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Assessing Safety, Hospitalization and Efficacy of rNAPc2 in COVID-19 (ASPEN)

Primary Purpose

Covid19

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
rNAPc2
Heparin
Sponsored by
ARCA Biopharma, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Covid19 focused on measuring D-dimer, Thromboprophylaxis, Anti-coagulant, Thrombotic Events, Coagulation, Inflammation, Heparin

Eligibility Criteria

18 Years - 90 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Age ≥ 18 years and ≤ 90 years at the Screening assessment
  2. Weight ≥ 50 kg at randomization
  3. Hospitalized with a diagnosis of COVID-19 and in need of inpatient medical care
  4. Positive for SARS-CoV-2 on nasopharyngeal, oropharyngeal or other tissue/body fluid samples by PCR or validated other test of ongoing infection (not an antibody test for prior exposure), within seven (7) days of hospitalization or screening assessment
  5. D-dimer level > upper limit of normal at screening
  6. Provided electronic or written informed consent, either personally or through a legally authorized representative (LAR)
  7. Must agree not to participate in a concurrent interventional study involving anticoagulation or anti-platelet therapy
  8. Female patients of reproductive or child-bearing potential must be willing to use an effective method of contraception for the duration of the study, and male patients must be willing to use an effective method of contraception to avoid partner pregnancy and abstain from sperm donation for at least 90 days after last dose

Exclusion Criteria:

  1. High bleeding risk, e.g. major surgery within prior 1 month, history of a major bleed while receiving anticoagulation, recent hemorrhagic stroke, current or planned (during current hospitalization) dual anti-platelet therapy, platelet count <25,000/uL, current therapeutic anticoagulation for a medical indication other than COVID-19, e.g. atrial fibrillation, known thrombosis, hereditary or acquired coagulopathy treated with therapeutic anticoagulation. Patients receiving prophylactic anticoagulation are eligible if they are willing to discontinue current anticoagulation.
  2. Sustained systolic blood pressure < 90 mmHg considered to be clinically significant
  3. Persistent eGFR <20 ml/min/1.73m2
  4. Known severe liver disease (e.g. bilirubin >3.5 mg/dL (60 umol/L))
  5. Life expectancy estimated to be < 72 hours based on current clinical condition
  6. Anticipated hospital discharge or transfer within 5 days based on current clinical condition
  7. Known anti-phospholipid syndrome
  8. Unable to receive heparin, e.g. history of heparin-induced thrombocytopenia and thrombosis (HITT)
  9. Participation in any interventional clinical study with an investigational product within seven (7) days of the Screening assessment or within 5 half-lives of the investigational agent, whichever is longer

Sites / Locations

  • ARCA Investigational Site #119
  • ARCA Investigational Site #118
  • ARCA Investigational Site #120
  • ARCA Investigational Site #104
  • ARCA Investigational Site #117
  • ARCA Investigational Site #101
  • ARCA Investigational Site #128
  • ARCA Investigational Site #113
  • ARCA Investigational Site #105
  • ARCA Investigational Site #114
  • ARCA Investigational Site #103
  • ARCA Investigational Site #127
  • ARCA Investigational Site #130
  • ARCA Investigational Site #112
  • ARCA Investigational Site #111
  • ARCA Investigational Site #115
  • ARCA Investigational Site #126
  • ARCA Investigational Site #129
  • ARCA Investigational Site #106
  • ARCA Investigational Site #125
  • ARCA Investigational Site #124
  • ARCA Investigational Site #122
  • ARCA Investigational Site #123
  • ARCA Investigational Site #121

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Active Comparator

Arm Label

rNAPc2 Higher Dose

rNAPc2 Lower Dose

Heparin

Arm Description

loading dose of 7.5 μg/kg SC on Day 1 followed by 5 μg/kg SC on Days 3 and 5

loading dose of 5 ug/kg SC on Day 1 followed by 3 ug/kg SC on Days 3 and 5

heparin at either prophylactic or therapeutic doses per Standard of Care at Institution

Outcomes

Primary Outcome Measures

Proportional Change in D-dimer Level From Baseline to Day 8, or Day of Discharge if Prior to Day 8 (Phase 2b)
Proportional change is represented as percent change, and is defined as: 100 × (D-Dimer level at Day 8 or early discharge - D-Dimer level at baseline) / D-Dimer level at baseline. Baseline and post-baseline D-Dimer results are tested in the same laboratory, i.e. both from central laboratory, or local laboratory paired samples if the central laboratory values are not available.

Secondary Outcome Measures

Proportional Change in D-dimer Level From Baseline to 24 Hours Post-dose (Day 2) and Day 3 (Phase 2b)
Proportional change is represented as percent change, and is defined as: 100 × (D-Dimer level at Day 2/3 or early discharge - D-Dimer level at baseline)/D-Dimer level at baseline. Baseline and post-baseline D-Dimer results are tested in the same laboratory.
Number of Major or Non-major Clinically Relevant Bleeding Events Within Eight (8) Days of Randomization as Compared to Heparin (Phase 2b)
Clinical events as reported by site. ISTH= International Society on Thrombosis and Haemostasis, TIMI= Thrombolysis in Myocardial Infarction. Heparin Dosing Strategy as indicated by Investigator. Where subjects have more than one bleeding event recorded, only the highest level of severity was summarized.
Number of Major or Non-major Clinically Relevant Bleeding Events With rNAPc2 vs. Heparin Through Day 30 (Phase 2b)
Clinical events as reported by site. ISTH= International Society on Thrombosis and Haemostasis, TIMI= Thrombolysis in Myocardial Infarction. Heparin Dosing Strategy as indicated by Investigator. Where subjects have more than one bleeding event recorded, only the highest level of severity was summarized.
Change in High Sensitivity C-reactive Protein Laboratory Values From Baseline Through Day 8 (Phase 2b)
Central lab samples collected per protocol. Proportional change is represented as percent change, and is defined as: 100 × (Biomarker level at Day 8 or early discharge - Biomarker level at baseline)/Biomarker level at baseline.
Change in Interleukin-6 Laboratory Values From Baseline Through Day 8 (Phase 2b)
Central lab samples collected per protocol. Proportional change is represented as percent change, and is defined as: 100 × (Biomarker level at Day 8 or early discharge - Biomarker level at baseline)/Biomarker level at baseline.
Change in Tissue Factor Laboratory Values From Baseline Through Day 8 (Phase 2b)
Central lab samples collected per protocol. Proportional change is represented as percent change, and is defined as: 100 × (Biomarker level at Day 8 or early discharge - Biomarker level at baseline)/Biomarker level at baseline.
Change in Antiphospholipid Antibodies Laboratory Values From Baseline Through Day 8 (Anti-Beta 2 Glycoprotein IgG) (Phase 2b)
Proportional change is represented as percent change, and is defined as: 100 × (Biomarker level at Day 8 or early discharge - Biomarker level at baseline)/Biomarker level at baseline.

Full Information

First Posted
December 2, 2020
Last Updated
January 30, 2023
Sponsor
ARCA Biopharma, Inc.
Collaborators
Colorado Prevention Center
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1. Study Identification

Unique Protocol Identification Number
NCT04655586
Brief Title
Assessing Safety, Hospitalization and Efficacy of rNAPc2 in COVID-19
Acronym
ASPEN
Official Title
Assessing Safety, Hospitalization and Efficacy of rNAPc2 in COVID-19 (ASPEN-COVID-19)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2022
Overall Recruitment Status
Completed
Study Start Date
December 10, 2020 (Actual)
Primary Completion Date
December 6, 2021 (Actual)
Study Completion Date
March 7, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
ARCA Biopharma, Inc.
Collaborators
Colorado Prevention Center

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
Sequential randomized, multicenter, active comparator study to evaluate the hypothesis that rNAPc2 (AB201), a novel, potent and highly selective tissue factor inhibitor with anticoagulant, anti-inflammatory and potential antiviral properties, shortens time to recovery compared to heparin in hospitalized patients with COVID-19 and elevated D-dimer levels.
Detailed Description
Sequential randomized, multicenter, active comparator study to evaluate the hypothesis that rNAPc2, a novel, potent and highly selective tissue factor inhibitor with anticoagulant, anti-inflammatory and potential antiviral properties, shortens time to recovery compared to heparin in hospitalized patients with COVID-19 and elevated D-dimer levels. Study participants and Clinical Endpoint Committee (CEC) members assessing the clinical endpoints will be blinded to treatment assignment. The protocol comprises sequential Phase 2b and Phase 3 studies. Analysis of Phase 2b data could lead to study discontinuation, adjustment of eligibility criteria or sample size, and will inform the rNAPc2 dose level to be studied in Phase 3.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Covid19
Keywords
D-dimer, Thromboprophylaxis, Anti-coagulant, Thrombotic Events, Coagulation, Inflammation, Heparin

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Parallel Assignment
Model Description
investigational product compared to active comparator
Masking
ParticipantOutcomes Assessor
Masking Description
Participant, clinical events committee members will be blind to treatment assignment. Investigator assessing outcomes will be blinded wherever possible.
Allocation
Randomized
Enrollment
160 (Actual)

8. Arms, Groups, and Interventions

Arm Title
rNAPc2 Higher Dose
Arm Type
Experimental
Arm Description
loading dose of 7.5 μg/kg SC on Day 1 followed by 5 μg/kg SC on Days 3 and 5
Arm Title
rNAPc2 Lower Dose
Arm Type
Experimental
Arm Description
loading dose of 5 ug/kg SC on Day 1 followed by 3 ug/kg SC on Days 3 and 5
Arm Title
Heparin
Arm Type
Active Comparator
Arm Description
heparin at either prophylactic or therapeutic doses per Standard of Care at Institution
Intervention Type
Drug
Intervention Name(s)
rNAPc2
Other Intervention Name(s)
AB201, Recombinant Nematode Anticoagulant Protein c2
Intervention Description
two dose levels of rNAPc2
Intervention Type
Drug
Intervention Name(s)
Heparin
Intervention Description
standard of care heparin per institution (therapeutic or prophylactic regimen)
Primary Outcome Measure Information:
Title
Proportional Change in D-dimer Level From Baseline to Day 8, or Day of Discharge if Prior to Day 8 (Phase 2b)
Description
Proportional change is represented as percent change, and is defined as: 100 × (D-Dimer level at Day 8 or early discharge - D-Dimer level at baseline) / D-Dimer level at baseline. Baseline and post-baseline D-Dimer results are tested in the same laboratory, i.e. both from central laboratory, or local laboratory paired samples if the central laboratory values are not available.
Time Frame
8 days
Secondary Outcome Measure Information:
Title
Proportional Change in D-dimer Level From Baseline to 24 Hours Post-dose (Day 2) and Day 3 (Phase 2b)
Description
Proportional change is represented as percent change, and is defined as: 100 × (D-Dimer level at Day 2/3 or early discharge - D-Dimer level at baseline)/D-Dimer level at baseline. Baseline and post-baseline D-Dimer results are tested in the same laboratory.
Time Frame
2 days and 3 days
Title
Number of Major or Non-major Clinically Relevant Bleeding Events Within Eight (8) Days of Randomization as Compared to Heparin (Phase 2b)
Description
Clinical events as reported by site. ISTH= International Society on Thrombosis and Haemostasis, TIMI= Thrombolysis in Myocardial Infarction. Heparin Dosing Strategy as indicated by Investigator. Where subjects have more than one bleeding event recorded, only the highest level of severity was summarized.
Time Frame
8 days
Title
Number of Major or Non-major Clinically Relevant Bleeding Events With rNAPc2 vs. Heparin Through Day 30 (Phase 2b)
Description
Clinical events as reported by site. ISTH= International Society on Thrombosis and Haemostasis, TIMI= Thrombolysis in Myocardial Infarction. Heparin Dosing Strategy as indicated by Investigator. Where subjects have more than one bleeding event recorded, only the highest level of severity was summarized.
Time Frame
30 days
Title
Change in High Sensitivity C-reactive Protein Laboratory Values From Baseline Through Day 8 (Phase 2b)
Description
Central lab samples collected per protocol. Proportional change is represented as percent change, and is defined as: 100 × (Biomarker level at Day 8 or early discharge - Biomarker level at baseline)/Biomarker level at baseline.
Time Frame
8 days
Title
Change in Interleukin-6 Laboratory Values From Baseline Through Day 8 (Phase 2b)
Description
Central lab samples collected per protocol. Proportional change is represented as percent change, and is defined as: 100 × (Biomarker level at Day 8 or early discharge - Biomarker level at baseline)/Biomarker level at baseline.
Time Frame
8 days
Title
Change in Tissue Factor Laboratory Values From Baseline Through Day 8 (Phase 2b)
Description
Central lab samples collected per protocol. Proportional change is represented as percent change, and is defined as: 100 × (Biomarker level at Day 8 or early discharge - Biomarker level at baseline)/Biomarker level at baseline.
Time Frame
8 days
Title
Change in Antiphospholipid Antibodies Laboratory Values From Baseline Through Day 8 (Anti-Beta 2 Glycoprotein IgG) (Phase 2b)
Description
Proportional change is represented as percent change, and is defined as: 100 × (Biomarker level at Day 8 or early discharge - Biomarker level at baseline)/Biomarker level at baseline.
Time Frame
8 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age ≥ 18 years and ≤ 90 years at the Screening assessment Weight ≥ 50 kg at randomization Hospitalized with a diagnosis of COVID-19 and in need of inpatient medical care Positive for SARS-CoV-2 on nasopharyngeal, oropharyngeal or other tissue/body fluid samples by PCR or validated other test of ongoing infection (not an antibody test for prior exposure), within seven (7) days of hospitalization or screening assessment D-dimer level > upper limit of normal at screening Provided electronic or written informed consent, either personally or through a legally authorized representative (LAR) Must agree not to participate in a concurrent interventional study involving anticoagulation or anti-platelet therapy Female patients of reproductive or child-bearing potential must be willing to use an effective method of contraception for the duration of the study, and male patients must be willing to use an effective method of contraception to avoid partner pregnancy and abstain from sperm donation for at least 90 days after last dose Exclusion Criteria: High bleeding risk, e.g. major surgery within prior 1 month, history of a major bleed while receiving anticoagulation, recent hemorrhagic stroke, current or planned (during current hospitalization) dual anti-platelet therapy, platelet count <25,000/uL, current therapeutic anticoagulation for a medical indication other than COVID-19, e.g. atrial fibrillation, known thrombosis, hereditary or acquired coagulopathy treated with therapeutic anticoagulation. Patients receiving prophylactic anticoagulation are eligible if they are willing to discontinue current anticoagulation. Sustained systolic blood pressure < 90 mmHg considered to be clinically significant Persistent eGFR <20 ml/min/1.73m2 Known severe liver disease (e.g. bilirubin >3.5 mg/dL (60 umol/L)) Life expectancy estimated to be < 72 hours based on current clinical condition Anticipated hospital discharge or transfer within 5 days based on current clinical condition Known anti-phospholipid syndrome Unable to receive heparin, e.g. history of heparin-induced thrombocytopenia and thrombosis (HITT) Participation in any interventional clinical study with an investigational product within seven (7) days of the Screening assessment or within 5 half-lives of the investigational agent, whichever is longer
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Marc Bonaca, MD, MPH
Organizational Affiliation
CPC Clinical Research
Official's Role
Principal Investigator
Facility Information:
Facility Name
ARCA Investigational Site #119
City
Fairhope
State/Province
Alabama
ZIP/Postal Code
36532
Country
United States
Facility Name
ARCA Investigational Site #118
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85006
Country
United States
Facility Name
ARCA Investigational Site #120
City
Tucson
State/Province
Arizona
ZIP/Postal Code
85724
Country
United States
Facility Name
ARCA Investigational Site #104
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
ARCA Investigational Site #117
City
Denver
State/Province
Colorado
ZIP/Postal Code
80204
Country
United States
Facility Name
ARCA Investigational Site #101
City
Jacksonville
State/Province
Florida
ZIP/Postal Code
32209
Country
United States
Facility Name
ARCA Investigational Site #128
City
Evanston
State/Province
Illinois
ZIP/Postal Code
60201
Country
United States
Facility Name
ARCA Investigational Site #113
City
New Orleans
State/Province
Louisiana
ZIP/Postal Code
70121
Country
United States
Facility Name
ARCA Investigational Site #105
City
Falls Church
State/Province
Virginia
ZIP/Postal Code
22042
Country
United States
Facility Name
ARCA Investigational Site #114
City
Richmond
State/Province
Virginia
ZIP/Postal Code
23230
Country
United States
Facility Name
ARCA Investigational Site #103
City
Tacoma
State/Province
Washington
ZIP/Postal Code
98405
Country
United States
Facility Name
ARCA Investigational Site #127
City
San Nicolás
State/Province
Buenos Aires
Country
Argentina
Facility Name
ARCA Investigational Site #130
City
Rosario
State/Province
Santa Fe
Country
Argentina
Facility Name
ARCA Investigational Site #112
City
Rosario
State/Province
Sante Fe
Country
Argentina
Facility Name
ARCA Investigational Site #111
City
Buenos Aires
Country
Argentina
Facility Name
ARCA Investigational Site #115
City
Caba
Country
Argentina
Facility Name
ARCA Investigational Site #126
City
Cordoba
Country
Argentina
Facility Name
ARCA Investigational Site #129
City
San Miguel de Tucuman
Country
Argentina
Facility Name
ARCA Investigational Site #106
City
San Miguel De Tucumán
Country
Argentina
Facility Name
ARCA Investigational Site #125
City
Campo Grande
State/Province
Mato Grosso Do Sul
Country
Brazil
Facility Name
ARCA Investigational Site #124
City
Braganca Paulista
State/Province
Sao Paolo
Country
Brazil
Facility Name
ARCA Investigational Site #122
City
Sao Jose do Rio Preto
State/Province
Sao Paolo
Country
Brazil
Facility Name
ARCA Investigational Site #123
City
Porto Alegre
Country
Brazil
Facility Name
ARCA Investigational Site #121
City
São Paulo
Country
Brazil

12. IPD Sharing Statement

Plan to Share IPD
No

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Assessing Safety, Hospitalization and Efficacy of rNAPc2 in COVID-19

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