A Phase 2 Study of APX-115 in Hospitalized Patients With Confirmed Mild to Moderate COVID-19.
Primary Purpose
COVID-19
Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
APX-115
Placebo
Sponsored by
About this trial
This is an interventional treatment trial for COVID-19 focused on measuring Pulmonary fibrosis, COVID-19, SARS-COV-2, ROS
Eligibility Criteria
Inclusion Criteria:
- Willing and able to provide informed consent themselves or through their legally authorized representative.
- Male or female patients, of any race or ethnicity, 18 to 80 years of age, inclusive, on the day of informed consent. Racial and ethnic minorities should be included in the study population to the greatest extent possible.
- Laboratory-confirmed SARS-CoV-2 infection as determined within 14 days of randomization by real time RT-PCR or other commercial or public health assay authorized by FDA or other applicable health authority .
- Onset of COVID-19 symptoms within 14 days prior to randomization.
- Have at least one of the following symptoms at screening: fever, cough, shortness of breath, myalgia, ageusia, anosmia, fatigue, or weakness.
- Hospitalized with COVID-19 disease (WHO COVID-19 Clinical Improvement Ordinal Scale score of 3 [hospitalized, no oxygen therapy], 4 [hospitalized, oxygen by mask or nasal prongs], or 5 [high-flow oxygen or non-invasive mechanical ventilation])
- Patient is aware of the investigational nature of this study and willing to comply with protocol treatments, blood tests, and other evaluations listed in the informed consent form.
Exclusion Criteria:
- Females who are pregnant (negative pregnancy test required for all women of childbearing potential at screening) or breastfeeding.
- Male patients and women of childbearing potential (women who are not surgically sterile or postmenopausal defined as postmenopausal for >12 months) who are not using at least one protocol specified method of contraception.
- COVID-19 disease as defined by the WHO COVID-19 Clinical Improvement Ordinal Scale, scores of 6 (intubation and mechanical ventilation) or 7 (ventilation + additional organ support - pressors, renal replacement therapy, extracorporeal membrane oxygenation).
- Expected survival less than 72 hours.
- Treatment with other drugs thought to possibly have activity against SARS CoV 2 infection within 7 days or within 5 half-lives, whichever is longer, prior to enrollment or concurrently. Drugs that have received FDA emergency use authorization or COVID-19 approval are allowed.
- Treatment with immunosuppressants, combination of 2 or more RAS blockers, UGT inhibitors and inducers, herbal/natural supplements, potassium-sparing diuretic, and radiographic contrast agent prior to enrollment or concurrently.
- History of abuse of drugs or alcohol that could interfere with adherence to study requirements as judged by the investigator.
- Use of any other concurrent investigational drugs while participating in the present study.
- Patient requires frequent or prolonged use of systemic corticosteroids (≥20 mg of prednisone/day or equivalent for >4 weeks) or other immunosuppressive drugs (eg, for organ transplantation or autoimmune conditions).
- Known renal disease with an estimated glomerular filtration rate <30 mL/min.
- Patients with clinically apparent liver disease (eg, jaundice, cholestasis, hepatic synthetic impairment, or active hepatitis) or moderate or severe hepatic impairment as determined by Child-Pugh score Class B or C.
- Alanine aminotransaminase (ALT) or aspartate aminotransaminase (AST) >3 × upper limit of normal (ULN) AND total bilirubin levels >2 × ULN OR ALT or AST >5 × ULN.
- Total bilirubin >1.5 × ULN, unless the patient has known Gilbert's syndrome.
- Hemoglobin <9 g/dL for females or <11 g/dL for males.
- Absolute neutrophil count <1500/mm3.
- Thrombocytopenia (platelets count <100 × 109/L).
- Inability to swallow oral medications or a gastrointestinal disorder with diarrhea (eg, Crohn's disease) or malabsorption at screening.
- Any other clinically significant medical condition or laboratory abnormality that, in the opinion of the investigator, would jeopardize the safety of the patient or potentially impact patient compliance or the safety/efficacy observations in the study.
- History of an allergic reaction or hypersensitivity to the study drug or any component of the study drug formulation.
Sites / Locations
- Alternative Research Associates, LLC
- Anne Arundel Medical CenterRecruiting
- Millennium Physicians Group
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Placebo Comparator
Arm Label
APX-115
Placebo
Arm Description
Oral administration of APX-115 100mg, daily for 14 days
Oral administration of Placebo, daily for 14 days
Outcomes
Primary Outcome Measures
Incidence of Treatment-Emergent Adverse Events
Adverse events will be assessed to evaluate the safety and tolerability of APX-115 in mild-to-moderate COVID-19 patients. Clinical laboratory evaluations, vital signs, and ECG will be used to assess adverse events.
Secondary Outcome Measures
Time to clinical recovery
Recovery is defined as when WHO Clinical Improvement Ordinal Scale equal to or less than 3
Time to discharge
WHO Clinical Improvement Ordinal Scale is equal to or less than 2
Time to symptomatic recovery
When none of the COVID-19 Symptom Assessment scores are higher than 1
Time to complete symptomatic recovery
When none of the COVID-19 Symptom Assessment scores are higher than 0
Change in log10 SARS-CoV-2 viral load
hange from baseline in log10 SARS-CoV-2 viral load as measured by RT-PCR by Days 5 and 14
Proportion of patients in clinical recovery
Symptom Assessment
scoring of WHO Clinical Improvement Ordinal Scale
9-point scale on key analysis days for levels ≥3
Changes from baseline in anti-inflammatory markers in blood
Blood will be analyzed for changes from baseline in anti-inflammatory markers, such as C-reactive protein, ferritin, lactate dehydrogenase, D-dimer, troponin, and transforming growth factor-β.
Changes from baseline in pro-inflammatory cytokines in blood
Blood will be analyzed for changes from baseline in pro-cytokine panel of the blood, such as interleukin (IL)-1β, IL-6, and interferon-γ.
Changes from baseline in 8-isoprostane in blood
Blood will be analyzed for changes from baseline in 8-isoprostane.
Trough (predose) plasma concentration (Ctrough)
Trough (predose) plasma concentration (Ctrough) will be analyzed from plasma samples for pharmacokinetic assessment of APX-115.
Maximum observed plasma concentration (Cmax)
Maximum observed plasma concentration (Cmax) will be analyzed from plasma samples for pharmacokinetic assessment of APX-115.
Time to Cmax (Tmax)
Time to Cmax (Tmax) will be analyzed from plasma samples for pharmacokinetic assessment of APX-115.
Area under the plasma concentration versus time curve (AUC) from time zero to the Time of last quantifiable concentration (AUC0-last)
Area under the plasma concentration versus time curve (AUC) from time zero to the time of last quantifiable concentration (AUC0-last) will be analyzed from plasma samples for pharmacokinetic assessment of APX-115.
AUC within a dosing interval (AUCtau, where tau = 12 hours)
AUC within a dosing interval (AUCtau, where tau = 12 hours) will be analyzed from plasma samples for pharmacokinetic assessment of APX-115.
Full Information
NCT ID
NCT04880109
First Posted
April 29, 2021
Last Updated
July 19, 2023
Sponsor
Aptabio Therapeutics, Inc.
Collaborators
Covance
1. Study Identification
Unique Protocol Identification Number
NCT04880109
Brief Title
A Phase 2 Study of APX-115 in Hospitalized Patients With Confirmed Mild to Moderate COVID-19.
Official Title
A Phase 2, Double-blind, Placebo-controlled, Efficacy, and Safety Study of APX-115 in Hospitalized Patients With Confirmed Mild to Moderate COVID-19.
Study Type
Interventional
2. Study Status
Record Verification Date
July 2023
Overall Recruitment Status
Recruiting
Study Start Date
October 20, 2021 (Actual)
Primary Completion Date
September 2023 (Anticipated)
Study Completion Date
September 2023 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Aptabio Therapeutics, Inc.
Collaborators
Covance
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 phase 2 study is to assess the safety and tolerability of APX-115 active doses compared to placebo following multiple oral dosing in hospitalized patients with confirmed, mild to moderate, symptomatic COVID-19. It is anticipated that approximately 80 patients will be randomized into the study in a 1:1 ratio to 100 mg APX-115 or placebo arm.
Detailed Description
APX-115 is a potent small molecule inhibitor of NADPH-oxidase (Nox) isozymes being developed by Aptabio Therapeutics Inc. The Nox enzymes represent a family of 7 membrane enzymes (Nox1, Nox2, Nox3, Nox4, Nox5, Duox1, and Duox2) which catalyze NADPH-dependent generation of superoxide and secondary reactive oxygen species (ROS).
ROS are often generated during virus infection, thus promoting apoptosis, lung injury, and inflammation/allergy.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
COVID-19
Keywords
Pulmonary fibrosis, COVID-19, SARS-COV-2, ROS
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
80 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
APX-115
Arm Type
Experimental
Arm Description
Oral administration of APX-115 100mg, daily for 14 days
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Oral administration of Placebo, daily for 14 days
Intervention Type
Drug
Intervention Name(s)
APX-115
Intervention Description
Oral administration of APX-115 100 mg capsule once daily for 14 days
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Oral administration of placebo capsule once daily for 14 days
Primary Outcome Measure Information:
Title
Incidence of Treatment-Emergent Adverse Events
Description
Adverse events will be assessed to evaluate the safety and tolerability of APX-115 in mild-to-moderate COVID-19 patients. Clinical laboratory evaluations, vital signs, and ECG will be used to assess adverse events.
Time Frame
over the 60-day period
Secondary Outcome Measure Information:
Title
Time to clinical recovery
Description
Recovery is defined as when WHO Clinical Improvement Ordinal Scale equal to or less than 3
Time Frame
Up to 60 Days
Title
Time to discharge
Description
WHO Clinical Improvement Ordinal Scale is equal to or less than 2
Time Frame
Up to Day 60
Title
Time to symptomatic recovery
Description
When none of the COVID-19 Symptom Assessment scores are higher than 1
Time Frame
Up to Day 60
Title
Time to complete symptomatic recovery
Description
When none of the COVID-19 Symptom Assessment scores are higher than 0
Time Frame
Up to Day 60
Title
Change in log10 SARS-CoV-2 viral load
Description
hange from baseline in log10 SARS-CoV-2 viral load as measured by RT-PCR by Days 5 and 14
Time Frame
Up to Day 14
Title
Proportion of patients in clinical recovery
Description
Symptom Assessment
Time Frame
Up to Day 29
Title
scoring of WHO Clinical Improvement Ordinal Scale
Description
9-point scale on key analysis days for levels ≥3
Time Frame
Up to Day 29
Title
Changes from baseline in anti-inflammatory markers in blood
Description
Blood will be analyzed for changes from baseline in anti-inflammatory markers, such as C-reactive protein, ferritin, lactate dehydrogenase, D-dimer, troponin, and transforming growth factor-β.
Time Frame
Day 1 and Day 14
Title
Changes from baseline in pro-inflammatory cytokines in blood
Description
Blood will be analyzed for changes from baseline in pro-cytokine panel of the blood, such as interleukin (IL)-1β, IL-6, and interferon-γ.
Time Frame
Day 1 and 14
Title
Changes from baseline in 8-isoprostane in blood
Description
Blood will be analyzed for changes from baseline in 8-isoprostane.
Time Frame
Days 1 and 14
Title
Trough (predose) plasma concentration (Ctrough)
Description
Trough (predose) plasma concentration (Ctrough) will be analyzed from plasma samples for pharmacokinetic assessment of APX-115.
Time Frame
Day 1
Title
Maximum observed plasma concentration (Cmax)
Description
Maximum observed plasma concentration (Cmax) will be analyzed from plasma samples for pharmacokinetic assessment of APX-115.
Time Frame
Days 1, 5, and 14
Title
Time to Cmax (Tmax)
Description
Time to Cmax (Tmax) will be analyzed from plasma samples for pharmacokinetic assessment of APX-115.
Time Frame
Days 1, 5, and 14
Title
Area under the plasma concentration versus time curve (AUC) from time zero to the Time of last quantifiable concentration (AUC0-last)
Description
Area under the plasma concentration versus time curve (AUC) from time zero to the time of last quantifiable concentration (AUC0-last) will be analyzed from plasma samples for pharmacokinetic assessment of APX-115.
Time Frame
Days 1, 5, and 14
Title
AUC within a dosing interval (AUCtau, where tau = 12 hours)
Description
AUC within a dosing interval (AUCtau, where tau = 12 hours) will be analyzed from plasma samples for pharmacokinetic assessment of APX-115.
Time Frame
Days 1, 5, and 14
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Willing and able to provide informed consent themselves or through their legally authorized representative.
Male or female patients, of any race or ethnicity, 18 to 80 years of age, inclusive, on the day of informed consent. Racial and ethnic minorities should be included in the study population to the greatest extent possible.
Laboratory-confirmed SARS-CoV-2 infection as determined within 14 days of randomization by real time RT-PCR or other commercial or public health assay authorized by FDA or other applicable health authority .
Onset of COVID-19 symptoms within 14 days prior to randomization.
Have at least one of the following symptoms at screening: fever, cough, shortness of breath, myalgia, ageusia, anosmia, fatigue, or weakness.
Hospitalized with COVID-19 disease (WHO COVID-19 Clinical Improvement Ordinal Scale score of 3 [hospitalized, no oxygen therapy], 4 [hospitalized, oxygen by mask or nasal prongs], or 5 [high-flow oxygen or non-invasive mechanical ventilation])
Patient is aware of the investigational nature of this study and willing to comply with protocol treatments, blood tests, and other evaluations listed in the informed consent form.
Exclusion Criteria:
Females who are pregnant (negative pregnancy test required for all women of childbearing potential at screening) or breastfeeding.
Male patients and women of childbearing potential (women who are not surgically sterile or postmenopausal defined as postmenopausal for >12 months) who are not using at least one protocol specified method of contraception.
COVID-19 disease as defined by the WHO COVID-19 Clinical Improvement Ordinal Scale, scores of 6 (intubation and mechanical ventilation) or 7 (ventilation + additional organ support - pressors, renal replacement therapy, extracorporeal membrane oxygenation).
Expected survival less than 72 hours.
Treatment with other drugs thought to possibly have activity against SARS CoV 2 infection within 7 days or within 5 half-lives, whichever is longer, prior to enrollment or concurrently. Drugs that have received FDA emergency use authorization or COVID-19 approval are allowed.
Treatment with immunosuppressants, combination of 2 or more RAS blockers, UGT inhibitors and inducers, herbal/natural supplements, potassium-sparing diuretic, and radiographic contrast agent prior to enrollment or concurrently.
History of abuse of drugs or alcohol that could interfere with adherence to study requirements as judged by the investigator.
Use of any other concurrent investigational drugs while participating in the present study.
Patient requires frequent or prolonged use of systemic corticosteroids (≥20 mg of prednisone/day or equivalent for >4 weeks) or other immunosuppressive drugs (eg, for organ transplantation or autoimmune conditions).
Known renal disease with an estimated glomerular filtration rate <30 mL/min.
Patients with clinically apparent liver disease (eg, jaundice, cholestasis, hepatic synthetic impairment, or active hepatitis) or moderate or severe hepatic impairment as determined by Child-Pugh score Class B or C.
Alanine aminotransaminase (ALT) or aspartate aminotransaminase (AST) >3 × upper limit of normal (ULN) AND total bilirubin levels >2 × ULN OR ALT or AST >5 × ULN.
Total bilirubin >1.5 × ULN, unless the patient has known Gilbert's syndrome.
Hemoglobin <9 g/dL for females or <11 g/dL for males.
Absolute neutrophil count <1500/mm3.
Thrombocytopenia (platelets count <100 × 109/L).
Inability to swallow oral medications or a gastrointestinal disorder with diarrhea (eg, Crohn's disease) or malabsorption at screening.
Any other clinically significant medical condition or laboratory abnormality that, in the opinion of the investigator, would jeopardize the safety of the patient or potentially impact patient compliance or the safety/efficacy observations in the study.
History of an allergic reaction or hypersensitivity to the study drug or any component of the study drug formulation.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Hyesung Shin
Phone
+82313653693
Email
hyesung.shin@aptabio.com
Facility Information:
Facility Name
Alternative Research Associates, LLC
City
Hialeah
State/Province
Florida
ZIP/Postal Code
33012
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Luis Mendez Mulet, Dr.
Facility Name
Anne Arundel Medical Center
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21401
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Barry Meisenberg, Dr.
Facility Name
Millennium Physicians Group
City
Houston
State/Province
Texas
ZIP/Postal Code
77070
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Mohsin Bajwa, Dr.
12. IPD Sharing Statement
Plan to Share IPD
Undecided
Learn more about this trial
A Phase 2 Study of APX-115 in Hospitalized Patients With Confirmed Mild to Moderate COVID-19.
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