search
Back to results

TOGETHER - Toronto: Trial to Evaluate the Effect of Peginterferon Lambda for the Treatment of COVID-19

Primary Purpose

Sars-CoV2, Covid19

Status
Active
Phase
Phase 3
Locations
Canada
Study Type
Interventional
Intervention
Peginterferon Lambda-1A
Placebo
Sponsored by
University Health Network, Toronto
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Sars-CoV2 focused on measuring Peginterferon lambda

Eligibility Criteria

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

Inclusion Criteria:

  1. Adult 18 years of age or older.
  2. Symptomatic and within 7 days of symptom onset.
  3. High risk for severe disease (as defined by one or more of the following):

    1. Age >50
    2. Diabetes mellitus requiring therapy
    3. Hypertension on medication
    4. BMI >30 kg/m2
    5. Cardiovascular disease
    6. Asthma requiring chronic controller medication
    7. Symptomatic respiratory disease
    8. Immunosuppressed patients (to maximum of 10mg prednisone daily +/- other immunosuppressive agents)
    9. Documented fever (>38C)
    10. One or more of the following symptoms: cough, shortness of breath (SOB), pleuritic chest pain and/or myalgias (to a maximum of 25% of enrollment)
  4. Discharged to home isolation.
  5. Willing and able to provide informed consent (including by substitute decision maker).
  6. Willing and able to follow-up by phone or videoconference.
  7. Female patients of childbearing potential and male patients with partners of childbearing potential must agree to use adequate methods of contraception during the study and through 90 days after the last dose of study medication. Female patients of childbearing potential are all those except patients who are surgically sterile, who have medically documented ovarian failure, or who are at least 1 year postmenopausal.

Exclusion Criteria:

  1. Pregnancy (or positive urine pregnancy test) or lactating.
  2. More than 14 days following completion of SARS-CoV-2 vaccition series
  3. The following pre-existing medical conditions:

    1. Known cirrhosis with any history of decompensation (ascites, variceal bleeding or hepatic encephalopathy)
    2. Known chronic kidney disease with estimated creatinine clearance < 30 mL/minute or need for dialysis
    3. Uncontrolled severe psychiatric disorder - schizophrenia, bipolar disorder, depression with prior suicidality
    4. Uncontrolled seizures or seizure in the prior 1 month
    5. Any other underlying medical (cardiac, liver, renal, neurological, respiratory) or psychiatric condition that in the view of the investigator would preclude use of peginterferon lambda
  4. Known alcohol or drug dependence that in the opinion of the investigator would impair study participation.
  5. Known prior intolerance to interferon treatment.
  6. Enrolment in another clinical trial testing an antiviral agent or receipt of an antiviral agent for COVID-19 in the past 7 days.
  7. Use of investigational, off-label therapy for COVID-19, or unproven therapy for COVID-19.

Sites / Locations

  • Toronto General Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Treatment

Placebo

Arm Description

To receive a dose of peginterferon lambda 180mcg SC at baseline (Day 0).

Patients in this arm will receive a single SC dose of 0.9% sodium chloride (normal saline) solution at baseline (Day 0). A plastic 1 mL syringe will be prefilled by the study pharmacy. Each syringe will contain 0.5 mL (0.45 mL to match the volume of the Interferon plus 0.05 mL overfill) to allow for needle priming by the unblinded study nurse.

Outcomes

Primary Outcome Measures

COVID-19 related urgent care visit, emergency room assessment, hospitalization or death by Day 28 (Primary efficacy endpoint)
Proportion with COVID-19-related emergency room assessment, hospitalization, or death by Day 28
SARS-CoV-2 RNA negativity (Primary virological endpoint)
The time to SARS-CoV-2 RNA negativity.
Treatment-emergent and treatment-related serious adverse events (Primary safety endpoint)
The rate of treatment-emergent and treatment-related serious adverse events (SAEs) by Day 28.

Secondary Outcome Measures

Respiratory symptom resolution (Clinical Outcome #1)
Time to resolution of respiratory symptoms.
Hospitalization (Clinical outcome #2)
Hospitalization for any cause
Death (Clinical outcome #3)
Death due to respiratory or cardiovascular causes
All symptom resolution (Clinical outcome #4)
Time to resolution of all symptoms (return to usual state of heath).
Oxygen saturation on room air (Clinical outcome #5)
Proportion of days with oxygen saturation below 93% on room air by Day 14
Seeking care from healthcare professional for COVID-19 (Clinical outcome #6)
Proportion seeking care from primary care provider/walk-in clinic or study healthcare provider for COVID-19.
Hospital Admission (Clinical outcome #7)
Duration of hospital admission up to Day 28
Time to viral negativity (Virologic/immunological outcome #1)
Time to SARS-CoV-2 RNA negativity.
Mean log of SARS-CoV-2 RNA (Virologic/immunological outcome #2)
Difference in mean SARS-CoV-2 RNA in log copies/mL
Mean log decline in SARS-CoV-2 RNA (Virologic/immunological outcome #3)
Difference in mean log decline in SARS-CoV-2 RNA.
Negative for SARS-CoV-2 RNA (Virologic/immunological outcome #4)
Proportion negative for SARS-CoV-2 RNA.
Negative for SARS-CoV-2 RNA (Virologic/immunological outcome #5)
Proportion negative for SARS-CoV-2 RNA.
Negative for SARS-CoV-2 RNA (Virologic/immunological outcome #6)
Proportion negative for SARS-CoV-2 RNA.
Proportion with antibodies (Virologic/immunological outcome #7)
Proportion with SARS-CoV-2 antibodies in blood.
Correlation with interferon lambda 4 genotype (Virologic/immunological outcome #8)
Correlation of response with interferon lambda 4 (IFNL4) genotype.
Laboratory markers (Virologic/immunological outcome #9)
Change in hemoglobin over time
Laboratory markers (Virologic/immunological outcome #10)
Change in white blood cell count over time
Laboratory markers (Virologic/immunological outcome #11)
Change in lymphocyte count over time.
Laboratory markers (Virologic/immunological outcome #12)
Change in ALT over time.
Laboratory markers (Virologic/immunological outcome #13)
Change in AST over time.
Laboratory markers (Virologic/immunological outcome #14)
Change in ALP over time.
Laboratory markers (Virologic/immunological outcome #15)
Change in total bilirubin over time.
Inflammatory markers (Virologic/immunological outcome #16)
Change in lactate dehydrogenase over time.
Inflammatory markers (Virologic/immunological outcome #17)
Change in c-reactive protein over time.
Inflammatory markers (Virologic/immunological outcome #18)
Change in D-dimers over time.
Inflammatory markers (Virologic/immunological outcome #19)
Change in creatine kinase over time.
COVID-19 in household contacts (Transmission outcome #1)
Confirmed diagnosis of COVID-19 in household contacts.

Full Information

First Posted
July 13, 2021
Last Updated
April 4, 2022
Sponsor
University Health Network, Toronto
search

1. Study Identification

Unique Protocol Identification Number
NCT04967430
Brief Title
TOGETHER - Toronto: Trial to Evaluate the Effect of Peginterferon Lambda for the Treatment of COVID-19
Official Title
TOGETHER-Toronto: A Phase III Randomized, Double-blind, Placebo-controlled, Multicenter, Trial to Evaluate the Effect of Peginterferon Lambda for the Treatment of COVID-19
Study Type
Interventional

2. Study Status

Record Verification Date
March 2022
Overall Recruitment Status
Active, not recruiting
Study Start Date
August 27, 2021 (Actual)
Primary Completion Date
March 21, 2022 (Actual)
Study Completion Date
June 30, 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University Health Network, Toronto

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
Interferon (IFN) lambda is one of the fundamental responses of the innate immune system. Peginterferon lambda is a long-acting form that has been studied extensively in human trials in viral hepatitis, confirming it safety and tolerability. It is particularly attractive for consideration in the use of acute respiratory illness due to the high expression of the lambda receptor in lung epithelia. We propose to evaluate peginterferon-lambda in ambulatory patients with mild to moderate COVID-19.
Detailed Description
In this study, individuals who attend an Assessment Centre/Emergency Department to be swabbed for COVID-19 and deemed well enough for home isolation will be informed about the study. There will be two major routes of recruitment. Where feasible, a rapid point-of-care (POC) laminar flow based COVID-19 test (the Abbott PanBio) will be performed and those who do not have a POC test at the assessment centre will be tested by PCR. Interested participants who contact study staff will be confirmed to have a positive COVID-19 test. Once confirmed will be further screened for eligibility criteria by research study staff. After review, a consent form will be emailed to the participant and informed consent will be obtained through witnessed telephone consent from the participant or a substitute decision maker (SDM). Participants who consent will be randomized to receive a single subcutaneous injection of Peginterferon lambda 180µg or saline placebo. Patients will be followed remotely with visits. In addition, participants will also attend outpatient clinic for swabs and blood work for routine laboratory and inflammatory markers on Days 7 and 14 with the primary endpoint being the time to SARS-CoV-2 RNA negativity and the proportion with COVID-19 related emergency room assessment >6 hours, hospitalization or death by Day 28. Numerous secondary endpoints will be evaluated as well. Safety data will be reviewed by the Data Safety and Monitoring Committee after the first 50% of randomized participants complete 14 days of follow-up after treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Sars-CoV2, Covid19
Keywords
Peginterferon lambda

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
763 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment
Arm Type
Experimental
Arm Description
To receive a dose of peginterferon lambda 180mcg SC at baseline (Day 0).
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Patients in this arm will receive a single SC dose of 0.9% sodium chloride (normal saline) solution at baseline (Day 0). A plastic 1 mL syringe will be prefilled by the study pharmacy. Each syringe will contain 0.5 mL (0.45 mL to match the volume of the Interferon plus 0.05 mL overfill) to allow for needle priming by the unblinded study nurse.
Intervention Type
Drug
Intervention Name(s)
Peginterferon Lambda-1A
Intervention Description
Peginterferon lambda is a covalent conjugate of human recombinant non-pegylated IFN lambda (IFN L) and a 20-kDa linear PEG chain. Peginterferon lambda Injection is a sterile, nonpyrogenic, ready-to-use solution (0.4 mg/mL) that is clear to opalescent, colorless to pale yellow, and essentially free of particles. Lambda Injection is provided in a 1-mL long Type I glass syringe (0.18 mg/syringe) with a staked 29-gauge, 1/2- inch, thin-walled needle. The syringe has a rigid needle shield and is stoppered with a plunger stopper. Syringes are prefilled with a solution of Peginterferon lambda Injection, mannitol, L-histidine, polysorbate 80, hydrochloric acid, and water for injection; they are intended for a single use at adjustable doses. The syringe is marked with dose indicator lines, which are used as a reference point for administering the correct dose.
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
The placebo will be 0.9% sodium chloride (normal saline) solution. A plastic 1 mL syringe will be prefilled by the study pharmacy. Each syringe will contain 0.5 mL (0.45 mL to match the volume of the Interferon plus 0.05 mL overfill) to allow for needle priming by the unblinded study nurse.
Primary Outcome Measure Information:
Title
COVID-19 related urgent care visit, emergency room assessment, hospitalization or death by Day 28 (Primary efficacy endpoint)
Description
Proportion with COVID-19-related emergency room assessment, hospitalization, or death by Day 28
Time Frame
At day 28
Title
SARS-CoV-2 RNA negativity (Primary virological endpoint)
Description
The time to SARS-CoV-2 RNA negativity.
Time Frame
Day 0 to Day 28
Title
Treatment-emergent and treatment-related serious adverse events (Primary safety endpoint)
Description
The rate of treatment-emergent and treatment-related serious adverse events (SAEs) by Day 28.
Time Frame
Day 0 to Day 28
Secondary Outcome Measure Information:
Title
Respiratory symptom resolution (Clinical Outcome #1)
Description
Time to resolution of respiratory symptoms.
Time Frame
Day 0 to Day 28
Title
Hospitalization (Clinical outcome #2)
Description
Hospitalization for any cause
Time Frame
Day 0 to Day 28
Title
Death (Clinical outcome #3)
Description
Death due to respiratory or cardiovascular causes
Time Frame
Day 0 to Day 28
Title
All symptom resolution (Clinical outcome #4)
Description
Time to resolution of all symptoms (return to usual state of heath).
Time Frame
Day 0 to Day 28
Title
Oxygen saturation on room air (Clinical outcome #5)
Description
Proportion of days with oxygen saturation below 93% on room air by Day 14
Time Frame
Day 0 to Day 14
Title
Seeking care from healthcare professional for COVID-19 (Clinical outcome #6)
Description
Proportion seeking care from primary care provider/walk-in clinic or study healthcare provider for COVID-19.
Time Frame
Day 0 - Day 14
Title
Hospital Admission (Clinical outcome #7)
Description
Duration of hospital admission up to Day 28
Time Frame
Day 0 to Day 28
Title
Time to viral negativity (Virologic/immunological outcome #1)
Description
Time to SARS-CoV-2 RNA negativity.
Time Frame
Day 0 to Day 14
Title
Mean log of SARS-CoV-2 RNA (Virologic/immunological outcome #2)
Description
Difference in mean SARS-CoV-2 RNA in log copies/mL
Time Frame
Day 3, 5, 7, 10 and 14
Title
Mean log decline in SARS-CoV-2 RNA (Virologic/immunological outcome #3)
Description
Difference in mean log decline in SARS-CoV-2 RNA.
Time Frame
Day 3, 5, 7, 10 and 14
Title
Negative for SARS-CoV-2 RNA (Virologic/immunological outcome #4)
Description
Proportion negative for SARS-CoV-2 RNA.
Time Frame
Day 3
Title
Negative for SARS-CoV-2 RNA (Virologic/immunological outcome #5)
Description
Proportion negative for SARS-CoV-2 RNA.
Time Frame
Day 7
Title
Negative for SARS-CoV-2 RNA (Virologic/immunological outcome #6)
Description
Proportion negative for SARS-CoV-2 RNA.
Time Frame
Day 14
Title
Proportion with antibodies (Virologic/immunological outcome #7)
Description
Proportion with SARS-CoV-2 antibodies in blood.
Time Frame
Day 0, 7, 14 and 90
Title
Correlation with interferon lambda 4 genotype (Virologic/immunological outcome #8)
Description
Correlation of response with interferon lambda 4 (IFNL4) genotype.
Time Frame
Day 0 to Day 28
Title
Laboratory markers (Virologic/immunological outcome #9)
Description
Change in hemoglobin over time
Time Frame
Day 0 to Day 7 and Day 7 to Day 14.
Title
Laboratory markers (Virologic/immunological outcome #10)
Description
Change in white blood cell count over time
Time Frame
Day 0 to Day 7 and Day 7 to Day 14.
Title
Laboratory markers (Virologic/immunological outcome #11)
Description
Change in lymphocyte count over time.
Time Frame
Day 0 to Day 7 and Day 7 to Day 14.
Title
Laboratory markers (Virologic/immunological outcome #12)
Description
Change in ALT over time.
Time Frame
Day 0 to Day 7 and Day 7 to Day 14.
Title
Laboratory markers (Virologic/immunological outcome #13)
Description
Change in AST over time.
Time Frame
Day 0 to Day 7 and Day 7 to Day 14.
Title
Laboratory markers (Virologic/immunological outcome #14)
Description
Change in ALP over time.
Time Frame
Day 0 to Day 7 and Day 7 to Day 14.
Title
Laboratory markers (Virologic/immunological outcome #15)
Description
Change in total bilirubin over time.
Time Frame
Day 0 to Day 7 and Day 7 to Day 14.
Title
Inflammatory markers (Virologic/immunological outcome #16)
Description
Change in lactate dehydrogenase over time.
Time Frame
Day 0 to Day 7 and Day 7 to Day 14.
Title
Inflammatory markers (Virologic/immunological outcome #17)
Description
Change in c-reactive protein over time.
Time Frame
Day 0 to Day 7 and Day 7 to Day 14.
Title
Inflammatory markers (Virologic/immunological outcome #18)
Description
Change in D-dimers over time.
Time Frame
Day 0 to Day 7 and Day 7 to Day 14.
Title
Inflammatory markers (Virologic/immunological outcome #19)
Description
Change in creatine kinase over time.
Time Frame
Day 0 to Day 7 and Day 7 to Day 14.
Title
COVID-19 in household contacts (Transmission outcome #1)
Description
Confirmed diagnosis of COVID-19 in household contacts.
Time Frame
Day 0 to Day 28

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Adult 18 years of age or older. Symptomatic and within 7 days of symptom onset. High risk for severe disease (as defined by one or more of the following): Age >50 Diabetes mellitus requiring therapy Hypertension on medication BMI >30 kg/m2 Cardiovascular disease Asthma requiring chronic controller medication Symptomatic respiratory disease Immunosuppressed patients (to maximum of 10mg prednisone daily +/- other immunosuppressive agents) Documented fever (>38C) One or more of the following symptoms: cough, shortness of breath (SOB), pleuritic chest pain and/or myalgias (to a maximum of 25% of enrollment) Discharged to home isolation. Willing and able to provide informed consent (including by substitute decision maker). Willing and able to follow-up by phone or videoconference. Female patients of childbearing potential and male patients with partners of childbearing potential must agree to use adequate methods of contraception during the study and through 90 days after the last dose of study medication. Female patients of childbearing potential are all those except patients who are surgically sterile, who have medically documented ovarian failure, or who are at least 1 year postmenopausal. Exclusion Criteria: Pregnancy (or positive urine pregnancy test) or lactating. More than 14 days following completion of SARS-CoV-2 vaccition series The following pre-existing medical conditions: Known cirrhosis with any history of decompensation (ascites, variceal bleeding or hepatic encephalopathy) Known chronic kidney disease with estimated creatinine clearance < 30 mL/minute or need for dialysis Uncontrolled severe psychiatric disorder - schizophrenia, bipolar disorder, depression with prior suicidality Uncontrolled seizures or seizure in the prior 1 month Any other underlying medical (cardiac, liver, renal, neurological, respiratory) or psychiatric condition that in the view of the investigator would preclude use of peginterferon lambda Known alcohol or drug dependence that in the opinion of the investigator would impair study participation. Known prior intolerance to interferon treatment. Enrolment in another clinical trial testing an antiviral agent or receipt of an antiviral agent for COVID-19 in the past 7 days. Use of investigational, off-label therapy for COVID-19, or unproven therapy for COVID-19.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jordan Feld, MD
Organizational Affiliation
University Health Network, Toronto
Official's Role
Principal Investigator
Facility Information:
Facility Name
Toronto General Hospital
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G 2C4
Country
Canada

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

TOGETHER - Toronto: Trial to Evaluate the Effect of Peginterferon Lambda for the Treatment of COVID-19

We'll reach out to this number within 24 hrs