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A Safety and Tolerability Study of Sotrovimab (VIR-7831) Prophylaxis Against COVID-19 in Immunocompromised Individuals

Primary Purpose

SARS CoV 2 Infection

Status
Active
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Sotrovimab
Sponsored by
Sophia Koo, M.D.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for SARS CoV 2 Infection focused on measuring Prophylaxis, Immunocompromised host, Transplant, Monoclonal antibodies

Eligibility Criteria

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

Inclusion Criteria:

  • Participant must be 18 years of age or older at the time of consent and weigh at least 40 kg. Children will be excluded from this study because dosing and adverse event data are limited for the use of sotrovimab in participants <18 years of age.
  • Participant must have one of the following immunocompromising conditions that increases their likelihood of having an impaired humoral immune response to SARS-CoV-2, while also increasing their risk of being infected with SARS-CoV-2 and risk of progression to severe COVID-19:

    1. Exposure to an anti-CD20 monoclonal antibody (e.g. all formulations of rituximab, obinutuzumab, ofatumumab, ocrelizumab, ibritumomab, tositumomab) for a hematologic malignancy or an autoimmune/inflammatory disease in the 12-month period prior to consent.
    2. Allogeneic hematopoietic cell transplant ≥ 3 months and ≤ 1 year prior to consent; or allogeneic hematopoietic cell transplant >1 year prior to consent plus active graft-versus host disease on systemic immunosuppressive therapy.
    3. Chimeric antigen receptor (CAR)-T cell therapy ≥ 4 weeks and ≤ 2 years prior to consent.
    4. Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), multiple myeloma, or Waldenström macroglobulinemia.
    5. Solid organ transplant recipient receiving immunosuppressive therapy.
    6. Congenital immunodeficiency syndrome (e.g. Wiskott-Aldrich syndrome, DiGeorge syndrome, common variable immunodeficiency).
    7. Patients with hematologic malignancy or autoimmune/inflammatory disease exposed to immunosuppressive medications specifically associated with a blunted humoral immune response to SARS-CoV-2 vaccination (e.g. mycophenolate mofetil, azathioprine, methotrexate, Bruton tyrosine kinase inhibitors, ruxolitinib, venetoclax, or corticosteroids (prednisone >20mg or equivalent daily for at least 14 days) in the 3-month period prior to consent.
  • Female participants must be:

    1. Postmenopausal for at least 1 year;
    2. Post-hysterectomy and/or post-bilateral oophorectomy;
    3. Of childbearing potential, with a negative urine or serum human chorionic gonadotropin pregnancy test prior to each sotrovimab dose, and agree to use a highly effective method of birth control throughout the study period.
  • Participants must have a negative or low-positive (<50 U/mL) SARS-CoV-2 spike antibody assay result within 28 days of consent.

Exclusion Criteria:

  • Participants with an active SARS-CoV-2 infection, with a positive SARS-CoV-2 RT-PCR or antigen test result within 21 days prior to consent.
  • Participants with symptoms suggestive of SARS-CoV-2 infection.
  • Close contact (less than 6 feet away for a cumulative total of ≥ 15 minutes over a 24-hour period) with an individual with COVID-19 in the 14 days prior to consent.
  • Individuals who are pregnant or breastfeeding.
  • Participants who are receiving any other investigational agents.
  • Participants who, in the judgment of the investigator, are likely to have a life expectancy of less than one year.
  • Known hypersensitivity to any constituent present in sotrovimab or any other anti-SARSCoV-2 monoclonal antibody product.
  • Active enrollment on another interventional research study of any agent for the treatment or prophylaxis of SARS-CoV-2 infection.
  • Exposure to any other anti-SARS-CoV-2 monoclonal antibody product for the treatment of COVID-19 in the prior 6 months.
  • Exposure to any other anti-SARS-CoV-2 monoclonal antibody product for prophylaxis against COVID-19 infection in the prior 12 months.
  • Receipt of a SARS-CoV-2 vaccine dose within the prior 28 days.

Sites / Locations

  • Massachusetts General Hospital
  • Brigham and Women's Hospital
  • Dana-Farber Cancer Institute

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

Sotrovimab

Arm Description

Two intravenous (IV) doses of sotrovimab were be administered in total - the first on Treatment Day 1 (500mg) and the second on Treatment Day 2, approximately 8-14 weeks after the first dose, at a higher 2000mg dose, in light of the reduced antiviral susceptibility of the BA.2 subvariant to sotrovimab, with the dosing interval determined by theoretical modeling of the duration of efficacy of sotrovimab as antiviral prophylaxis based on the rising prevalence of the Omicron BA.2 subvariant.

Outcomes

Primary Outcome Measures

Proportion of patients with treatment-emergent adverse events, serious adverse events, and adverse events of specific interest
Assessment of the safety and tolerability of sotrovimab in immunocompromised patients with impaired humoral immunity against SARS-CoV-2. This measure will include: The proportion of patients with treatment-emergent grade 3-4 adverse events (TEAEs). The proportion of patients with treatment-emergent serious adverse events (SAEs). The proportion of patients with adverse events of special interest (AESI), including infusion-related and hypersensitivity reactions, the development of anti-drug antibody (ADA) levels, and antibody-dependent enhancement (ADE) of COVID-19 disease.
Serum sotrovimab levels to assess pharmacokinetics over time, with determination of maximum serum sotrovimab concentration (Cmax)
Cmax determination
Serum sotrovimab levels to assess pharmacokinetics over time, with determination of time to maximal sotrovimab serum concentration (Tmax)
Tmax determination
Serum sotrovimab levels to assess pharmacokinetics over time, with determination of minimal sotrovimab serum concentration (Cmin)
Cmin determination
Serum sotrovimab levels to assess pharmacokinetics over time, with determination of last sotrovimab concentration (Clast)
Clast determination
Serum sotrovimab levels to assess pharmacokinetics over time, with determination of time of last measurable sotrovimab concentration (Tlast)
Tlast determination
Serum sotrovimab levels to assess pharmacokinetics over time, with determination of area under the curve extrapolated to infinity (AUC(0-∞)
AUC(0-∞)
Serum sotrovimab levels to assess pharmacokinetics over time, with determination of AUC(0-∞) vs. dose
AUC(0-∞) vs. dose
Serum sotrovimab levels to assess pharmacokinetics over time, with determination of half life (t 1/2)
Sotrovimab half-life (t 1/2)
Serum sotrovimab levels to assess pharmacokinetics over time, with determination of sotrovimab concentration in serum 28 days after dosing (C28)
Concentration in serum 28 days after dosing (C28)

Secondary Outcome Measures

Symptomatic COVID-19 infection of any severity
An assessment of rates of symptomatic COVID-19 infection (of any severity) in this cohort of immunocompromised patients with impaired humoral immunity against SARS-CoV-2 after receiving sotrovimab.
Asymptomatic COVID-19 infection
An assessment of rates of asymptomatic COVID-19 infection in this cohort of immunocompromised patients with impaired humoral immunity against SARS-CoV-2 after receiving sotrovimab.
Severe COVID-19 infection
An assessment of rates of severe COVID-19 infection (with hospitalization, intensive care unit admission and/or mechanical ventilation, or death), in this cohort of immunocompromised patients with impaired humoral immunity against SARS-CoV-2 after receiving sotrovimab.
Greatest extent of COVID-19 symptoms
In patients who develop COVID-19, a determination of the greatest extent of COVID-19 symptoms using the 8-point National Institute of Allergy and Infectious Diseases ordinal scale (NIAID-OS), ranging from 1-8 with higher scores corresponding to worse clinical outcomes, assessed at the end of hospitalization or 14 days after the diagnosis of COVID-19.
Health-related quality of life
Health-related quality of life will be measured longitudinally during the study using the Short Form Health Survey (SF-36) instrument.

Full Information

First Posted
January 25, 2022
Last Updated
February 7, 2023
Sponsor
Sophia Koo, M.D.
Collaborators
Massachusetts General Hospital, Dana-Farber Cancer Institute, GlaxoSmithKline
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1. Study Identification

Unique Protocol Identification Number
NCT05210101
Brief Title
A Safety and Tolerability Study of Sotrovimab (VIR-7831) Prophylaxis Against COVID-19 in Immunocompromised Individuals
Official Title
A Safety and Tolerability Study of Sotrovimab (VIR-7831) Prophylaxis Against COVID-19 Infection in Immunocompromised Individuals With Impaired SARS-CoV-2 Humoral Immunity
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
February 7, 2022 (Actual)
Primary Completion Date
April 1, 2023 (Anticipated)
Study Completion Date
April 1, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Sophia Koo, M.D.
Collaborators
Massachusetts General Hospital, Dana-Farber Cancer Institute, GlaxoSmithKline

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 an open-label study examining the safety and tolerability of sotrovimab, administered in two sequential doses as prophylaxis in immunocompromised patients with impaired humoral immunity against SARS-CoV-2.
Detailed Description
This open-label study evaluated the safety and tolerability of sotrovimab, administered in two sequential doses, as COVID-19 prophylaxis in immunocompromised patients with impaired humoral immunity against SARS-CoV-2. 93 patients were enrolled in this study, 10 patients in an initial lead-in PK cohort initially planned to determine the optimal dosing interval between the first and second dose of sotrovimab and assess the safety and tolerability of the drug (prior to the spread of the BA.2 variant, which made it necessary to administer the repeat sotrovimab dose earlier than originally anticipated, using theoretical modeling and logistical considerations), 50 patients (including the 10 patients in the lead-in PK cohort) in a safety and tolerability lead-in cohort to examine rates of infusion-related reactions (IRR) with a 30-minute sotrovimab IV infusion, and the remainder in an expansion cohort for further assessment of the safety and tolerability of sotrovimab in this patient population, with the sotrovimab infusion duration determined by the rate of IRRs in the 50-patient safety and tolerability lead-in cohort. The first treatment consisted of sotrovimab 500mg as an intravenous (IV) infusion over 30 minutes, followed by a one-hour monitoring period. The second treatment, administered in a time when BA.2 became the dominant SARS-CoV-2 variant, consisted of sotrovimab 2000mg as an intravenous (IV) infusion over 60 minutes, followed by a two-hour monitoring period in the first 10 patients administered this dose, who comprised a second lead-in safety cohort for this 2000mg dose, and a one-hour monitoring period in all patients subsequently receiving their second sotrovimab dose, maintaining this one-hour monitoring period as long as there were no grade >2 infusion-related reactions or other SAEs potentially related to the sotrovimab dose in this 2000mg dose lead-in safety cohort.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
SARS CoV 2 Infection
Keywords
Prophylaxis, Immunocompromised host, Transplant, Monoclonal antibodies

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
93 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Sotrovimab
Arm Type
Other
Arm Description
Two intravenous (IV) doses of sotrovimab were be administered in total - the first on Treatment Day 1 (500mg) and the second on Treatment Day 2, approximately 8-14 weeks after the first dose, at a higher 2000mg dose, in light of the reduced antiviral susceptibility of the BA.2 subvariant to sotrovimab, with the dosing interval determined by theoretical modeling of the duration of efficacy of sotrovimab as antiviral prophylaxis based on the rising prevalence of the Omicron BA.2 subvariant.
Intervention Type
Drug
Intervention Name(s)
Sotrovimab
Other Intervention Name(s)
VIR-7831
Intervention Description
Two intravenous (IV) doses of sotrovimab were administered over the study period, the first 500mg, and the second 2000mg, in light of the reduced antiviral neutralization of sotrovimab against the BA.2 subvariant.
Primary Outcome Measure Information:
Title
Proportion of patients with treatment-emergent adverse events, serious adverse events, and adverse events of specific interest
Description
Assessment of the safety and tolerability of sotrovimab in immunocompromised patients with impaired humoral immunity against SARS-CoV-2. This measure will include: The proportion of patients with treatment-emergent grade 3-4 adverse events (TEAEs). The proportion of patients with treatment-emergent serious adverse events (SAEs). The proportion of patients with adverse events of special interest (AESI), including infusion-related and hypersensitivity reactions, the development of anti-drug antibody (ADA) levels, and antibody-dependent enhancement (ADE) of COVID-19 disease.
Time Frame
36 weeks after the second dose of sotrovimab
Title
Serum sotrovimab levels to assess pharmacokinetics over time, with determination of maximum serum sotrovimab concentration (Cmax)
Description
Cmax determination
Time Frame
36 weeks after the second dose of sotrovimab
Title
Serum sotrovimab levels to assess pharmacokinetics over time, with determination of time to maximal sotrovimab serum concentration (Tmax)
Description
Tmax determination
Time Frame
36 weeks after the second dose of sotrovimab
Title
Serum sotrovimab levels to assess pharmacokinetics over time, with determination of minimal sotrovimab serum concentration (Cmin)
Description
Cmin determination
Time Frame
36 weeks after the second dose of sotrovimab
Title
Serum sotrovimab levels to assess pharmacokinetics over time, with determination of last sotrovimab concentration (Clast)
Description
Clast determination
Time Frame
36 weeks after the second dose of sotrovimab
Title
Serum sotrovimab levels to assess pharmacokinetics over time, with determination of time of last measurable sotrovimab concentration (Tlast)
Description
Tlast determination
Time Frame
36 weeks after the second dose of sotrovimab
Title
Serum sotrovimab levels to assess pharmacokinetics over time, with determination of area under the curve extrapolated to infinity (AUC(0-∞)
Description
AUC(0-∞)
Time Frame
36 weeks after the second dose of sotrovimab
Title
Serum sotrovimab levels to assess pharmacokinetics over time, with determination of AUC(0-∞) vs. dose
Description
AUC(0-∞) vs. dose
Time Frame
36 weeks after the second dose of sotrovimab
Title
Serum sotrovimab levels to assess pharmacokinetics over time, with determination of half life (t 1/2)
Description
Sotrovimab half-life (t 1/2)
Time Frame
36 weeks after the second dose of sotrovimab
Title
Serum sotrovimab levels to assess pharmacokinetics over time, with determination of sotrovimab concentration in serum 28 days after dosing (C28)
Description
Concentration in serum 28 days after dosing (C28)
Time Frame
28 weeks after the first dose of sotrovimab
Secondary Outcome Measure Information:
Title
Symptomatic COVID-19 infection of any severity
Description
An assessment of rates of symptomatic COVID-19 infection (of any severity) in this cohort of immunocompromised patients with impaired humoral immunity against SARS-CoV-2 after receiving sotrovimab.
Time Frame
36 weeks after the second dose of sotrovimab
Title
Asymptomatic COVID-19 infection
Description
An assessment of rates of asymptomatic COVID-19 infection in this cohort of immunocompromised patients with impaired humoral immunity against SARS-CoV-2 after receiving sotrovimab.
Time Frame
36 weeks after the second dose of sotrovimab
Title
Severe COVID-19 infection
Description
An assessment of rates of severe COVID-19 infection (with hospitalization, intensive care unit admission and/or mechanical ventilation, or death), in this cohort of immunocompromised patients with impaired humoral immunity against SARS-CoV-2 after receiving sotrovimab.
Time Frame
36 weeks after the second dose of sotrovimab
Title
Greatest extent of COVID-19 symptoms
Description
In patients who develop COVID-19, a determination of the greatest extent of COVID-19 symptoms using the 8-point National Institute of Allergy and Infectious Diseases ordinal scale (NIAID-OS), ranging from 1-8 with higher scores corresponding to worse clinical outcomes, assessed at the end of hospitalization or 14 days after the diagnosis of COVID-19.
Time Frame
36 weeks after the second dose of sotrovimab (study subjects are at risk of developing COVID-19 infection over the entire study period).
Title
Health-related quality of life
Description
Health-related quality of life will be measured longitudinally during the study using the Short Form Health Survey (SF-36) instrument.
Time Frame
36 weeks after the second dose of sotrovimab
Other Pre-specified Outcome Measures:
Title
New cellular or antibody-mediated rejection events in solid organ transplant recipients
Description
Assessment of rates of new cellular or antibody-mediated rejection events in solid organ transplant (SOT) recipients exposed to sotrovimab.
Time Frame
36 weeks after the second dose of sotrovimab
Title
New-onset or worsening graft-versus-host disease in hematopoietic cell transplant recipients
Description
Assessment of rates of new-onset or worsening graft-versus-host disease in hematopoietic cell transplant (HCT) recipients exposed to sotrovimab.
Time Frame
36 weeks after the second dose of sotrovimab
Title
New-onset allograft or stem cell failure requiring retransplantation in HCT recipients
Description
Assessment of rates of new-onset allograft or stem cell failure requiring retransplantation in HCT recipients exposed to sotrovimab.
Time Frame
36 weeks after the second dose of sotrovimab

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Participant must be 18 years of age or older at the time of consent and weigh at least 40 kg. Children will be excluded from this study because dosing and adverse event data are limited for the use of sotrovimab in participants <18 years of age. Participant must have one of the following immunocompromising conditions that increases their likelihood of having an impaired humoral immune response to SARS-CoV-2, while also increasing their risk of being infected with SARS-CoV-2 and risk of progression to severe COVID-19: Exposure to an anti-CD20 monoclonal antibody (e.g. all formulations of rituximab, obinutuzumab, ofatumumab, ocrelizumab, ibritumomab, tositumomab) for a hematologic malignancy or an autoimmune/inflammatory disease in the 12-month period prior to consent. Allogeneic hematopoietic cell transplant ≥ 3 months and ≤ 1 year prior to consent; or allogeneic hematopoietic cell transplant >1 year prior to consent plus active graft-versus host disease on systemic immunosuppressive therapy. Chimeric antigen receptor (CAR)-T cell therapy ≥ 4 weeks and ≤ 2 years prior to consent. Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), multiple myeloma, or Waldenström macroglobulinemia. Solid organ transplant recipient receiving immunosuppressive therapy. Congenital immunodeficiency syndrome (e.g. Wiskott-Aldrich syndrome, DiGeorge syndrome, common variable immunodeficiency). Patients with hematologic malignancy or autoimmune/inflammatory disease exposed to immunosuppressive medications specifically associated with a blunted humoral immune response to SARS-CoV-2 vaccination (e.g. mycophenolate mofetil, azathioprine, methotrexate, Bruton tyrosine kinase inhibitors, ruxolitinib, venetoclax, or corticosteroids (prednisone >20mg or equivalent daily for at least 14 days) in the 3-month period prior to consent. Female participants must be: Postmenopausal for at least 1 year; Post-hysterectomy and/or post-bilateral oophorectomy; Of childbearing potential, with a negative urine or serum human chorionic gonadotropin pregnancy test prior to each sotrovimab dose, and agree to use a highly effective method of birth control throughout the study period. Participants must have a negative or low-positive (<50 U/mL) SARS-CoV-2 spike antibody assay result within 28 days of consent. Exclusion Criteria: Participants with an active SARS-CoV-2 infection, with a positive SARS-CoV-2 RT-PCR or antigen test result within 21 days prior to consent. Participants with symptoms suggestive of SARS-CoV-2 infection. Close contact (less than 6 feet away for a cumulative total of ≥ 15 minutes over a 24-hour period) with an individual with COVID-19 in the 14 days prior to consent. Individuals who are pregnant or breastfeeding. Participants who are receiving any other investigational agents. Participants who, in the judgment of the investigator, are likely to have a life expectancy of less than one year. Known hypersensitivity to any constituent present in sotrovimab or any other anti-SARSCoV-2 monoclonal antibody product. Active enrollment on another interventional research study of any agent for the treatment or prophylaxis of SARS-CoV-2 infection. Exposure to any other anti-SARS-CoV-2 monoclonal antibody product for the treatment of COVID-19 in the prior 6 months. Exposure to any other anti-SARS-CoV-2 monoclonal antibody product for prophylaxis against COVID-19 infection in the prior 12 months. Receipt of a SARS-CoV-2 vaccine dose within the prior 28 days.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sophia Koo, MD
Organizational Affiliation
Brigham and Women's Hospital/Dana-Farber Cancer Institute
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Jennifer Manne-Goehler, MD, ScD
Organizational Affiliation
Brigham and Women's Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Sarah P Hammond, MD
Organizational Affiliation
Massachusetts General Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Facility Name
Brigham and Women's Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Facility Name
Dana-Farber Cancer Institute
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

A Safety and Tolerability Study of Sotrovimab (VIR-7831) Prophylaxis Against COVID-19 in Immunocompromised Individuals

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