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Safety and Efficacy of Dupilumab for Treatment of Hospitalized COVID-19 Patients (SafeDrop)

Primary Purpose

COVID-19

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Dupilumab
Placebo
Sponsored by
University of Virginia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for COVID-19 focused on measuring Anti-Inflammatory Agents

Eligibility Criteria

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

Inclusion Criteria:

  • Male or female 18 years of age or older at the time of enrollment.
  • Patients hospitalized with a positive RT-PCR for SARS-CoV-2 within the last 14 days, with illness duration within the last 14 days, and evidence of moderate to severe COVID-19 infection as defined by NIH COVID-19 Severity Categorization (8):

    • Moderate illness: Individuals who show evidence of lower respiratory disease during clinical assessment or imaging and who have saturation of oxygen SpO2≥ 94% on room air at sea level.
    • Severe illness: Individuals who have SpO2 <94% on room air at sea level, a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mm Hg, respiratory frequency >30 breaths/min, or lung infiltrates >50%.
  • Patient and/or legally authorized representative is willing and able to provide written informed consent and comply with all protocol requirements.
  • Patients with hematologic malignancies or solid tumors are eligible.
  • Patients with autoimmune disorders are eligible.
  • Patients with immunodeficiency and organ or stem cell transplant recipients are eligible.
  • Patients with acute or chronic renal injury/failure are eligible.
  • Patients with neutropenia/lymphopenia are eligible.
  • Patients with elevated liver function tests are eligible.
  • Women who are not taking contraception are eligible.
  • Patients who are currently or have recently received steroids and/or remdesivir are eligible.
  • Patient agrees to not participate in another clinical trial for the treatment of COVID-19 through end of study period.

Exclusion Criteria:

  • Patients who do not require inpatient admission for COVID-19 infection.
  • Patients who require invasive mechanical ventilation at time of enrollment.
  • A pre-existing condition or use of a medication that, in the opinion of the site investigator, may place the individual at a substantially increased risk due to study participation.
  • Pregnancy or breast feeding (lactating women who agree to discard breast milk from day 1 until two weeks after the last study product is given are not excluded).
  • Allergy to Dupilumab or its excipients.
  • Received any of the following in the two weeks prior to screening as treatment of COVID-19:
  • small molecule tyrosine kinase inhibitors (e.g. imatinib, gefitinib, acalabrutinib, etc.);
  • monoclonal antibodies targeting cytokines (e.g., TNF inhibitors, anti-interleukin-1 [IL-1], anti-IL-6 [or sarilumab], etc.);
  • monoclonal antibodies targeting T-cells or B-cells as treatment for COVID-19;
  • Any other immunomodulatory (other than steroids) medications within 5 half-lives or 30 days prior to randomization.
  • Current acute parasitic helminth infection or history of chronic parasitic infection.
  • History of ocular scleritis, uveitis, keratitis or recent (<6 months) eye injury (chemical or traumatic), infection or vascular occlusion.
  • Have received any live vaccine (that is, live attenuated) within 4 weeks before screening, or intend to receive a live vaccine (or live attenuated) during the study. Note: Use of non-live (inactivated) vaccinations is allowed for all subjects.

Sites / Locations

  • UVA Health

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Dupilimab

Placebo

Arm Description

Active Dupilimab: 600 mg, given as two 300 mg subcutaneous injections on day 0/1. If participants are still hospitalized a second and third dose (300 mg) will be given on days 14 and 28.

Dupilimab Placebo: placebo (normal saline) will be given as two one mL subcutaneous injections on day 0/1. If participants are still hospitalized a second and third dose (1 mL) will be given on days 14 and 28.

Outcomes

Primary Outcome Measures

Recovery
proportion of patients alive and free of invasive mechanical ventilation
Follow-up Study 1 year outcome Pulmonary function tests
Proportion of patients with abnormal diffusing capacity for carbon monoxide (DLCO) and/or 6 minute walk testing 1 year after acute COVID-19 infection.

Secondary Outcome Measures

proportion of patients with eosinophilia
defined as an absolute eosinophil count > 0.6 k/µl at ≥ 1 measurement throughout the study period
Cumulative incidence of grade 3 and 4 clinical adverse events, serious adverse events (SAEs) or death
defined as number of new events divided by the total number of individuals in the population at risk for the time interval
percentage of SARS-CoV-2 PCR positivity
postiive PCR test
change in Plasma total Immunoglobulin E (IgE) levels
change in levels
Change in C-reactive protein (CRP)
change in levels
Change in Ferritin
change in levels
Duration of hospitalization
measured in days
Change in Plasma cytokine levels
a number of cytokines will be examined
Change in PaO2/SaO2 to FiO2 ratio
change in levels
All-cause mortality rate
mortality rate
Recovery
Proportion of patients alive and free of invasive mechanical ventilation
Follow-up Study 1 year outcome: Change in Plasma cytokine levels
a number of cytokines will be examined
Follow-up Study 1 year outcome: Differences in high resolution computed tomography (HRCT) chest scan appearance post recovery
Compare Enrollment HRCT to 1 year HRCT
Follow-up Study 1 year outcome: Conduct a 6 minute walk testing
Proportion of patients with greater than 3% oxygen desaturation during 6 minute walk testing
Follow-up Study 1 year outcome: symptom incidence
Evaluate long haul symptom incidence post COVID-19 recovery in the dupilumab arm compared to placebo.
Follow-up Study 1 year outcome: assess oxygen requirement post COVID-19 hospitalization
Proportion of patients with new oxygen requirement after COVID-19 hospitalization
Follow-up Study 1 year outcome: Conduct pulmonary function tests
Determine the proportion of abnormal predicted forced expiratory volume (FEV1), forced vital capacity (FVC) and/or total lung capacity (TLC) in the dupilumab arm compared to placebo.
Follow-up Study 1 year outcome: assess neurocognitive function using the MOCA
Determine the proportion of patients with reduce neurocognitive function

Full Information

First Posted
June 8, 2021
Last Updated
April 24, 2023
Sponsor
University of Virginia
Collaborators
PBM C19 Research, LLC (a COVID-19 research entity of the Paul Manning Foundation), Virginia Catalyst, Virginia Biosciences Health Research Corporation (VBHRC)
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1. Study Identification

Unique Protocol Identification Number
NCT04920916
Brief Title
Safety and Efficacy of Dupilumab for Treatment of Hospitalized COVID-19 Patients
Acronym
SafeDrop
Official Title
Safety and Efficacy of the Treatment of Hospitalized Patients With COVID 19 Infection With an Inhibitor of IL-4 and IL-13 Signaling: A Phase IIa Trial
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Completed
Study Start Date
May 25, 2021 (Actual)
Primary Completion Date
April 18, 2023 (Actual)
Study Completion Date
April 18, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Virginia
Collaborators
PBM C19 Research, LLC (a COVID-19 research entity of the Paul Manning Foundation), Virginia Catalyst, Virginia Biosciences Health Research Corporation (VBHRC)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a randomized, double-blind, placebo-controlled, superiority phase IIa trial to assess the safety and efficacy of dupilumab use in hospitalized patients with moderate to severe COVID-19 infection. We are also conducting a 1 year follow-up study. This study aims to determine the difference in post recovery pulmonary function between those randomized to dupilumab arm versus placebo for acute moderate to severe COVID-19.
Detailed Description
A total of 40 eligible subject will be enrolled and randomized in a 1:1 ratio to receive either dupilumab or placebo, stratifying on the disease severity measured by the required oxygen ≤ 15L or > 15L by nasal cannula. Both arms will receive standard of care management per current National Institutes of Health (NIH) COVID-19 treatment guidelines (8) in addition to their randomized treatments. Patients will be followed prospectively for up to 360 days after enrollment. As an extension to the randomized double-blind placebo-controlled trial assessing dupilumab for treatment of those hospitalized with acute moderate to severe COVID-19, this 1 year follow up assessment of this study cohort post recovery from COVID-19 for evaluation of pulmonary function testing (PFT), pulmonary imaging, immune biomarkers and symptoms.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
COVID-19
Keywords
Anti-Inflammatory Agents

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
40 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Dupilimab
Arm Type
Experimental
Arm Description
Active Dupilimab: 600 mg, given as two 300 mg subcutaneous injections on day 0/1. If participants are still hospitalized a second and third dose (300 mg) will be given on days 14 and 28.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Dupilimab Placebo: placebo (normal saline) will be given as two one mL subcutaneous injections on day 0/1. If participants are still hospitalized a second and third dose (1 mL) will be given on days 14 and 28.
Intervention Type
Biological
Intervention Name(s)
Dupilumab
Other Intervention Name(s)
DUPIXENT
Intervention Description
Participants will receive a loading dose of dupilumab (600 mg, given as two 300 mg subcutaneous injections) on day 0/1. If participants are still hospitalized a second and third dose (300 mg) will be given on days 14 and 28.
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
normal Saline
Intervention Description
Participants will receive a loading dose of normal saline (2 ml, given as two one ml subcutaneous injections) on day 0/1. If participants are still hospitalized a second and third dose (1 ml) will be given on days 14 and 28.
Primary Outcome Measure Information:
Title
Recovery
Description
proportion of patients alive and free of invasive mechanical ventilation
Time Frame
at 28 Days ± 2d
Title
Follow-up Study 1 year outcome Pulmonary function tests
Description
Proportion of patients with abnormal diffusing capacity for carbon monoxide (DLCO) and/or 6 minute walk testing 1 year after acute COVID-19 infection.
Time Frame
365 ± 90 days
Secondary Outcome Measure Information:
Title
proportion of patients with eosinophilia
Description
defined as an absolute eosinophil count > 0.6 k/µl at ≥ 1 measurement throughout the study period
Time Frame
Day 0 through Day 60
Title
Cumulative incidence of grade 3 and 4 clinical adverse events, serious adverse events (SAEs) or death
Description
defined as number of new events divided by the total number of individuals in the population at risk for the time interval
Time Frame
Day 0 through Day 60
Title
percentage of SARS-CoV-2 PCR positivity
Description
postiive PCR test
Time Frame
at Day 14
Title
change in Plasma total Immunoglobulin E (IgE) levels
Description
change in levels
Time Frame
Day 0 and Day 14
Title
Change in C-reactive protein (CRP)
Description
change in levels
Time Frame
Day 0 through Day 14
Title
Change in Ferritin
Description
change in levels
Time Frame
Day 0 through Day 14
Title
Duration of hospitalization
Description
measured in days
Time Frame
Day 0 through Day 30
Title
Change in Plasma cytokine levels
Description
a number of cytokines will be examined
Time Frame
Day 0 through Day 30
Title
Change in PaO2/SaO2 to FiO2 ratio
Description
change in levels
Time Frame
Day 0 through Day 30
Title
All-cause mortality rate
Description
mortality rate
Time Frame
at Day 28
Title
Recovery
Description
Proportion of patients alive and free of invasive mechanical ventilation
Time Frame
at Day 60 and assessed every 3 months up to 1 year
Title
Follow-up Study 1 year outcome: Change in Plasma cytokine levels
Description
a number of cytokines will be examined
Time Frame
365 ± 90 days
Title
Follow-up Study 1 year outcome: Differences in high resolution computed tomography (HRCT) chest scan appearance post recovery
Description
Compare Enrollment HRCT to 1 year HRCT
Time Frame
365 ± 90 days
Title
Follow-up Study 1 year outcome: Conduct a 6 minute walk testing
Description
Proportion of patients with greater than 3% oxygen desaturation during 6 minute walk testing
Time Frame
365 ± 90 days
Title
Follow-up Study 1 year outcome: symptom incidence
Description
Evaluate long haul symptom incidence post COVID-19 recovery in the dupilumab arm compared to placebo.
Time Frame
365 ± 90 days
Title
Follow-up Study 1 year outcome: assess oxygen requirement post COVID-19 hospitalization
Description
Proportion of patients with new oxygen requirement after COVID-19 hospitalization
Time Frame
365 ± 90 days
Title
Follow-up Study 1 year outcome: Conduct pulmonary function tests
Description
Determine the proportion of abnormal predicted forced expiratory volume (FEV1), forced vital capacity (FVC) and/or total lung capacity (TLC) in the dupilumab arm compared to placebo.
Time Frame
365 ± 90 days
Title
Follow-up Study 1 year outcome: assess neurocognitive function using the MOCA
Description
Determine the proportion of patients with reduce neurocognitive function
Time Frame
365 ± 90 days
Other Pre-specified Outcome Measures:
Title
Change in National Institute of Allergy and Infectious Diseases 8-point ordinal scale
Description
Change in scale at Day 0, 2, 5, 7, 14, 28, 60, 180 and 360
Time Frame
Day 0 through Day 360
Title
Percentage of patients needing vasopressors
Description
Percentage
Time Frame
Day 0 through Day 60
Title
Percentage of patients needing renal replacement therapy
Description
Percentage
Time Frame
Day 0 through Day 60
Title
Percentage of patients needing extracorporeal membrane oxygenation (ECMO)
Description
Percentage
Time Frame
Day 0 through Day 60
Title
ICU length of stay (LOS)
Description
compare LOS between placebo vs dupilumab groups
Time Frame
Day 0 through Day 30

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female 18 years of age or older at the time of enrollment. Patients hospitalized with a positive RT-PCR for SARS-CoV-2 within the last 14 days, with illness duration within the last 14 days, and evidence of moderate to severe COVID-19 infection as defined by NIH COVID-19 Severity Categorization (8): Moderate illness: Individuals who show evidence of lower respiratory disease during clinical assessment or imaging and who have saturation of oxygen SpO2≥ 94% on room air at sea level. Severe illness: Individuals who have SpO2 <94% on room air at sea level, a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mm Hg, respiratory frequency >30 breaths/min, or lung infiltrates >50%. Patient and/or legally authorized representative is willing and able to provide written informed consent and comply with all protocol requirements. Patients with hematologic malignancies or solid tumors are eligible. Patients with autoimmune disorders are eligible. Patients with immunodeficiency and organ or stem cell transplant recipients are eligible. Patients with acute or chronic renal injury/failure are eligible. Patients with neutropenia/lymphopenia are eligible. Patients with elevated liver function tests are eligible. Women who are not taking contraception are eligible. Patients who are currently or have recently received steroids and/or remdesivir are eligible. Patient agrees to not participate in another clinical trial for the treatment of COVID-19 through end of study period. Exclusion Criteria: Patients who do not require inpatient admission for COVID-19 infection. Patients who require invasive mechanical ventilation at time of enrollment. A pre-existing condition or use of a medication that, in the opinion of the site investigator, may place the individual at a substantially increased risk due to study participation. Pregnancy or breast feeding (lactating women who agree to discard breast milk from day 1 until two weeks after the last study product is given are not excluded). Allergy to Dupilumab or its excipients. Received any of the following in the two weeks prior to screening as treatment of COVID-19: small molecule tyrosine kinase inhibitors (e.g. imatinib, gefitinib, acalabrutinib, etc.); monoclonal antibodies targeting cytokines (e.g., TNF inhibitors, anti-interleukin-1 [IL-1], anti-IL-6 [or sarilumab], etc.); monoclonal antibodies targeting T-cells or B-cells as treatment for COVID-19; Any other immunomodulatory (other than steroids) medications within 5 half-lives or 30 days prior to randomization. Current acute parasitic helminth infection or history of chronic parasitic infection. History of ocular scleritis, uveitis, keratitis or recent (<6 months) eye injury (chemical or traumatic), infection or vascular occlusion. Have received any live vaccine (that is, live attenuated) within 4 weeks before screening, or intend to receive a live vaccine (or live attenuated) during the study. Note: Use of non-live (inactivated) vaccinations is allowed for all subjects.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
William A Petri Jr., MD, PhD
Organizational Affiliation
University of Virginia Division of Infectious Disease
Official's Role
Principal Investigator
Facility Information:
Facility Name
UVA Health
City
Charlottesville
State/Province
Virginia
ZIP/Postal Code
22908
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
35959207
Citation
Sasson J, Donlan AN, Ma JZ, Haughey HM, Coleman R, Nayak U, Mathers AJ, Laverdure S, Dewar R, Jackson PEH, Heysell SK, Sturek JM, Petri WA Jr. Safety and Efficacy of Dupilumab for the Treatment of Hospitalized Patients With Moderate to Severe Coronavirus Disease 2019: A Phase 2a Trial. Open Forum Infect Dis. 2022 Jul 27;9(8):ofac343. doi: 10.1093/ofid/ofac343. eCollection 2022 Aug.
Results Reference
result
PubMed Identifier
35411349
Citation
Sasson J, Donlan AN, Ma JZ, Haughey HM, Coleman R, Nayak U, Mathers AJ, Laverdure S, Dewar R, Jackson PEH, Heysell SK, Sturek JM, Petri WA Jr. Safety and Efficacy of Dupilumab for the Treatment of Hospitalized Patients with Moderate to Severe COVID 19: A Phase IIa Trial. medRxiv. 2022 May 19:2022.03.30.22273194. doi: 10.1101/2022.03.30.22273194. Preprint.
Results Reference
result

Learn more about this trial

Safety and Efficacy of Dupilumab for Treatment of Hospitalized COVID-19 Patients

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