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REVERSE-Long COVID-19 With Baricitinib Pilot Study (REVERSE-LC)

Primary Purpose

Post-Acute COVID-19 Syndrome

Status
Not yet recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Baricitinib 4 MG
Sponsored by
Vanderbilt University Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Post-Acute COVID-19 Syndrome

Eligibility Criteria

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

In order to be eligible to participate in this study, an individual must meet all of the following criteria: Obtain a signed and dated informed consent form from participant State their willingness to comply with all study procedures and availability for the duration of the study Male or female, aged ≥18 years old Meet the following criteria for "Post-COVID Condition" or Long COVID: 6-months prior, documented SARS-CoV-2 infection Cognitive impairment as defined by having at least 20% positive (worse or much worse) items on the ECOG assessment Neurocognitive symptoms must have been present for at least 60 days prior to screening. Symptoms that wax and wane must have been initially present at least 60 days prior to screening. Ability to take oral medication and be willing to adhere to the baricitinib regimen Females of childbearing potential must agree to either abstinence or use at least one acceptable method of contraception from the time of screening though at least 28 days after the end of the study intervention period. Note: Acceptable methods include barrier contraceptives (condoms or diaphragm) with spermicide, intrauterine devices (IUDs), hormonal contraceptives, oral contraceptive pills, and surgical sterilization. Exclusion Criteria: An individual who meets any of the following criteria will be excluded from participation in this study: Pre-existing cognitive impairment not exacerbated by acute COVID as determined by study physicians after thorough review of participant's history and medical records Current use of baricitinib or other disease-modifying antirheumatic drug (DMARDs) Known allergic reactions to components of the baricitinib Have ever been randomized in this study or any other study investigating baricitinib Positive SARS-CoV-2 PCR or rapid Antigen test in the past 14 days Pregnancy or breastfeeding Any history of venous thromboembolism ever History of malignancy or lymphoproliferative disorder Renal dysfunction with estimated glomerular filtration rate of < 30 mL/min/1.73m2 Absolute Neutrophil Count (ANC) <1200 cells/mm3 History or evidence of severe or end-stage liver disease (e.g. bilirubin ≥1.5x or AST/ALT >2x normal). Positive Hepatitis B surface antibody, antigen or core antibody, or Positive Hepatitis C RNR or antigen Positive HIV 4th generation (antibody/antigen) ELISA test Have had symptomatic herpes zoster infection within 3 months prior to study entry or have a history of disseminated/complicated herpes zoster or herpes simplex infection History of latent (diagnosed with Quantiferon testing) or active tuberculosis History of a current or recent (< 30 days from screening) clinically significant viral, bacterial, fungal, or parasitic infection History of chronic alcohol abuse, Intravenous (IV) drug abuse, or other illicit drug abuse within the 2 years prior to study entry Are immunocompromised and, in the opinion of the investigator, are at an unacceptable risk for participating in the study Treatment with another investigational drug or other intervention < 30 days of study enrollment Are unable or unwilling to make themselves available for the duration of the study and/or are unwilling to follow study restrictions/procedures Severe cognitive, physical, or psychological disability that would prevent participation in the study

Sites / Locations

  • University of California San Francisco
  • Yale University
  • Emory University
  • University of Minnesota
  • Vanderbilt University
  • Vanderbilt University Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Experimental

Arm Label

Placebo

Intervention #1

Arm Description

These participants will receive placebo for 12 weeks (3 mo)

These participants will receive baricitinib 4 mg daily for 12 weeks

Outcomes

Primary Outcome Measures

Enrollment
2 participants per month, on average, are randomized
Diversity in enrollment
40% of participants will be from individuals disproportionally affected by COVID (Black, Hispanic, Asian, American Indian)
Study drug prescribed
80% of participants received every prescribed dose of the study drug
Study withdrawals
Less than 20% participants will be deemed lost to follow up
Adverse event reporting
100% of Serious Adverse Events reported to Data Safety Monitoring Board within 24 hours of study team awareness
Study dosing
100% adherence to study drug dose adjustments guidelines
Study completion
80% of participants adhere to all study procedures and requirements

Secondary Outcome Measures

Severe and Serious Adverse Events
Compare the percentage of severe and serious adverse events between study arms from baseline to week 12.
Premature study discontinuation
Compare the rate of study drug/placebo premature discontinuation by study arm (tolerability)
Global Neuropsychological Function
Assess percentage changes of global neuropsychological function as measured using the CNS Vital Signs Neurocognition Index cognitive battery between baricitinib and placebo study arm from baseline to week 12.
Cardiopulmonary testing
Assess percentage changes of exercise capacity (peak VO2) using cardiopulmonary exercise testing (CPET) in the baricitinib arm compared to the placebo arm from baseline to week 12
Everyday Cognition
Assess percentage changes of cognitive impairment using Everyday Cognition (ECog) scale in the baricitinib arm compared to the placebo arm from baseline to week 12
Functional Status
Assess percentage changes of functional status measures in the baricitinib arm compared to the placebo arm from baseline to week 12
Quality of Life Measures
Assess percentage changes of quality of life measures in the baricitinib arm compared to the placebo arm from baseline to week 12
Post-Exertional Malaise
Assess percentage changes of post-exertional malaise using De Paul Symptom Questionnaire - Post-Exertional Malaise (DSQ-PEM) in the baricitinib arm compared to the placebo arm from baseline to week 12
Shortness of Breath
Assess percentage changes of the effect of breathlessness on daily activities using the Modified Medical Research Council Dyspnea Scale (mMRC) in the baricitinib arm compared to the placebo arm from baseline to week 12
Symptom Burden
Assess percentage changes of post COVID-19 symptom burden using the Symptom Burden Questionnaire for Long COVID (SBQ-LC) Circulation Subscale in the baricitinib arm compared to the placebo arm from baseline to week 12
Inflammation biomarkers
Decreases in plasma biomarkers of inflammation in the baricitinib arm compared to placebo arm from baseline to week 12
Viral Reservoirs
Decreases in viral reservoirs for the baricitinib arm compared to placebo arm from baseline to week 12

Full Information

First Posted
March 28, 2023
Last Updated
May 11, 2023
Sponsor
Vanderbilt University Medical Center
Collaborators
Emory University, University of California, San Francisco, University of Minnesota, Vanderbilt University, Yale University
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1. Study Identification

Unique Protocol Identification Number
NCT05858515
Brief Title
REVERSE-Long COVID-19 With Baricitinib Pilot Study
Acronym
REVERSE-LC
Official Title
REVERSE-Long COVID: A Multicenter Randomized, Placebo-Controlled Clinical Trial of Immunomodulation (With Baricitinib) for Long COVID Related Cognitive Impairment and ADRD (Alzheimer's Disease and Related Dementias)- Pilot Study
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
June 1, 2023 (Anticipated)
Primary Completion Date
June 30, 2024 (Anticipated)
Study Completion Date
June 30, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Vanderbilt University Medical Center
Collaborators
Emory University, University of California, San Francisco, University of Minnesota, Vanderbilt University, Yale University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a pilot study for REVERSE-LC, a phase 3 trial of baricitinib versus placebo in adults with neurocognitive impairment (a form of Alzheimer's Disease and Related Dementias or ADRD) or cardiopulmonary symptoms due to Long COVID.
Detailed Description
This is a pilot study of the multi-site randomized, placebo-controlled, double blind, parallel-design REVERSE-LC phase 3 study. Individuals meeting inclusion criteria will be randomized to one of two arms: the intervention arm of baricitinib 4 mg daily for 12 weeks (dose adjusted to 2 mg or 1 mg for baseline renal dysfunction) versus the placebo arm for 12 weeks. In addition to safety, a variety of clinical and biological outcome measures will be assessed.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Post-Acute COVID-19 Syndrome

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Randomized, placebo-controlled, double-blind, parallel-design superiority design
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
The block size and treatment allocation will only be known to the biostatistician creating the randomization list and will not be shared with trial investigators or any other study personnel. This list will be directly uploaded into REDCap's randomization module. This maintains the concealment of future allocations and has been used successfully for several of our large RCTs. The details of the randomization procedure including details regarding stratification and block sizes will fully be reported in the trial publication to enable readers to assess the risk of bias. Randomization assignments will be accessible 24 hours a day, 7 days a week to the study coordinators and staff
Allocation
Randomized
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
These participants will receive placebo for 12 weeks (3 mo)
Arm Title
Intervention #1
Arm Type
Experimental
Arm Description
These participants will receive baricitinib 4 mg daily for 12 weeks
Intervention Type
Drug
Intervention Name(s)
Baricitinib 4 MG
Other Intervention Name(s)
Olumiant
Intervention Description
Nonproprietary name: Baricitinib
Primary Outcome Measure Information:
Title
Enrollment
Description
2 participants per month, on average, are randomized
Time Frame
6 months
Title
Diversity in enrollment
Description
40% of participants will be from individuals disproportionally affected by COVID (Black, Hispanic, Asian, American Indian)
Time Frame
6 months
Title
Study drug prescribed
Description
80% of participants received every prescribed dose of the study drug
Time Frame
9 months
Title
Study withdrawals
Description
Less than 20% participants will be deemed lost to follow up
Time Frame
18 months
Title
Adverse event reporting
Description
100% of Serious Adverse Events reported to Data Safety Monitoring Board within 24 hours of study team awareness
Time Frame
18 months
Title
Study dosing
Description
100% adherence to study drug dose adjustments guidelines
Time Frame
9 months
Title
Study completion
Description
80% of participants adhere to all study procedures and requirements
Time Frame
18 months
Secondary Outcome Measure Information:
Title
Severe and Serious Adverse Events
Description
Compare the percentage of severe and serious adverse events between study arms from baseline to week 12.
Time Frame
9 months
Title
Premature study discontinuation
Description
Compare the rate of study drug/placebo premature discontinuation by study arm (tolerability)
Time Frame
9 months
Title
Global Neuropsychological Function
Description
Assess percentage changes of global neuropsychological function as measured using the CNS Vital Signs Neurocognition Index cognitive battery between baricitinib and placebo study arm from baseline to week 12.
Time Frame
9 months
Title
Cardiopulmonary testing
Description
Assess percentage changes of exercise capacity (peak VO2) using cardiopulmonary exercise testing (CPET) in the baricitinib arm compared to the placebo arm from baseline to week 12
Time Frame
9 months
Title
Everyday Cognition
Description
Assess percentage changes of cognitive impairment using Everyday Cognition (ECog) scale in the baricitinib arm compared to the placebo arm from baseline to week 12
Time Frame
9 months
Title
Functional Status
Description
Assess percentage changes of functional status measures in the baricitinib arm compared to the placebo arm from baseline to week 12
Time Frame
9 months
Title
Quality of Life Measures
Description
Assess percentage changes of quality of life measures in the baricitinib arm compared to the placebo arm from baseline to week 12
Time Frame
9 months
Title
Post-Exertional Malaise
Description
Assess percentage changes of post-exertional malaise using De Paul Symptom Questionnaire - Post-Exertional Malaise (DSQ-PEM) in the baricitinib arm compared to the placebo arm from baseline to week 12
Time Frame
9 months
Title
Shortness of Breath
Description
Assess percentage changes of the effect of breathlessness on daily activities using the Modified Medical Research Council Dyspnea Scale (mMRC) in the baricitinib arm compared to the placebo arm from baseline to week 12
Time Frame
9 months
Title
Symptom Burden
Description
Assess percentage changes of post COVID-19 symptom burden using the Symptom Burden Questionnaire for Long COVID (SBQ-LC) Circulation Subscale in the baricitinib arm compared to the placebo arm from baseline to week 12
Time Frame
9 months
Title
Inflammation biomarkers
Description
Decreases in plasma biomarkers of inflammation in the baricitinib arm compared to placebo arm from baseline to week 12
Time Frame
9 months
Title
Viral Reservoirs
Description
Decreases in viral reservoirs for the baricitinib arm compared to placebo arm from baseline to week 12
Time Frame
9 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
In order to be eligible to participate in this study, an individual must meet all of the following criteria: Obtain a signed and dated informed consent form from participant State their willingness to comply with all study procedures and availability for the duration of the study Male or female, aged ≥18 years old Meet the following criteria for "Post-COVID Condition" or Long COVID: 6-months prior, documented SARS-CoV-2 infection Cognitive impairment as defined by having at least 20% positive (worse or much worse) items on the ECOG assessment Neurocognitive symptoms must have been present for at least 60 days prior to screening. Symptoms that wax and wane must have been initially present at least 60 days prior to screening. Ability to take oral medication and be willing to adhere to the baricitinib regimen Females of childbearing potential must agree to either abstinence or use at least one acceptable method of contraception from the time of screening though at least 28 days after the end of the study intervention period. Note: Acceptable methods include barrier contraceptives (condoms or diaphragm) with spermicide, intrauterine devices (IUDs), hormonal contraceptives, oral contraceptive pills, and surgical sterilization. Exclusion Criteria: An individual who meets any of the following criteria will be excluded from participation in this study: Pre-existing cognitive impairment not exacerbated by acute COVID as determined by study physicians after thorough review of participant's history and medical records Current use of baricitinib or other disease-modifying antirheumatic drug (DMARDs) Known allergic reactions to components of the baricitinib Have ever been randomized in this study or any other study investigating baricitinib Positive SARS-CoV-2 PCR or rapid Antigen test in the past 14 days Pregnancy or breastfeeding Any history of venous thromboembolism ever History of malignancy or lymphoproliferative disorder Renal dysfunction with estimated glomerular filtration rate of < 30 mL/min/1.73m2 Absolute Neutrophil Count (ANC) <1200 cells/mm3 History or evidence of severe or end-stage liver disease (e.g. bilirubin ≥1.5x or AST/ALT >2x normal). Positive Hepatitis B surface antibody, antigen or core antibody, or Positive Hepatitis C RNR or antigen Positive HIV 4th generation (antibody/antigen) ELISA test Have had symptomatic herpes zoster infection within 3 months prior to study entry or have a history of disseminated/complicated herpes zoster or herpes simplex infection History of latent (diagnosed with Quantiferon testing) or active tuberculosis History of a current or recent (< 30 days from screening) clinically significant viral, bacterial, fungal, or parasitic infection History of chronic alcohol abuse, Intravenous (IV) drug abuse, or other illicit drug abuse within the 2 years prior to study entry Are immunocompromised and, in the opinion of the investigator, are at an unacceptable risk for participating in the study Treatment with another investigational drug or other intervention < 30 days of study enrollment Are unable or unwilling to make themselves available for the duration of the study and/or are unwilling to follow study restrictions/procedures Severe cognitive, physical, or psychological disability that would prevent participation in the study
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
E. Wesley Ely, MD. MPH
Phone
615-936-2795
Email
wes.ely@vumc.org
First Name & Middle Initial & Last Name or Official Title & Degree
Rebecca Abel, MA
Phone
615-875-3763
Email
rebecca.abel@vumc.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
E. Wesley Ely, MD, MPH
Organizational Affiliation
Vanderbilt University Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of California San Francisco
City
San Francisco
State/Province
California
ZIP/Postal Code
30329
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Priscilla Hsue, MD
Email
priscilla.hsue@ucsf.edu
Facility Name
Yale University
City
New Haven
State/Province
Connecticut
ZIP/Postal Code
06520
Country
United States
Facility Name
Emory University
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30329
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Vince Marconi, MD
Email
vcmarco@emory.edu
Facility Name
University of Minnesota
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55455
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Carolyn Bramante
Email
bramanate@umn.edu
Facility Name
Vanderbilt University
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37203
Country
United States
Facility Name
Vanderbilt University Medical Center
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37232-8300
Country
United States

12. IPD Sharing Statement

Learn more about this trial

REVERSE-Long COVID-19 With Baricitinib Pilot Study

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