CRISIS2: A Phase 2 Study of the Safety and Antiviral Activity of Brequinar in Non-hospitalized Pts With COVID-19 (CRISIS2)
Primary Purpose
COVID-19 Infection
Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Brequinar
Placebo
Sponsored by

About this trial
This is an interventional treatment trial for COVID-19 Infection
Eligibility Criteria
Inclusion Criteria:
- Willing and able to provide informed consent for the trial, written, electronic, verbal or other method deemed acceptable by the institution and IRB.
- 18 years of age or older.
- Laboratory-confirmed SARS-CoV-2 infection as determined by real time polymerase chain reaction (RT-PCR) or other FDA-approved commercial or public health assay.
- Out-patient (never hospitalized as an in-patient for COVID-19 or was evaluated/treated for COVID-19 only in the Emergency Room with a stay of < 24 hours)
- The effects of brequinar on the developing human fetus are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Men and women treated or enrolled on this protocol must also agree to use adequate contraception for the duration of study participation, and for 90 days after completion of brequinar administration.
- Male subjects must agree to refrain from sperm donation and female subjects must agree to refrain from ovum donation from initial study drug administration until 90 days after the last dose of brequinar.
- Must have at least one COVID-19 symptom including but not limited to fever, cough, sore throat, malaise, headache, muscle pain, gastrointestinal symptoms, shortness of breath, dyspnea, anosmia, dysgeusia, or other symptom commonly associated with COVID-19 in the opinion of the investigator. Symptom onset must be ≤7 days prior to first dose. Subject must have one or more symptoms at first dose.
- Able to swallow capsules.
Exclusion Criteria:
- Any physical examination findings and/or history of any illness that, in the opinion of the study investigator, might confound the results of the study or pose an additional risk to the patient
- Nursing women or women of childbearing potential (WOCBP) with a positive pregnancy test
- Treatment with another DHODH inhibitor (e.g., leflunomide, teriflunomide) or other agents known to cause bone marrow suppression leading to thrombocytopenia
- Platelets ≤150,000 cell/mm3
- Hemoglobin < 10 gm/dL
- Absolute neutrophil count < 1500 cells/mm3
- Renal dysfunction, i.e., creatinine clearance < 30 mL/min
- AST or ALT > 2 x ULN, or total bilirubin > ULN. Gilbert's Syndrome is allowed.
- Bleeding disorders or blood loss requiring transfusion in the six weeks preceding enrollment
- Ongoing gastrointestinal ulcer, or gastrointestinal bleeding within 6 weeks of randomization.
- Chronic hepatitis B infection, active hepatitis C infection, active liver disease and/or cirrhosis per subject report.
- Heart failure, current uncontrolled cardiovascular disease, including unstable angina, uncontrolled arrhythmias, major adverse cardiac event within 6 months (e.g. stroke, myocardial infarction, hospitalization due to heart failure, or revascularization procedure).
Sites / Locations
- Central Alabama Research
- Ark Clinical Research
- Doral Medical Research
- South Jersey Infectious Disease
- Monroe Biomedical Research
- Wilmington Health
- Remington-Davis, Inc.
- Toledo Institute of Clinical Research
- VitaLink - Gaffney
- Self Regional Healthcare Research Center - Self Medical Group
- VitaLink Research
- Clinical Trials Center of Middle Tennessee
- Centex Studies, Inc. - McAllen
- Synexus Clinical Research US, Inc. - Olympus Family Medicine
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Placebo Comparator
Arm Label
Brequinar 100 mg
Placebo
Arm Description
Brequinar oral capsules 100 mg x 5 days
Placebo for Brequinar capsules x 5 days
Outcomes
Primary Outcome Measures
Log10 SARS-CoV-2 Viral Load
Median Change from Baseline in Quantitative Log10 SARS-CoV-2 viral load at Days 4, 8, 12, 15, 22, and 29.
Secondary Outcome Measures
Rates of AEs and SAEs Including Laboratory Assessments
Safety measured by number of participants with AEs and SAEs including laboratory assessments.
Viral Shedding Duration
Duration of viral shedding was defined as the time to viral clearance (two consecutive negative test results) for the Microbiology Evaluable Set population.
Hospital Admission
Percentage of subjects requiring admission as an inpatient for >24 hours
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT04575038
Brief Title
CRISIS2: A Phase 2 Study of the Safety and Antiviral Activity of Brequinar in Non-hospitalized Pts With COVID-19
Acronym
CRISIS2
Official Title
The CRISIS2 Study: A Phase 2, Randomized, Double Blind, Placebo-controlled, Multi-center Study Assessing the Safety and Anti-coronavirus Response of Suppression of Host Nucleotide Synthesis in Out-patient Adults With SARS-CoV-2
Study Type
Interventional
2. Study Status
Record Verification Date
April 2022
Overall Recruitment Status
Completed
Study Start Date
November 19, 2020 (Actual)
Primary Completion Date
April 28, 2021 (Actual)
Study Completion Date
April 28, 2021 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Clear Creek Bio, Inc.
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
This study will assess the efficacy and safety of DHODHi (brequinar) as an antiviral via 5 days of treatment of participants with positive COVID-19 and at least one symptom of COVI019 in an out-patient setting. The study is multi-center, randomized, and placebo-controlled.
Detailed Description
Brequinar is a potent DHODH inhibitor that has been previously studied in more than 1,000 cancer, psoriasis, and organ transplant patients. Brequinar has been found to have potent in vitro antiviral activity against many RNA viruses including SARS-CoV-2. The antiviral activity of brequinar against SARS-CoV-2 is likely due to DHODH inhibition and shows nanomolar potency and a high selectivity index in inhibiting viral replication in in vitro studies.
The CRISIS2 trial will study out-patients (non-hospitalized patients) who have a positive SARS-CoV-2 test and are symptomatic. Subjects will be randomized to receive standard of care (SOC) + 5 days of brequinar or SOC + 5 days of placebo. The purpose of this study is to determine if the in vitro antiviral activity of brequinar can be duplicated in patients infected with SARS-CoV-2 by measuring the effect of brequinar on viral shedding. Importantly, the safety and tolerability of brequinar will also be determined in these patients. The results of this proof-of-concept study will inform future studies that will help determine if brequinar is a safe and effective drug for the treatment of SARS-CoV-2 infection.
This will be a phase II randomized, placebo-controlled, double blind, multi-center study with approximately 100 subjects. All subjects will receive standard of care (SOC) per institutional guidelines for treatment of patients with COVID-19 infection. In addition to SOC, the subjects will self-administer one capsule once daily for 5 days.
Subjects will have a Screening Visit followed as soon as possible with Study Day 1. Study visits (virtual or in person) will take place at Screening and on specified days. The visits that include bloodwork must be conducted at the study site or arrangements made for sample collection at the subject's home or other appropriate location. Other visits/visit activities for that visit may be conducted remotely using telemedicine or other remote technique. Subjects are to self-collect a viral load sample, obtain their respiratory rate, heart rate, body temperature and SpO2, and complete a symptom assessment checklist on specified days.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
COVID-19 Infection
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Randomized 1:1 brequinar 100 mg or placebo
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Double blind
Allocation
Randomized
Enrollment
115 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Brequinar 100 mg
Arm Type
Experimental
Arm Description
Brequinar oral capsules 100 mg x 5 days
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo for Brequinar capsules x 5 days
Intervention Type
Drug
Intervention Name(s)
Brequinar
Intervention Description
Dihydroorotate dehydrogenase inhibitor (DHODHi)
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo capsules
Primary Outcome Measure Information:
Title
Log10 SARS-CoV-2 Viral Load
Description
Median Change from Baseline in Quantitative Log10 SARS-CoV-2 viral load at Days 4, 8, 12, 15, 22, and 29.
Time Frame
Days 4, 8, 12, 15, 22, and 29
Secondary Outcome Measure Information:
Title
Rates of AEs and SAEs Including Laboratory Assessments
Description
Safety measured by number of participants with AEs and SAEs including laboratory assessments.
Time Frame
Through Day 29
Title
Viral Shedding Duration
Description
Duration of viral shedding was defined as the time to viral clearance (two consecutive negative test results) for the Microbiology Evaluable Set population.
Time Frame
Through Day 36
Title
Hospital Admission
Description
Percentage of subjects requiring admission as an inpatient for >24 hours
Time Frame
Day 29
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Willing and able to provide informed consent for the trial, written, electronic, verbal or other method deemed acceptable by the institution and IRB.
18 years of age or older.
Laboratory-confirmed SARS-CoV-2 infection as determined by real time polymerase chain reaction (RT-PCR) or other FDA-approved commercial or public health assay.
Out-patient (never hospitalized as an in-patient for COVID-19 or was evaluated/treated for COVID-19 only in the Emergency Room with a stay of < 24 hours)
The effects of brequinar on the developing human fetus are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Men and women treated or enrolled on this protocol must also agree to use adequate contraception for the duration of study participation, and for 90 days after completion of brequinar administration.
Male subjects must agree to refrain from sperm donation and female subjects must agree to refrain from ovum donation from initial study drug administration until 90 days after the last dose of brequinar.
Must have at least one COVID-19 symptom including but not limited to fever, cough, sore throat, malaise, headache, muscle pain, gastrointestinal symptoms, shortness of breath, dyspnea, anosmia, dysgeusia, or other symptom commonly associated with COVID-19 in the opinion of the investigator. Symptom onset must be ≤7 days prior to first dose. Subject must have one or more symptoms at first dose.
Able to swallow capsules.
Exclusion Criteria:
Any physical examination findings and/or history of any illness that, in the opinion of the study investigator, might confound the results of the study or pose an additional risk to the patient
Nursing women or women of childbearing potential (WOCBP) with a positive pregnancy test
Treatment with another DHODH inhibitor (e.g., leflunomide, teriflunomide) or other agents known to cause bone marrow suppression leading to thrombocytopenia
Platelets ≤150,000 cell/mm3
Hemoglobin < 10 gm/dL
Absolute neutrophil count < 1500 cells/mm3
Renal dysfunction, i.e., creatinine clearance < 30 mL/min
AST or ALT > 2 x ULN, or total bilirubin > ULN. Gilbert's Syndrome is allowed.
Bleeding disorders or blood loss requiring transfusion in the six weeks preceding enrollment
Ongoing gastrointestinal ulcer, or gastrointestinal bleeding within 6 weeks of randomization.
Chronic hepatitis B infection, active hepatitis C infection, active liver disease and/or cirrhosis per subject report.
Heart failure, current uncontrolled cardiovascular disease, including unstable angina, uncontrolled arrhythmias, major adverse cardiac event within 6 months (e.g. stroke, myocardial infarction, hospitalization due to heart failure, or revascularization procedure).
Facility Information:
Facility Name
Central Alabama Research
City
Homewood
State/Province
Alabama
ZIP/Postal Code
35209
Country
United States
Facility Name
Ark Clinical Research
City
Long Beach
State/Province
California
ZIP/Postal Code
90806
Country
United States
Facility Name
Doral Medical Research
City
Doral
State/Province
Florida
ZIP/Postal Code
33166
Country
United States
Facility Name
South Jersey Infectious Disease
City
Somers Point
State/Province
New Jersey
ZIP/Postal Code
08244
Country
United States
Facility Name
Monroe Biomedical Research
City
Monroe
State/Province
North Carolina
ZIP/Postal Code
28112
Country
United States
Facility Name
Wilmington Health
City
Wilmington
State/Province
North Carolina
ZIP/Postal Code
28401
Country
United States
Facility Name
Remington-Davis, Inc.
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43215
Country
United States
Facility Name
Toledo Institute of Clinical Research
City
Toledo
State/Province
Ohio
ZIP/Postal Code
43617
Country
United States
Facility Name
VitaLink - Gaffney
City
Gaffney
State/Province
South Carolina
ZIP/Postal Code
29615
Country
United States
Facility Name
Self Regional Healthcare Research Center - Self Medical Group
City
Greenwood
State/Province
South Carolina
ZIP/Postal Code
29646
Country
United States
Facility Name
VitaLink Research
City
Spartanburg
State/Province
South Carolina
ZIP/Postal Code
29303
Country
United States
Facility Name
Clinical Trials Center of Middle Tennessee
City
Franklin
State/Province
Tennessee
ZIP/Postal Code
37067
Country
United States
Facility Name
Centex Studies, Inc. - McAllen
City
McAllen
State/Province
Texas
ZIP/Postal Code
78504
Country
United States
Facility Name
Synexus Clinical Research US, Inc. - Olympus Family Medicine
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84117
Country
United States
12. IPD Sharing Statement
Learn more about this trial
CRISIS2: A Phase 2 Study of the Safety and Antiviral Activity of Brequinar in Non-hospitalized Pts With COVID-19
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