COVID-19 disease (e.g., cardiac failure, septic shock) or severe pulmonary involvement)
  • Positive pregnancy test at screening for women of childbearing potential
  • Lactating female at baseline for women of childbearing potential Note: A female will be considered eligible who is lactating at screening if she agrees to discontinue breastfeeding for the duration of the trial plus 14 days post last dose
  • ≥5 × upper limit of normal (ULN) for alanine or aspartate aminotransferases or total bilirubin >1.5 × ULN at screening or known history of Child-Pugh Class C, hepatitis B or C, or HIV infection
  • Glomerular filtration rate <30 mL/min/1.73 m2 at screening
  • QTcF >450 msec for male or >470 msec for females or evidence of cardiac dysrhythmia at screening
  • Significant history or evidence of clinically significant disorder, condition, current illness, illicit drug or other addiction, or disease that, in the opinion of the Investigator, would pose a risk to subject safety or interfere with the study evaluation, procedures, or completion
  • Has been treated with immunomodulators or immunosuppressants including, but not limited to, interleukin (IL)-6 inhibitors, tumor necrosis factor (TNF) inhibitors, anti-IL-1 agents, and Janus kinase inhibitors, within 5 half-lives or 30 days, whichever is longer, prior to randomization, or plan to receive these agents any time during the study period
  • Treatment with hydroxychloroquine/ chloroquine in the past 30 days or plan to receive these agents as part of investigational clinical trials or SOC any time during the study period
  • Recent (within 30 days) or current participation in other COVID-19 therapeutic trials or expanded access programs
  • Prior or current participation in COVID-19 vaccine trials

Sites / Locations

  • University of California Irvine - Irvine Medical Center
  • University of Miami
  • University of South Florida
  • Beth Israel Deaconess Medical Center
  • Memorial Hermann Hospital South West
  • University of Texas Health Science Center at Houston
  • United Medical Memorial Hospital
  • Hospital Universitario Cassiano Antonio de Moraes-HUCAM/Hospital das Clinicas
  • Santa Casa de Misericordia de Belo Horizonte
  • Irmandade de Santa Casa de Misericordia de Porto Alegre
  • Hospital Santa Paula
  • Hospital Civil Fray Antonio Alcalde
  • Nuevo Hospital Civil de Guadalajara
  • JM Research Cuernavaca
  • Centro para el Desarrollo de la Medicina y de Asistencia Médica Especializada, S.C.
  • Hospital Nacional Carlos Alberto Seguín Escobedo - EsSalud Arequipa

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Losmapimod

Placebo

Arm Description

COVID-19 patients with PCR confirmation will receive Losmapimod 15 mg twice daily given as two 7.5 mg tablets per dose by mouth; for a total of 4 pills or 30 mg daily for 14 days.

COVID-19 patients with PCR confirmation will receive Placebo twice daily given as two tablets per dose by mouth; for a total of 4 tablets daily for 14 days.

Outcomes

Primary Outcome Measures

Day 28 Mortality
The efficacy of Losmapimod will be assessed by the development of progression to critical disease as evidence of mortality or development of respiratory failure by Day 28.

Secondary Outcome Measures

Clinical Status Assessment
The change from baseline in clinical disease status will be evaluated using the 9-point World Health Organization (WHO) ordinal scale: 0 indicating, no clinical evidence of SARS-CoV-2 infection and 8 indicating death.
Respiratory Failure Assessment
The response to treatment with Losmapimod in COVID-19 patients will be assessed by the total number of study days not requiring oxygen supplementation.
Treatment Survival
To assess the effect on survival following treatment with Losmapimod, mortality will be evaluated by the number of days alive by Day 28.
Treatment-Emergent Adverse Events
To evaluate the safety and tolerability of Losmapimod, the incidence of treatment-emergent adverse events will be assessed by clinically significant changes in laboratory test results and vital signs.
Treatment-Emergent Adverse Events
To characterize changes in SARS-CoV-2 infection following treatment with losmapimod versus placebo.

Full Information

First Posted
August 8, 2020
Last Updated
March 30, 2022
Sponsor
Fulcrum Therapeutics
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1. Study Identification

Unique Protocol Identification Number
NCT04511819
Brief Title
Losmapimod Safety and Efficacy in COVID-19
Acronym
LOSVID
Official Title
A Phase 3, Randomized, Double-Blind, Placebo-Controlled Study of the Safety and Efficacy of Losmapimod in Adult Subjects With COVID-19 (LOSVID STUDY)
Study Type
Interventional

2. Study Status

Record Verification Date
March 2022
Overall Recruitment Status
Terminated
Why Stopped
Study terminated due to the rapidly evolving environment for the treatment of Covid-19 and ongoing challenges to identify and enroll qualified patients to participate.
Study Start Date
August 28, 2020 (Actual)
Primary Completion Date
March 31, 2021 (Actual)
Study Completion Date
March 31, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Fulcrum Therapeutics

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
The therapeutic hypothesis for the use of losmapimod in COVID-19 disease is that increased mortality and severe disease is caused by p38 mitogen-activated protein kinase (MAPK)-mediated exaggerated acute inflammatory response resulting from SARS-CoV-2 infection. The study Sponsor hypothesize's that the early initiation of p38α/β inhibitor therapy in patients hospitalized with moderate COVID-19 who are at increased risk of a poor prognosis based on older age and elevated systemic inflammation will reduce clinical deterioration including progression to respiratory failure and death. To address this hypothesis, Fulcrum Therapeutics is conducting a Phase 3, multicenter, randomized, double-blind, placebo-controlled study that will evaluate the safety and efficacy of losmapimod versus placebo in subjects 50 and older who are hospitalized with moderate COVID-19 disease.
Detailed Description
The therapeutic hypothesis for the use of losmapimod in COVID-19 disease is that increased disease severity and consequent increased mortality is caused by p38 mitogen-activated protein kinase (MAPK)-mediated exaggerated acute inflammatory response resulting from SARS-CoV-2 infection. It is anticipated that the early initiation of p38α/β inhibitor therapy in patients with moderate COVID-19 will prevent further clinical deterioration and reduce the need for both increased respiratory support as well as mortality. This is the main hypothesis for this study. To address this hypothesis, Fulcrum Therapeutics is conducting a Phase 3, multicenter, randomized, double-blind, placebo-controlled study that will evaluate the safety and efficacy of losmapimod versus placebo in subjects with COVID-19 disease. Losmapimod is currently in Phase 2 clinical trials for the treatment of facioscapulohumeral dystrophy (FSHD) and has previously been administered to more than 3600 adult healthy volunteers and subjects including participants in a large Phase 3 trial which looked at clinical outcomes and safety after major cardiovascular events. Patients will participate in this study for approximately 34 days. The total treatment duration will be 14 days. Subjects will be evaluated during a 3 day pre-treatment period (Screening and Baseline Visits) to establish pre-treatment baseline assessments and eligibility. Subjects will then be randomized to treatment with losmapimod or placebo for 14 days and assessed frequently for changes from pre-treatment in various clinical outcome assessments. Patients must have a confirmed diagnosis of COVID-19 by viral PCR prior to randomization and first dosing. Patients will receive 15 mg of losmapimod, or placebo twice daily given as two 7.5 mg tablets per dose by mouth: for a total of 4 pills or 30 mg daily for 14 consecutive days. All study visits during the first week of treatment are anticipated to be conducted in the inpatient setting while later visits are anticipated to be conducted as outpatient. The primary endpoint of the study is to assess the efficacy of losmapimod tablets compared with placebo for the treatment of COVID-19 when administered concurrently with the local standard of care. Secondary endpoints include evaluating the effect of losmapimod compared with placebo on clinical outcomes, clinical status, effect on survival, safety, and tolerability and to characterize changes in the levels of SARS-CoV-2 infection.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
COVID-19
Keywords
COVID-19 pandemic, COVID-19 virus disease, COVID-19 virus infection, SARS-CoV-2 infection, coronavirus disease 2019, 2019 novel coronavirus disease, 2019 novel coronavirus infection

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
This study is a randomized, double-blind, placebo-controlled study.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
This study will be performed in a double-blind fashion. The investigator, study staff, subjects, Sponsor, and monitor will remain blinded to the treatment until study closure.
Allocation
Randomized
Enrollment
52 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Losmapimod
Arm Type
Experimental
Arm Description
COVID-19 patients with PCR confirmation will receive Losmapimod 15 mg twice daily given as two 7.5 mg tablets per dose by mouth; for a total of 4 pills or 30 mg daily for 14 days.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
COVID-19 patients with PCR confirmation will receive Placebo twice daily given as two tablets per dose by mouth; for a total of 4 tablets daily for 14 days.
Intervention Type
Drug
Intervention Name(s)
Losmapimod oral tablet
Intervention Description
This study includes a 14-day treatment period. Patients will receive losmapimod 15 mg twice daily given as two 7.5 mg tablets per dose by mouth: for a total of 4 pills or 30 mg daily. The study drug should be taken with food when possible.
Intervention Type
Drug
Intervention Name(s)
Placebo oral tablet
Intervention Description
This study includes a 14-day treatment period. Patients will receive Placebo twice daily given as two tablets per dose by mouth: for a total of 4 tablets daily. The study drug should be taken with food when possible.
Primary Outcome Measure Information:
Title
Day 28 Mortality
Description
The efficacy of Losmapimod will be assessed by the development of progression to critical disease as evidence of mortality or development of respiratory failure by Day 28.
Time Frame
Day 28
Secondary Outcome Measure Information:
Title
Clinical Status Assessment
Description
The change from baseline in clinical disease status will be evaluated using the 9-point World Health Organization (WHO) ordinal scale: 0 indicating, no clinical evidence of SARS-CoV-2 infection and 8 indicating death.
Time Frame
Day 7 and Day 14
Title
Respiratory Failure Assessment
Description
The response to treatment with Losmapimod in COVID-19 patients will be assessed by the total number of study days not requiring oxygen supplementation.
Time Frame
Day 28
Title
Treatment Survival
Description
To assess the effect on survival following treatment with Losmapimod, mortality will be evaluated by the number of days alive by Day 28.
Time Frame
Day 28
Title
Treatment-Emergent Adverse Events
Description
To evaluate the safety and tolerability of Losmapimod, the incidence of treatment-emergent adverse events will be assessed by clinically significant changes in laboratory test results and vital signs.
Time Frame
Screening, Date of enrollment and Days 2-14 and 7 and 14 days after the last dose of study drug
Title
Treatment-Emergent Adverse Events
Description
To characterize changes in SARS-CoV-2 infection following treatment with losmapimod versus placebo.
Time Frame
Day 7
Other Pre-specified Outcome Measures:
Title
Changes in C-Reactive Protein
Description
The change from baseline in levels of C-reactive protein (CRP), a biomarker of systemic inflammatory response to infection with the SARS-CoV-2 virus will be evaluated in serum by immunoturbidimetric assay.
Time Frame
Days 1, 4, 7 and 14
Title
Changes in Levels of Cytokines
Description
The change from baseline in the levels of cytokines (IFNγ, IL-2, IL-10 in normalized protein expression (NPX)) in response to the SARS-CoV-2 virus in serum will be evaluated using the Olink immunoassay panel.
Time Frame
Days 1, 4, 7 and 14
Title
Changes in Levels of Chemokines
Description
The change from baseline in the levels of chemokines (CXCL10, CXCL9 in normalized protein expression (NPX)) in response to the SARS-CoV-2 virus in serum will be evaluated using the Olink immunoassay panel.
Time Frame
Days 1, 4, 7 and 14

10. Eligibility

Sex
All
Minimum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Able and willing to provide written informed consent Willing and able to comply with all study procedures Age ≥50 years at time of screening Confirmed infection with SARS-CoV-2 virus at or before the baseline visit by polymerase chain reaction (PCR) testing ≤7 days to the time of randomization from the time of collection of the specimen that tested positive for the SARS-CoV-2 virus Hospitalization at the time of the baseline visit ≥90% oxygen saturation on room air and/or ≥94% oxygen saturation on oxygen administration at 2 L/min by nasal cannula at the baseline visit Radiographic (X-ray or computed tomography scan, per local standard of care) and/or clinical evidence of pulmonary involvement consistent with COVID-19 at screening or baseline, per the judgment of the investigator Clinical syndrome consistent with COVID-19 at screening, per the judgment of the investigator (CDC 2020) CRP at screening >15 mg/L (i.e., >1.5 mg/dL) on local laboratory testing Agrees to practice an approved method of birth control Exclusion Criteria: Inability to take oral medication at screening or baseline visit Evidence at screening or baseline of critical COVID-19 disease (e.g., cardiac failure, septic shock) or severe pulmonary involvement) Positive pregnancy test at screening for women of childbearing potential Lactating female at baseline for women of childbearing potential Note: A female will be considered eligible who is lactating at screening if she agrees to discontinue breastfeeding for the duration of the trial plus 14 days post last dose ≥5 × upper limit of normal (ULN) for alanine or aspartate aminotransferases or total bilirubin >1.5 × ULN at screening or known history of Child-Pugh Class C, hepatitis B or C, or HIV infection Glomerular filtration rate <30 mL/min/1.73 m2 at screening QTcF >450 msec for male or >470 msec for females or evidence of cardiac dysrhythmia at screening Significant history or evidence of clinically significant disorder, condition, current illness, illicit drug or other addiction, or disease that, in the opinion of the Investigator, would pose a risk to subject safety or interfere with the study evaluation, procedures, or completion Has been treated with immunomodulators or immunosuppressants including, but not limited to, interleukin (IL)-6 inhibitors, tumor necrosis factor (TNF) inhibitors, anti-IL-1 agents, and Janus kinase inhibitors, within 5 half-lives or 30 days, whichever is longer, prior to randomization, or plan to receive these agents any time during the study period Treatment with hydroxychloroquine/ chloroquine in the past 30 days or plan to receive these agents as part of investigational clinical trials or SOC any time during the study period Recent (within 30 days) or current participation in other COVID-19 therapeutic trials or expanded access programs Prior or current participation in COVID-19 vaccine trials
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
John Ziegler, MD, FASA
Organizational Affiliation
Fulcrum Therapeutics
Official's Role
Study Director
Facility Information:
Facility Name
University of California Irvine - Irvine Medical Center
City
Irvine
State/Province
California
ZIP/Postal Code
92697
Country
United States
Facility Name
University of Miami
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Facility Name
University of South Florida
City
Tampa
State/Province
Florida
ZIP/Postal Code
33606
Country
United States
Facility Name
Beth Israel Deaconess Medical Center
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States
Facility Name
Memorial Hermann Hospital South West
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
University of Texas Health Science Center at Houston
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
United Medical Memorial Hospital
City
Houston
State/Province
Texas
ZIP/Postal Code
77091
Country
United States
Facility Name
Hospital Universitario Cassiano Antonio de Moraes-HUCAM/Hospital das Clinicas
City
Vitória
State/Province
ES
ZIP/Postal Code
29043260
Country
Brazil
Facility Name
Santa Casa de Misericordia de Belo Horizonte
City
Belo Horizonte
State/Province
MG
ZIP/Postal Code
30150221
Country
Brazil
Facility Name
Irmandade de Santa Casa de Misericordia de Porto Alegre
City
Porto Alegre
State/Province
SC
ZIP/Postal Code
90035-075
Country
Brazil
Facility Name
Hospital Santa Paula
City
San Paolo
State/Province
SP
ZIP/Postal Code
04550-000
Country
Brazil
Facility Name
Hospital Civil Fray Antonio Alcalde
City
Guadalajara
State/Province
Jalisco
ZIP/Postal Code
44280
Country
Mexico
Facility Name
Nuevo Hospital Civil de Guadalajara
City
Guadalajara
State/Province
JC
ZIP/Postal Code
44340
Country
Mexico
Facility Name
JM Research Cuernavaca
City
Cuernavaca
State/Province
Morelos
ZIP/Postal Code
662284
Country
Mexico
Facility Name
Centro para el Desarrollo de la Medicina y de Asistencia Médica Especializada, S.C.
City
Culiacán
State/Province
Sinaloa
ZIP/Postal Code
80230
Country
Mexico
Facility Name
Hospital Nacional Carlos Alberto Seguín Escobedo - EsSalud Arequipa
City
Arequipa
State/Province
AR
ZIP/Postal Code
04001
Country
Peru

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
32422320
Citation
Grimes JM, Grimes KV. p38 MAPK inhibition: A promising therapeutic approach for COVID-19. J Mol Cell Cardiol. 2020 Jul;144:63-65. doi: 10.1016/j.yjmcc.2020.05.007. Epub 2020 May 16.
Results Reference
background
PubMed Identifier
25122212
Citation
Jimenez-Guardeno JM, Nieto-Torres JL, DeDiego ML, Regla-Nava JA, Fernandez-Delgado R, Castano-Rodriguez C, Enjuanes L. The PDZ-binding motif of severe acute respiratory syndrome coronavirus envelope protein is a determinant of viral pathogenesis. PLoS Pathog. 2014 Aug 14;10(8):e1004320. doi: 10.1371/journal.ppat.1004320. eCollection 2014 Aug.
Results Reference
background
PubMed Identifier
29155150
Citation
Vukmanovic-Stejic M, Chambers ES, Suarez-Farinas M, Sandhu D, Fuentes-Duculan J, Patel N, Agius E, Lacy KE, Turner CT, Larbi A, Birault V, Noursadeghi M, Mabbott NA, Rustin MHA, Krueger JG, Akbar AN. Enhancement of cutaneous immunity during aging by blocking p38 mitogen-activated protein (MAP) kinase-induced inflammation. J Allergy Clin Immunol. 2018 Sep;142(3):844-856. doi: 10.1016/j.jaci.2017.10.032. Epub 2017 Nov 17.
Results Reference
background
PubMed Identifier
24461903
Citation
Watz H, Barnacle H, Hartley BF, Chan R. Efficacy and safety of the p38 MAPK inhibitor losmapimod for patients with chronic obstructive pulmonary disease: a randomised, double-blind, placebo-controlled trial. Lancet Respir Med. 2014 Jan;2(1):63-72. doi: 10.1016/S2213-2600(13)70200-5. Epub 2013 Dec 5.
Results Reference
background
Citation
World Health Organization (WHO). WHO R&D blueprint novel coronavirus COVID-19 therapeutic trial synopsis. Draft Feb 18, 2020.
Results Reference
background

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Losmapimod Safety and Efficacy in COVID-19

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