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A Trial Looking at the Use of Camostat in People Who Have Tested Positive for Coronavirus (COVID-19) (SPIKE-1) (SPIKE-1)

Primary Purpose

COVID-19 Infection

Status
Terminated
Phase
Phase 2
Locations
United Kingdom
Study Type
Interventional
Intervention
Camostat
Sponsored by
Cancer Research UK
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for COVID-19 Infection focused on measuring COVID-19, Coronavirus Infections, Respiratory Tract Infections, Pneumonia, Viral, Virus Diseases, Camostat, Protease Inhibitors, Enzyme Inhibitors, Serine Proteinase Inhibitors

Eligibility Criteria

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

Inclusion Criteria:

  1. Patient willing and able to give informed consent
  2. Adults, 18 years of age and above
  3. Symptomatic COVID-19 infection
  4. Evidence of current COVID-19 infection from a validated assay

Exclusion Criteria:

The patient may not enter the trial if ANY of the following apply:

  1. Significant electrolyte disturbance (e.g. hyperkalaemia, potassium > site specific upper limit of normal)
  2. Alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) and/or Alkaline Phosphatase (ALP) > 2.5 x ULN
  3. Any condition that, in the Investigator's opinion, would not make the patient a good candidate for the clinical trial or would prevent adequate compliance with trial therapy e.g. mild cognitive impairment (unable to follow instructions for self-assessment readings as assessed by the Investigator).
  4. Patients on long term supplementary oxygen requirement (patients for whom hospital admission would not be considered e.g. care plan in the community is in place, are not excluded)
  5. Known hypersensitivity to camostat
  6. Platelet count <100 x 10^9/L
  7. Co-enrolment with a Clinical Trial of an Investigational Medicinal Product (CTIMP) will not be permitted. Co-enrolment with a clinical investigation of a Medical Device or a non-interventional clinical study will be considered on a study-by-study basis and in discussion with the relevant Chief Investigators and Sponsors and industrial collaborators.
  8. Co-enrolment involving non-interventional research (including questionnaire or tissue only studies) will be allowed provided this is not expected to affect the outcomes of both studies or place undue burden upon participants and their families.
  9. Female patients who are able to become pregnant (or are already pregnant or lactating). However, those patients who are of child bearing potential and have a negative serum or urine pregnancy test before enrolment and agree to use two forms of contraception (one effective form plus a barrier method [oral, injected or implanted hormonal contraception and condom; intra-uterine device and condom; diaphragm with spermicidal gel and condom]) or agree to sexual abstinence*, effective from the first administration of camostat, throughout the trial and for 28 days afterwards are considered eligible.

    (*Abstinence is only considered to be an acceptable method of contraception when this is in line with the preferred and usual lifestyle of the subject. Periodic abstinence [e.g. calendar, ovulation, symptothermal, post-ovulation methods] and withdrawal are not acceptable methods of contraception.)

  10. Male patients with partners of child-bearing potential (unless they agree to take measures not to father children by using a barrier method of contraception [condom plus spermicide] or to sexual abstinence* effective from the first administration of camostat, throughout the trial and for 28 days afterwards. Men with partners of child-bearing potential must also be willing to ensure that their partner uses an effective method of contraception for the same duration for example, hormonal contraception, intrauterine device, diaphragm with spermicidal gel or sexual abstinence). Men with pregnant or lactating partners must be advised to use barrier method contraception (for example, condom plus spermicidal gel) to prevent exposure of the foetus or neonate.

    (*Abstinence is only considered to be an acceptable method of contraception when this is in line with the preferred and usual lifestyle of the subject. Periodic abstinence [e.g. calendar, ovulation, symptothermal, post-ovulation methods] and withdrawal are not acceptable methods of contraception.)

  11. Significant cardiovascular disease (as assessed via the participant's medical record and history) as defined by:

    1. History of congestive heart failure requiring therapy (New York Heart Association [NYHA] III or IV)
    2. History of unstable angina pectoris or myocardial infarction up to 6 months prior to trial entry
    3. Presence of severe valvular heart disease
    4. Presence of a ventricular arrhythmia requiring treatment

Known allergic reactions to components of camostat e.g., lactose intolerance

Sites / Locations

  • Chawton Park Surgery
  • The University of Edinburgh
  • Church Avenue Medical Group
  • Oxford University Hospitals NHS Foundation Trust
  • Trafalgar Medical Practice
  • Preston Lantern Centre
  • Clarence Medical Centre
  • Velindre Cancer Centre
  • Eynsham Medical Centre

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

Camostat

Control arm

Arm Description

Patient to receive treatment with camostat tablets, 200mg four times daily (qds) for 14 days.

Patient to receive best supportive care.

Outcomes

Primary Outcome Measures

Number of camostat related AEs and SAEs.
Number of camostat related AEs and SAEs
Number of AEs by severity grade
Number of AEs by severity grade (mild, moderate, severe)

Secondary Outcome Measures

PK parameter Maximum concentration (Cmax) of 4-(4-Guanidinobenzoyloxy)phenylacetic acid (GBPA).
Maximum concentration (Cmax) of GBPA as assessed by population estimates from population PK analysis
PK parameter time to maximum concentration (Tmax) of GBPA, as assessed by population estimates from population PK analysis.
Time to maximum concentration (Tmax) of GBPA, as assessed by population estimates from population PK analysis
PK parameter area under the curve (AUC) of GBPA
Area under the curve (AUC) of GBPA, as assessed by population estimates from population PK analysis
PK parameter to confirm half-life (T1/2) of GBPA
Half-life (T1/2) of GBPA as assessed by population estimates from population PK analysis
Number of community patients admitted to hospital due to COVID-19
Number of community patients admitted to hospital due to COVID-19
Number of oxygen free days
Number of oxygen free days
Number of ventilator - free days
Number of ventilator - free days
Time to worst point on the scale or deterioration of two points or more (from randomisation) on 9 point category ordinal scale ranging from '0 - Uninfected, no clinical or virological evidence of infection' to '8 - Death'
Median time and range to worst point on the scale or deterioration of two points or more (from randomisation) on 9 point category ordinal scale. The scale was described in the protocol as follows: '0 - Uninfected, no clinical or virological evidence of infection, 1 - Ambulatory, no limitation of activities, 2 - Ambulatory, limitation of activities, 3 - Hospitalised - mild disease, no oxygen therapy, 4 - Hospitalised - mild disease, oxygen by mask or nasal prongs, 5 - Hospitalised - severe disease, non-invasive, ventilation or high-flow oxygen, 6 - Hospitalised - severe disease, intubation and mechanical ventilation, 7 - Hospitalised - severe disease, ventilation and additional organ support - vasopressors, renal replacement therapy (RRT), extracorporeal membrane oxygenation (ECMO), 8 - Death'

Full Information

First Posted
June 25, 2020
Last Updated
June 10, 2022
Sponsor
Cancer Research UK
Collaborators
Latus Therapeutics
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1. Study Identification

Unique Protocol Identification Number
NCT04455815
Brief Title
A Trial Looking at the Use of Camostat in People Who Have Tested Positive for Coronavirus (COVID-19) (SPIKE-1)
Acronym
SPIKE-1
Official Title
A Randomised Phase II Trial in Early COVID-19, Assessing Use of Camostat by Blocking SARS-CoV-2 Spike Protein-initiated Membrane Fusion.
Study Type
Interventional

2. Study Status

Record Verification Date
June 2022
Overall Recruitment Status
Terminated
Why Stopped
Sponsor decision
Study Start Date
September 25, 2020 (Actual)
Primary Completion Date
March 3, 2022 (Actual)
Study Completion Date
March 3, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Cancer Research UK
Collaborators
Latus Therapeutics

4. Oversight

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

5. Study Description

Brief Summary
This is a phase II randomised, multicentre, prospective, open label clinical trial. The trial aims to recruit patients who test positive for COVID-19 who have mild symptoms and therefore can treat their symptoms in the community. Patients who test positive for COVID-19 at hospital may also be able to participate.
Detailed Description
Coronavirus-induced disease 2019 (COVID-19) caused by SARS-CoV-2 infection is a highly contagious disease with a high and unpredictable morbidity and mortality, for which there is currently no specific treatment. Progression from a mild fatigue, fever and cough, to severe respiratory failure requiring mechanical ventilation may occur 1 to 2 weeks into the disease. This provides a window of opportunity in which patients in the early phase of the disease could be treated with a disease-modifying agent, to halt disease progression, prevent hospital admissions with respiratory failure and prevent death. Camostat is a serine protease inhibitor in clinical use in Japan since 1985 to treat patients with chronic pancreatitis (inflammation of the pancreas) and has an acceptable safety profile. Camostat has been shown to inhibit SARS-CoV-2 entry into epithelial cells in vitro. A trial of this repurposed drug for treatment of COVID-19 in humans is urgently required to assess its impact on disease progression to respiratory failure and whether it can reduce mortality. This trial will recruit up to 100 patients. Patients will be randomised into a treatment arm (camostat tablets) or control arm (best supportive care). Community patients will be called daily at home for 14 days by the clinical trial team to collect symptoms and record the general well-being of the patient. For those patients recruited from hospital, visits will continue in hospital, where feasible, until discharge when home visits will be able to continue. The primary aim of this trial is to further assess the safety and toxicity profile of camostat to support integration into a Phase III trial. Secondary aims are to determine if camostat can reduce the clinical progression of COVID-19 and therefore the need for hospital admission and supplemental oxygen as well as include collection of patient reported health status, severity of symptoms and biological markers of the virus and confirm PK profile for the active metabolite of camostat. As the understanding of COVID-19 develops and improves, the inclusion criteria may be adapted to support the trial outcomes. Patients will be recruited through various settings which may include primary care 'COVID-19 hub' clinics, COVID-19 community-based testing centres, identification through other hospital departments, NHS digital, Test and Trace (or equivalent) or other clinical environments.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
COVID-19 Infection
Keywords
COVID-19, Coronavirus Infections, Respiratory Tract Infections, Pneumonia, Viral, Virus Diseases, Camostat, Protease Inhibitors, Enzyme Inhibitors, Serine Proteinase Inhibitors

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
34 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Camostat
Arm Type
Experimental
Arm Description
Patient to receive treatment with camostat tablets, 200mg four times daily (qds) for 14 days.
Arm Title
Control arm
Arm Type
No Intervention
Arm Description
Patient to receive best supportive care.
Intervention Type
Drug
Intervention Name(s)
Camostat
Other Intervention Name(s)
Camostat mesylate, Camostat mesilate
Intervention Description
Patient to receive treatment with camostat tablets, 200mg four times daily (qds) for 14 days.
Primary Outcome Measure Information:
Title
Number of camostat related AEs and SAEs.
Description
Number of camostat related AEs and SAEs
Time Frame
Days 1 - 28
Title
Number of AEs by severity grade
Description
Number of AEs by severity grade (mild, moderate, severe)
Time Frame
Days 1 - 28
Secondary Outcome Measure Information:
Title
PK parameter Maximum concentration (Cmax) of 4-(4-Guanidinobenzoyloxy)phenylacetic acid (GBPA).
Description
Maximum concentration (Cmax) of GBPA as assessed by population estimates from population PK analysis
Time Frame
Days 7 and 14
Title
PK parameter time to maximum concentration (Tmax) of GBPA, as assessed by population estimates from population PK analysis.
Description
Time to maximum concentration (Tmax) of GBPA, as assessed by population estimates from population PK analysis
Time Frame
Days 7 and 14
Title
PK parameter area under the curve (AUC) of GBPA
Description
Area under the curve (AUC) of GBPA, as assessed by population estimates from population PK analysis
Time Frame
Days 7 and 14
Title
PK parameter to confirm half-life (T1/2) of GBPA
Description
Half-life (T1/2) of GBPA as assessed by population estimates from population PK analysis
Time Frame
Days 1 - 28
Title
Number of community patients admitted to hospital due to COVID-19
Description
Number of community patients admitted to hospital due to COVID-19
Time Frame
Days 1 - 28
Title
Number of oxygen free days
Description
Number of oxygen free days
Time Frame
Days 1 - 28
Title
Number of ventilator - free days
Description
Number of ventilator - free days
Time Frame
Days 1 - 28
Title
Time to worst point on the scale or deterioration of two points or more (from randomisation) on 9 point category ordinal scale ranging from '0 - Uninfected, no clinical or virological evidence of infection' to '8 - Death'
Description
Median time and range to worst point on the scale or deterioration of two points or more (from randomisation) on 9 point category ordinal scale. The scale was described in the protocol as follows: '0 - Uninfected, no clinical or virological evidence of infection, 1 - Ambulatory, no limitation of activities, 2 - Ambulatory, limitation of activities, 3 - Hospitalised - mild disease, no oxygen therapy, 4 - Hospitalised - mild disease, oxygen by mask or nasal prongs, 5 - Hospitalised - severe disease, non-invasive, ventilation or high-flow oxygen, 6 - Hospitalised - severe disease, intubation and mechanical ventilation, 7 - Hospitalised - severe disease, ventilation and additional organ support - vasopressors, renal replacement therapy (RRT), extracorporeal membrane oxygenation (ECMO), 8 - Death'
Time Frame
Days 1 - 28

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient willing and able to give informed consent Adults, 18 years of age and above Symptomatic COVID-19 infection Evidence of current COVID-19 infection from a validated assay Exclusion Criteria: The patient may not enter the trial if ANY of the following apply: Significant electrolyte disturbance (e.g. hyperkalaemia, potassium > site specific upper limit of normal) Alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) and/or Alkaline Phosphatase (ALP) > 2.5 x ULN Any condition that, in the Investigator's opinion, would not make the patient a good candidate for the clinical trial or would prevent adequate compliance with trial therapy e.g. mild cognitive impairment (unable to follow instructions for self-assessment readings as assessed by the Investigator). Patients on long term supplementary oxygen requirement (patients for whom hospital admission would not be considered e.g. care plan in the community is in place, are not excluded) Known hypersensitivity to camostat Platelet count <100 x 10^9/L Co-enrolment with a Clinical Trial of an Investigational Medicinal Product (CTIMP) will not be permitted. Co-enrolment with a clinical investigation of a Medical Device or a non-interventional clinical study will be considered on a study-by-study basis and in discussion with the relevant Chief Investigators and Sponsors and industrial collaborators. Co-enrolment involving non-interventional research (including questionnaire or tissue only studies) will be allowed provided this is not expected to affect the outcomes of both studies or place undue burden upon participants and their families. Female patients who are able to become pregnant (or are already pregnant or lactating). However, those patients who are of child bearing potential and have a negative serum or urine pregnancy test before enrolment and agree to use two forms of contraception (one effective form plus a barrier method [oral, injected or implanted hormonal contraception and condom; intra-uterine device and condom; diaphragm with spermicidal gel and condom]) or agree to sexual abstinence*, effective from the first administration of camostat, throughout the trial and for 28 days afterwards are considered eligible. (*Abstinence is only considered to be an acceptable method of contraception when this is in line with the preferred and usual lifestyle of the subject. Periodic abstinence [e.g. calendar, ovulation, symptothermal, post-ovulation methods] and withdrawal are not acceptable methods of contraception.) Male patients with partners of child-bearing potential (unless they agree to take measures not to father children by using a barrier method of contraception [condom plus spermicide] or to sexual abstinence* effective from the first administration of camostat, throughout the trial and for 28 days afterwards. Men with partners of child-bearing potential must also be willing to ensure that their partner uses an effective method of contraception for the same duration for example, hormonal contraception, intrauterine device, diaphragm with spermicidal gel or sexual abstinence). Men with pregnant or lactating partners must be advised to use barrier method contraception (for example, condom plus spermicidal gel) to prevent exposure of the foetus or neonate. (*Abstinence is only considered to be an acceptable method of contraception when this is in line with the preferred and usual lifestyle of the subject. Periodic abstinence [e.g. calendar, ovulation, symptothermal, post-ovulation methods] and withdrawal are not acceptable methods of contraception.) Significant cardiovascular disease (as assessed via the participant's medical record and history) as defined by: History of congestive heart failure requiring therapy (New York Heart Association [NYHA] III or IV) History of unstable angina pectoris or myocardial infarction up to 6 months prior to trial entry Presence of severe valvular heart disease Presence of a ventricular arrhythmia requiring treatment Known allergic reactions to components of camostat e.g., lactose intolerance
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kevin Dhaliwal, Professor
Organizational Affiliation
University of Edinburgh
Official's Role
Principal Investigator
Facility Information:
Facility Name
Chawton Park Surgery
City
Alton
Country
United Kingdom
Facility Name
The University of Edinburgh
City
Edinburgh
Country
United Kingdom
Facility Name
Church Avenue Medical Group
City
Harrogate
Country
United Kingdom
Facility Name
Oxford University Hospitals NHS Foundation Trust
City
Oxford
Country
United Kingdom
Facility Name
Trafalgar Medical Practice
City
Portsmouth
Country
United Kingdom
Facility Name
Preston Lantern Centre
City
Preston
Country
United Kingdom
Facility Name
Clarence Medical Centre
City
Rhyl
Country
United Kingdom
Facility Name
Velindre Cancer Centre
City
Wales
Country
United Kingdom
Facility Name
Eynsham Medical Centre
City
Witney
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
34412682
Citation
Halford S, Wan S, Dragoni I, Silvester J, Nazarov B, Anthony D, Anthony S, Ladds E, Norrie J, Dhaliwal K; CDD SPIKE-1 Project Team. SPIKE-1: A Randomised Phase II/III trial in a community setting, assessing use of camostat in reducing the clinical progression of COVID-19 by blocking SARS-CoV-2 Spike protein-initiated membrane fusion. Trials. 2021 Aug 19;22(1):550. doi: 10.1186/s13063-021-05461-9. Erratum In: Trials. 2022 Apr 21;23(1):336.
Results Reference
derived
Links:
URL
https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/spike-1-covid-19/
Description
A lay summary of the trial on the Health Research Authority website

Learn more about this trial

A Trial Looking at the Use of Camostat in People Who Have Tested Positive for Coronavirus (COVID-19) (SPIKE-1)

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