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Treatment of Patients With Mild Coronavirus-19 (COVID-19) Disease With Methotrexate Associated to LDL Like Nanoparticles (Nano-COVID19) (Nano-COVID19)

Primary Purpose

Coronavirus, Inflammation, Covid19

Status
Unknown status
Phase
Phase 1
Locations
Brazil
Study Type
Interventional
Intervention
Methotrexate-LDE phase 1
Methotrexate-LDE phase 2
Placebo-LDE phase 2
Sponsored by
University of Sao Paulo General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Coronavirus focused on measuring coronavirus, inflammation, nanoparticles, methotrexate, covid19

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients who were hospitalized with confirmed COVID-19
  • Mild Coronavirus-19 disease (WHO Coronavirus-19 scale < 5)
  • Fewer than 14 days since symptom onset.
  • Female patient is not of childbearing potential, defined as postmenopausal for at least 1 year or surgically sterile.
  • Female patient is of childbearing potential must has a negative pregnancy test.
  • Signing the study informed consent.

Exclusion Criteria:

  • Need for oxygen supplementation >4 L/min via nasal cannula or ≥40% via Venturi mask.
  • Need for oxygen supplementation via high-flow nasal cannula.
  • Need for invasive mechanical ventilation.
  • Extent of pulmonary involvement > 50% by CT scan.
  • Chronic renal failure (estimated glomerular filtration rate <30 mL/min/1.73 m2)
  • History of liver cirrhosis (Bilirubins levels > 3mg/dl)
  • History of heart failure ( Ejection fraction <40%)
  • History of Steven-Johnson disease
  • History of stroke in the last 6 months
  • History of sickle cell disease
  • Chronic use of oral steroid therapy or other immunosuppressive or biologic response modifiers.
  • Prior history of chronic hepatitis B or C infection and known HIV positive.
  • Patient undergoing chemotherapy for cancer
  • Sepsis caused by fungal or multidrug resistant gram-negative bacteria
  • Known allergy to methotrexate.
  • Body mass index(BMI) > 40 or <18.5
  • Pregnancy or breastfeeding.
  • Patients enrolled in other clinical trials in the last 12 months
  • Patient is considered by the investigator, for any reason, to be an unsuitable candidate for the study.

Sites / Locations

  • Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, BrazilRecruiting
  • Hospital Santa Marcelina
  • Institute Prevent Senior

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Placebo Comparator

Arm Label

MTX-LDE phase 1

MTX-LDE phase 2

Placebo-LDE phase 2

Arm Description

Methotrexate carried by a lipid nanoparticle (MTX-LDE)

Methotrexate carried by a lipid nanoparticle (MTX-LDE)

Lipid nanoparticle (LDE)

Outcomes

Primary Outcome Measures

Duration of hospital stay
Compare the duration of hospital stay between groups

Secondary Outcome Measures

Number of participants requiring mechanical ventilation
The secondary outcome is the need for mechanical ventilation between groups
Number of participants requiring vasoactive drugs
The secondary outcome is the need for vasoactive drugs between groups
Number of participants requiring renal replacement therapy
The secondary outcome is the need for renal replacement therapy between groups
Incidence of secondary infection
The secondary outcome is the incidence of secondary infection between groups
Sequential Organ Failure Assessment (SOFA) score
The secondary outcome is the comparison of Sequential Organ Failure Assessment (SOFA) score between groups
World Health Organization (WHO) COVID-19 score
The secondary outcome is the comparison of World Health Organization (WHO) COVID-19 clinical score between groups
Interleukin 6 (IL-6)
The secondary outcome is the comparison of IL-6 levels between groups
Dimer-D
The secondary outcome is the comparison of dimer-D levels between groups
Chest CT scan
The secondary outcome is the comparison of chest CT scan between groups
Incidence and severity of laboratory alterations
The secondary outcome is the comparison of red blood cells; white blood cells;Platelets; Urea;Creatinine levels between groups
Clinical side effects
Compare the incidence of clinical significant symptoms (new and persistent stomatitis, vomiting, diarrhea, alopecia, neurotoxicity, bradycardia, hypotension, local pain) reported between groups.
Other adverse events
Compare the incidence of other adverse events (not expected) between groups

Full Information

First Posted
October 24, 2020
Last Updated
January 13, 2021
Sponsor
University of Sao Paulo General Hospital
Collaborators
Hospital Santa Marcelina
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1. Study Identification

Unique Protocol Identification Number
NCT04610567
Brief Title
Treatment of Patients With Mild Coronavirus-19 (COVID-19) Disease With Methotrexate Associated to LDL Like Nanoparticles (Nano-COVID19)
Acronym
Nano-COVID19
Official Title
Two Phases Clinical Trial to Evaluate Safety and Efficacy of Methotrexate Associated to LDL Like Nanoparticles (LDE-MTX) in the Treatment of Patients With Mild Coronavirus-19 (COVID-19) Disease.
Study Type
Interventional

2. Study Status

Record Verification Date
January 2021
Overall Recruitment Status
Unknown status
Study Start Date
October 27, 2020 (Actual)
Primary Completion Date
March 15, 2021 (Anticipated)
Study Completion Date
July 15, 2021 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Sao Paulo General Hospital
Collaborators
Hospital Santa Marcelina

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
The investigators propose a prospective, randomized, double-blind, placebo-controlled study, conducted in two phases. The purpose of the study is to evaluate the safety and efficacy of methotrexate in a cholesterol-rich non-protein nanoparticle (MTX -LDE) in adults diagnosed with mild Coronavirus-19(COVID-19) disease. A total of 100 patients will be randomized to receive MTX-LDE or placebo each 7 days, up to 3 times, during in hospital treatment.
Detailed Description
The objective of the study is to evaluate the safety and efficacy of (MTX -LDE) in patients with mild Coronavirus-19 (COVID-19) disease. In phase 1, firstly 3 patients with moderate COVID-19 disease will receive MTX-LDE IV 15mg each 7 days, up to 3 times, during hospitalization. After that, 9 patients with moderate COVID-19 disease will receive MTX-LDE IV 30mg each 7 days, up to 3 times, during hospitalization. Follow-up assessments will occur daily following randomization during in hospital treatment and 2 weeks after discharge for evaluation of the occurrence of adverse events.The purpose of this phase will be evaluate safety and pharmacokinetics. If no objection by data and safety monitoring board (DSMB), will be authorized to start the second phase. In phase 2, 88 patients with moderate COVID-19 disease will be randomized to receive MTX-LDE IV 30mg or placebo-LDE IV each 7 days, up to 3 times, during hospitalization. Follow-up assessments will occur daily following randomization during in hospital treatment and 2 weeks after discharge for evaluation of the occurrence of any trial endpoints or other adverse events.The primary endpoint of this phase will be reduction in duration of hospitalization stay between groups. Patients will undergo clinical and laboratory safety evaluations daily. An algorithm for drug suspension based on clinical and laboratory finding will be followed.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Coronavirus, Inflammation, Covid19
Keywords
coronavirus, inflammation, nanoparticles, methotrexate, covid19

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Model Description
This will be a randomized, double-blind, placebo-controlled, multi-center study.
Masking
ParticipantCare ProviderOutcomes Assessor
Allocation
Randomized
Enrollment
100 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
MTX-LDE phase 1
Arm Type
Experimental
Arm Description
Methotrexate carried by a lipid nanoparticle (MTX-LDE)
Arm Title
MTX-LDE phase 2
Arm Type
Experimental
Arm Description
Methotrexate carried by a lipid nanoparticle (MTX-LDE)
Arm Title
Placebo-LDE phase 2
Arm Type
Placebo Comparator
Arm Description
Lipid nanoparticle (LDE)
Intervention Type
Drug
Intervention Name(s)
Methotrexate-LDE phase 1
Other Intervention Name(s)
MTX-LDE phase 1
Intervention Description
3 patients will receive MTX-LDE at the dose of 15mg IV each 7 days during hospitalization, up to 3 times . After that, 9 patients will receive MTX-LDE at the dose of 30mg IV each 7 days during hospitalization, up to 3 times . All patients will receive Leucovorin (calcium foliate) 25mg IV, 24hr after administration of MTX-LDE
Intervention Type
Drug
Intervention Name(s)
Methotrexate-LDE phase 2
Other Intervention Name(s)
MTX-LDE phase 2
Intervention Description
44 patients will receive MTX-LDE at the dose of 30mg IV each 7 days during hospitalization, up to 3 times dose of 30mg IV each 7 days during hospitalization, up to 3 times . All patients will receive Leucovorin (calcium foliate) 25mg IV, 24hr after administration of MTX-LDE
Intervention Type
Drug
Intervention Name(s)
Placebo-LDE phase 2
Intervention Description
44 patients will receive Placebo-LDE IV each 7 days during hospitalization, up to 3 times dose of 30mg IV each 7 days during hospitalization, up to 3 times . All patients will receive Leucovorin (calcium foliate) 25mg IV, 24hr after administration of Placebo-LDE
Primary Outcome Measure Information:
Title
Duration of hospital stay
Description
Compare the duration of hospital stay between groups
Time Frame
30 days after randomization
Secondary Outcome Measure Information:
Title
Number of participants requiring mechanical ventilation
Description
The secondary outcome is the need for mechanical ventilation between groups
Time Frame
15 days after randomization
Title
Number of participants requiring vasoactive drugs
Description
The secondary outcome is the need for vasoactive drugs between groups
Time Frame
15 days after randomization
Title
Number of participants requiring renal replacement therapy
Description
The secondary outcome is the need for renal replacement therapy between groups
Time Frame
15 days after randomization
Title
Incidence of secondary infection
Description
The secondary outcome is the incidence of secondary infection between groups
Time Frame
15 days after randomization
Title
Sequential Organ Failure Assessment (SOFA) score
Description
The secondary outcome is the comparison of Sequential Organ Failure Assessment (SOFA) score between groups
Time Frame
Baseline and change from baseline to 15 days after randomization
Title
World Health Organization (WHO) COVID-19 score
Description
The secondary outcome is the comparison of World Health Organization (WHO) COVID-19 clinical score between groups
Time Frame
Baseline and change from baseline to 15 days after randomization
Title
Interleukin 6 (IL-6)
Description
The secondary outcome is the comparison of IL-6 levels between groups
Time Frame
Baseline and change from baseline to 15 days after randomization
Title
Dimer-D
Description
The secondary outcome is the comparison of dimer-D levels between groups
Time Frame
Baseline and change from baseline to 15 days after randomization
Title
Chest CT scan
Description
The secondary outcome is the comparison of chest CT scan between groups
Time Frame
Baseline and change from baseline to 15 days after randomization
Title
Incidence and severity of laboratory alterations
Description
The secondary outcome is the comparison of red blood cells; white blood cells;Platelets; Urea;Creatinine levels between groups
Time Frame
30 days after randomization
Title
Clinical side effects
Description
Compare the incidence of clinical significant symptoms (new and persistent stomatitis, vomiting, diarrhea, alopecia, neurotoxicity, bradycardia, hypotension, local pain) reported between groups.
Time Frame
30 days after randomization
Title
Other adverse events
Description
Compare the incidence of other adverse events (not expected) between groups
Time Frame
30 days after randomization

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients who were hospitalized with confirmed COVID-19 Mild Coronavirus-19 disease (WHO Coronavirus-19 scale < 5) Fewer than 14 days since symptom onset. Female patient is not of childbearing potential, defined as postmenopausal for at least 1 year or surgically sterile. Female patient is of childbearing potential must has a negative pregnancy test. Signing the study informed consent. Exclusion Criteria: Need for oxygen supplementation >4 L/min via nasal cannula or ≥40% via Venturi mask. Need for oxygen supplementation via high-flow nasal cannula. Need for invasive mechanical ventilation. Extent of pulmonary involvement > 50% by CT scan. Chronic renal failure (estimated glomerular filtration rate <30 mL/min/1.73 m2) History of liver cirrhosis (Bilirubins levels > 3mg/dl) History of heart failure ( Ejection fraction <40%) History of Steven-Johnson disease History of stroke in the last 6 months History of sickle cell disease Chronic use of oral steroid therapy or other immunosuppressive or biologic response modifiers. Prior history of chronic hepatitis B or C infection and known HIV positive. Patient undergoing chemotherapy for cancer Sepsis caused by fungal or multidrug resistant gram-negative bacteria Known allergy to methotrexate. Body mass index(BMI) > 40 or <18.5 Pregnancy or breastfeeding. Patients enrolled in other clinical trials in the last 12 months Patient is considered by the investigator, for any reason, to be an unsuitable candidate for the study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Raul Maranhão, MD;PhD
Phone
+551126615951
Email
raul.maranhao@incor.usp.br
Facility Information:
Facility Name
Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, Brazil
City
São Paulo
State/Province
SP
ZIP/Postal Code
05403900
Country
Brazil
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lucas Marinho, MD
Phone
+5511948045001
Email
lucaslage@hotmail.com
Facility Name
Hospital Santa Marcelina
City
São Paulo
State/Province
SP
Country
Brazil
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jose Salvador Oliveira, MD;PhD
Facility Name
Institute Prevent Senior
City
São Paulo
State/Province
SP
Country
Brazil
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Rodrigo Esper, MD;PhD

12. IPD Sharing Statement

Plan to Share IPD
No
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Links:
URL
https://www.who.int/docs/default-source/blue-print/covid-19-therapeutic-trial-synopsis.pdf?sfvrsn=44b83344_1&download=true.
Description
WHO COVID-19 Therapeutic Trial Synopsis

Learn more about this trial

Treatment of Patients With Mild Coronavirus-19 (COVID-19) Disease With Methotrexate Associated to LDL Like Nanoparticles (Nano-COVID19)

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