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Safety, Tolerability and Efficacy of Uproleselan (GMI-1271) in Patients With COVID-19 Pneumonia

Primary Purpose

COVID-19 Pneumonia

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Uproleselan
Sponsored by
Lena Napolitano, MD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for COVID-19 Pneumonia focused on measuring Uproleselan, Selectin Inhibitor

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Documented COVID-19 pneumonia: defined as upper respiratory tract specimen (nasopharyngeal swab (NPS) or viral throat swab) positive for COVID-19 and/or imaging at computed tomography scan suggestive of COVID-19 pneumonia.
  • Confirmed coronavirus (SARS-CoV-2) (positive real-time reverse transcription polymerase chain reaction test (RT-PCR) for SARS-CoV-2 within 72 hours) enrolled ≤ 48 hours of need for supplemental oxygen.
  • Currently hospitalized requiring supplemental oxygen.
  • Have severe COVID-19 according to the World Health Organization (WHO) Interim Guidance with confirmation by real-time RT-PCR assay. The enrollment criteria with one of the following: respiratory distress, respiratory rate (RR) ≥30 beats/min; oxygen saturation level less than 93% in resting state; or partial pressure of oxygen (PaO2)/oxygen concentration (FiO2) ≤ 300 mmHg.
  • Willing and able to participate in all required evaluations and procedures.

Exclusion Criteria:

  • In the opinion of at least two investigators, unlikely to survive for >48 hours from screening.
  • Severe chronic respiratory disease (e.g. Chronic obstructive pulmonary disease or other) requiring supplemental oxygen and/or having required mechanical ventilation pre-COVID-19 infection.
  • Concurrent enrollment in a COVID related interventional drug trial. Use of remdesivir, steroids, and convalescent plasma are permitted along with other standard of care therapies for COVID.37
  • Currently on invasive mechanical ventilation.
  • Hypotension defined as systolic blood pressure < 90 mmHg on two sequential readings at least 4 hours apart.
  • Total Bilirubin ≤ 3 x upper limit of normal (ULN), Creatinine Clearance ≥ 30 mL/min/1.73m2.
  • Pregnant or breastfeeding.
  • Known diagnosis of an acute thrombosis on admission.
  • Concurrent dual antithrombotic therapy (aspirin or P2Y12 inhibitor plus anticoagulation to treat deep venous thrombosis or pulmonary embolism (single antiplatelet or anticoagulant agent at prophylactic dose is permitted).
  • Concomitant use of thrombolytic therapy.
  • Concomitant therapeutic systemic anticoagulant therapy (e.g. heparin, warfarin, direct thrombin inhibitors and direct factor Xa inhibitors). As per NIH Guidelines: Hospitalized adults with COVID-19 should receive Venous thromboembolism (VTE) prophylaxis per the standard of care for other hospitalized adults (AIII). Anticoagulant or antiplatelet therapy should not be used to prevent arterial thrombosis outside of the usual standard of care for patients without COVID-19 (AIII); https://www.covid19treatmentguidelines.nih.gov/therapeutic-management/
  • History of recent major bleeding, defined in accordance with the criteria of the International Society on Thrombosis and Hemostasis (ISTH).
  • History of bleeding disorder thought to impose excessive bleeding risk as per investigator discretion
  • Hemodynamic instability, defined as inability to maintain mean arterial pressure.
  • Hypersensitivity to the active substance or to any of the excipients of uproleselan.
  • Any physical examination findings and/or history of any illness that, in the opinion of the investigator, might confound the results of the study or pose an additional risk to the patient by their participation in the study

Sites / Locations

  • The University of Michigan

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Uproleselan

Arm Description

Uproleselan injection is a sterile solution for IV administration, supplied in single-dose vials at a concentration of 50 mg/mL.

Outcomes

Primary Outcome Measures

Safety of Uproleselan - as Measured by Serious Adverse Events
Descriptive statistics will be calculated for quantitative safety data
Safety of Uproleselan- as Measured by Frequency of Serious Adverse Events
Frequency counts will be compiled for classification of qualitative safety data.

Secondary Outcome Measures

Change in the Progression to Acute Respiratory Failure for Patients With a Baseline PaO2/FiO2 >= 200
Patients with a baseline PaO2/FiO2 >= 200: progression of respiratory failure is defined by: severe gas transfer deficit (PaO2/FiO2 < 200); persistent respiratory distress while receiving oxygen (persistent marked dyspnea, use of accessory respiratory muscles, paradoxical respiratory movements); The rate will be calculated as the proportion of patients who experienced at least one of the events above by day+15 from treatment start.
Number of Patients Alive Who Are Free of Respiratory Failure
Number of patients alive and free of acute respiratory failure which required initiation of mechanical ventilation
All-cause Mortality
All-cause hospital mortality
Time to Change Oxygenation
Number of days it took to reduce their oxygen requirements
Number of Patients Requiring Mechanical Ventilation
Number of patients requiring mechanical ventilation
Change in the World Health Organization (WHO) COVID-19, "8-point Ordinal Scale" as Shown by Presenting Selected Time Points Through Day 28
WHO COVID-19, "8-point ordinal scale" has a range of 1-8 with higher numbers indicating a more severe disease.
Actual Duration of Hospitalization
Duration of hospitalization - number of inpatient hospital days. Participants were planned to be followed for up to 28 days, although the longest actual hospital stay for a participant was 10 days.
Actual Duration of ICU Care
Duration of ICU stay - number of ICU days. Participants were planned to be followed for up to 28 days, although the longest actual hospital stay for a participant was 10 days.
Participants Who Experienced Grade 3-4 Hemorrhagic Events
Number of participants who experienced a Grade 3 or Grade 4 hemorrhagic event based on the World Health Organization's (WHO) Bleeding Scale. On the scale, a Grade 3 event means gross blood loss, and a Grade 4 event means debilitating blood loss.
Change in E-selectin Plasma Concentrations, as Shown by Values for Each of Those Days
Changes in E-selectin plasma concentrations measured each day for 6 days.
Participants Who Experienced Venous Thromboembolism (Deep Venous Thrombosis or Pulmonary Embolism)
Venous thromboembolism - DVT or PE
Number of Mechanical Ventilation and Vasopressor Days
Days of mechanical ventilation and days of vasopressors

Full Information

First Posted
September 23, 2021
Last Updated
June 16, 2023
Sponsor
Lena Napolitano, MD
Collaborators
GlycoMimetics Incorporated
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1. Study Identification

Unique Protocol Identification Number
NCT05057221
Brief Title
Safety, Tolerability and Efficacy of Uproleselan (GMI-1271) in Patients With COVID-19 Pneumonia
Official Title
A Pilot Study to Assess the Safety, Tolerability and Efficacy of Selectin Inhibitor Uproleselan (GMI-1271) in Patients With COVID-19 Pneumonia
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Terminated
Why Stopped
No more eligible patients were available.
Study Start Date
November 12, 2021 (Actual)
Primary Completion Date
March 9, 2022 (Actual)
Study Completion Date
March 9, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Lena Napolitano, MD
Collaborators
GlycoMimetics Incorporated

4. Oversight

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

5. Study Description

Brief Summary
The purpose of this study is to find out whether the drug uproleselan can help patients with severe COVID-19 pneumonia. Investigators will study both the side effects of the drug and assess if the drug will help patients recover more quickly and slow down the progression of acute respiratory failure.
Detailed Description
Soluble E-selectin is a significant biomarker for adult respiratory distress syndrome (ARDS). Soluble E-selectin also has pro-inflammatory properties further releasing cytokines and promoting its synthesis and the continued influx of neutrophils. Small molecule glycomimetic antagonists of E-selectin (rivipansel and uproleselan) are 500- to 1000-fold more potent inhibitors of E-selectin and have shown activity and no measurable toxicity in human clinical trials for other indications. Treatment with these E-selectin inhibitors reduced the levels of soluble E-selectin in the bloodstream which occurs during recovery of ARDS. Thus, antagonists of E-selectin which include glycomimetic antagonists and more specifically, rivipansel (GMI-1070) and uproleselan (GMI-1271), may be used to treat COVID-19 patients with respiratory symptoms that may lead to ARDS Primary Objective: Safety of uproleselan in patients with severe COVID-19 pneumonia. Secondary Objectives: To evaluate if treatment with uproleselan administered intravenously in addition to the best available therapy according to institutional guidelines is able to reduce the progression of acute respiratory failure, in patients with severe COVID-19 pneumonia. To evaluate proportion of patients alive and free of respiratory failure through Day 28 To evaluate overall survival and all-cause mortality at day 15 and 28. To evaluate changes in the COVID ordinal outcomes scale. To assess adverse events to evaluate the safety of uproleselan. To assess ventilator-free days, ICU-free days, oxygen, vasopressor free days. To evaluate changes in D-dimer. Exploratory Objectives: To examine the correlation of plasma soluble E-selectin concentrations with clinical outcomes. To examine the correlations of other biomarkers of interest with clinical outcome. Previous versions of this record mistakenly suggested the trial would assess the number of participants who experienced a Grade 3-5 hemorrhagic event. The outcome title has been corrected to state the number of participants with a Grade 3-4 hemorrhagic event were assessed, as the scale used does not go to Grade 5.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
COVID-19 Pneumonia
Keywords
Uproleselan, Selectin Inhibitor

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Model Description
This is a prospective, interventional, single-arm, open label trial, with 1:1 matched de-identified retrospective control cohort.
Masking
None (Open Label)
Allocation
N/A
Enrollment
6 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Uproleselan
Arm Type
Experimental
Arm Description
Uproleselan injection is a sterile solution for IV administration, supplied in single-dose vials at a concentration of 50 mg/mL.
Intervention Type
Drug
Intervention Name(s)
Uproleselan
Intervention Description
Uproleselan 20 mg/kg BID up to maximum dose of 2500 mg, infused IV over 20 minutes on days 1-7 or until hospital discharge. It should be administered intravenously (IV) into a peripheral line, a central catheter, or a peripherally inserted central line catheter (PICC). Infusion should take place at a steady rate over a period of 20 minutes ±2 minutes using a syringe pump or IV pump.
Primary Outcome Measure Information:
Title
Safety of Uproleselan - as Measured by Serious Adverse Events
Description
Descriptive statistics will be calculated for quantitative safety data
Time Frame
Up to 28 days
Title
Safety of Uproleselan- as Measured by Frequency of Serious Adverse Events
Description
Frequency counts will be compiled for classification of qualitative safety data.
Time Frame
Up to 28 days
Secondary Outcome Measure Information:
Title
Change in the Progression to Acute Respiratory Failure for Patients With a Baseline PaO2/FiO2 >= 200
Description
Patients with a baseline PaO2/FiO2 >= 200: progression of respiratory failure is defined by: severe gas transfer deficit (PaO2/FiO2 < 200); persistent respiratory distress while receiving oxygen (persistent marked dyspnea, use of accessory respiratory muscles, paradoxical respiratory movements); The rate will be calculated as the proportion of patients who experienced at least one of the events above by day+15 from treatment start.
Time Frame
Enrollment, 15 days
Title
Number of Patients Alive Who Are Free of Respiratory Failure
Description
Number of patients alive and free of acute respiratory failure which required initiation of mechanical ventilation
Time Frame
Up to 28 days
Title
All-cause Mortality
Description
All-cause hospital mortality
Time Frame
Up to 28 days
Title
Time to Change Oxygenation
Description
Number of days it took to reduce their oxygen requirements
Time Frame
during hospitalization; hospital stay ranged from 2 to 10 days
Title
Number of Patients Requiring Mechanical Ventilation
Description
Number of patients requiring mechanical ventilation
Time Frame
Up to 28 days
Title
Change in the World Health Organization (WHO) COVID-19, "8-point Ordinal Scale" as Shown by Presenting Selected Time Points Through Day 28
Description
WHO COVID-19, "8-point ordinal scale" has a range of 1-8 with higher numbers indicating a more severe disease.
Time Frame
Enrollment, day 28
Title
Actual Duration of Hospitalization
Description
Duration of hospitalization - number of inpatient hospital days. Participants were planned to be followed for up to 28 days, although the longest actual hospital stay for a participant was 10 days.
Time Frame
Up to 28 days
Title
Actual Duration of ICU Care
Description
Duration of ICU stay - number of ICU days. Participants were planned to be followed for up to 28 days, although the longest actual hospital stay for a participant was 10 days.
Time Frame
Up to 28 days
Title
Participants Who Experienced Grade 3-4 Hemorrhagic Events
Description
Number of participants who experienced a Grade 3 or Grade 4 hemorrhagic event based on the World Health Organization's (WHO) Bleeding Scale. On the scale, a Grade 3 event means gross blood loss, and a Grade 4 event means debilitating blood loss.
Time Frame
Up to 28 days
Title
Change in E-selectin Plasma Concentrations, as Shown by Values for Each of Those Days
Description
Changes in E-selectin plasma concentrations measured each day for 6 days.
Time Frame
6 Days
Title
Participants Who Experienced Venous Thromboembolism (Deep Venous Thrombosis or Pulmonary Embolism)
Description
Venous thromboembolism - DVT or PE
Time Frame
Enrollment, up to day 28
Title
Number of Mechanical Ventilation and Vasopressor Days
Description
Days of mechanical ventilation and days of vasopressors
Time Frame
Up to Day 28

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Documented COVID-19 pneumonia: defined as upper respiratory tract specimen (nasopharyngeal swab (NPS) or viral throat swab) positive for COVID-19 and/or imaging at computed tomography scan suggestive of COVID-19 pneumonia. Confirmed coronavirus (SARS-CoV-2) (positive real-time reverse transcription polymerase chain reaction test (RT-PCR) for SARS-CoV-2 within 72 hours) enrolled ≤ 48 hours of need for supplemental oxygen. Currently hospitalized requiring supplemental oxygen. Have severe COVID-19 according to the World Health Organization (WHO) Interim Guidance with confirmation by real-time RT-PCR assay. The enrollment criteria with one of the following: respiratory distress, respiratory rate (RR) ≥30 beats/min; oxygen saturation level less than 93% in resting state; or partial pressure of oxygen (PaO2)/oxygen concentration (FiO2) ≤ 300 mmHg. Willing and able to participate in all required evaluations and procedures. Exclusion Criteria: In the opinion of at least two investigators, unlikely to survive for >48 hours from screening. Severe chronic respiratory disease (e.g. Chronic obstructive pulmonary disease or other) requiring supplemental oxygen and/or having required mechanical ventilation pre-COVID-19 infection. Concurrent enrollment in a COVID related interventional drug trial. Use of remdesivir, steroids, and convalescent plasma are permitted along with other standard of care therapies for COVID.37 Currently on invasive mechanical ventilation. Hypotension defined as systolic blood pressure < 90 mmHg on two sequential readings at least 4 hours apart. Total Bilirubin ≤ 3 x upper limit of normal (ULN), Creatinine Clearance ≥ 30 mL/min/1.73m2. Pregnant or breastfeeding. Known diagnosis of an acute thrombosis on admission. Concurrent dual antithrombotic therapy (aspirin or P2Y12 inhibitor plus anticoagulation to treat deep venous thrombosis or pulmonary embolism (single antiplatelet or anticoagulant agent at prophylactic dose is permitted). Concomitant use of thrombolytic therapy. Concomitant therapeutic systemic anticoagulant therapy (e.g. heparin, warfarin, direct thrombin inhibitors and direct factor Xa inhibitors). As per NIH Guidelines: Hospitalized adults with COVID-19 should receive Venous thromboembolism (VTE) prophylaxis per the standard of care for other hospitalized adults (AIII). Anticoagulant or antiplatelet therapy should not be used to prevent arterial thrombosis outside of the usual standard of care for patients without COVID-19 (AIII); https://www.covid19treatmentguidelines.nih.gov/therapeutic-management/ History of recent major bleeding, defined in accordance with the criteria of the International Society on Thrombosis and Hemostasis (ISTH). History of bleeding disorder thought to impose excessive bleeding risk as per investigator discretion Hemodynamic instability, defined as inability to maintain mean arterial pressure. Hypersensitivity to the active substance or to any of the excipients of uproleselan. Any physical examination findings and/or history of any illness that, in the opinion of the investigator, might confound the results of the study or pose an additional risk to the patient by their participation in the study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lena Napolitano, MD
Organizational Affiliation
University of Michigan
Official's Role
Principal Investigator
Facility Information:
Facility Name
The University of Michigan
City
Ann Arbor
State/Province
Michigan
ZIP/Postal Code
48109
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Safety, Tolerability and Efficacy of Uproleselan (GMI-1271) in Patients With COVID-19 Pneumonia

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