A Trial of Aclaris Therapeutics, Inc. (ATI)-450 in Patients With Moderate-severe Novel Coronavirus Disease 2019 (COVID-19)
Primary Purpose
Covid19
Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
ATI-450
Placebo
Sponsored by
About this trial
This is an interventional treatment trial for Covid19
Eligibility Criteria
Inclusion Criteria:
- Able to comprehend and be willing to sign the Institutional Review Board (IRB)-approved subject informed consent form (ICF) prior to administration of any study-related procedures, or consent from surrogate decision maker when the above criteria cannot be met
- Male or non-pregnant female adult ≥18 years of age at time of enrollment; female patients must have a negative serum pregnancy test at study enrollment
- Has laboratory-confirmed COVID-19 coronavirus infection as determined by polymerase chain reaction (PCR), or other commercial or public health assay in oropharyngeal or nasopharyngeal testing within 14 days of hospitalization. An additional 24-hour COVID-19 PCR test will be performed at KUMC. Patients outside of KUMC will have their samples sent to KUMC as a Central Lab for test processing
- Hospitalized as a result of symptoms and signs related to COVID-19 infection, and ≤14 days since positive test
- Evidence of hypoxic respiratory failure: SpO2≤93% on room air, or SpO2 >93% requiring ≥ 2 Liters (L) O2, or Pa02/Fi02 ratio <300 Millimeter of Mercury (mmHg), or tachypnea (respiratory rate > 30 breaths/min)
- Evidence of pulmonary involvement by: chest imaging or pulmonary exam
- Previous use of hydroxychloroquine or chloroquine is allowed in this study
- Adequate organ function per laboratory tests
- Females of child-bearing potential and males with partners of child-bearing potential must agree to practice sexual abstinence or to use the forms of contraception listed in Child-Bearing Potential/Pregnancy section for the duration of study participation and for 30 Days for females and 90 days for males following completion of therapy
Exclusion Criteria:
- Known hypersensitivity to ATI-450
- History or evidence of active or latent tuberculosis or recent exposure (within last 30d) to a person with active Tb
- Evidence of active, untreated bacterial infection. Patients who are treated with antibiotics for at least 72 hours, will become eligible for rescreening for trial enrollment
- Active use of immunosuppressant medication(s) (i.e. anti-rejection ,immunomodulators or immunosuppressant drugs, including but not limited to IL-6 inhibitors, TNF inhibitors, anti-IL-1 agents and Janus kinase (JAK) inhibitors within 5 half-lives or 30 days (whichever is longer) prior to randomization. (Use of hydroxychloroquine/chloroquine should be discontinued)
- Oncology patients who are on active chemotherapy or immunotherapy. However, oncology patients who come off active therapy prior to enrollment and have absolute neutrophil count (ANC) ≥1500/mmc are eligible for enrollment
- Active participation in a concurrent COVID-19 clinical trial with investigative medical drug therapies. However, co-enrollment for non-investigative drug therapies will be allowed; use or re-purposing of FDA approved treatments will be considered at the discretion of the medical monitor
- In the opinion of the investigator, unlikely to survive for at least 48 hours from screening or anticipate mechanical ventilation within 48 hours
- Pregnancy or breast feeding
- Prisoner
- Intubation and ventilation at time of enrollment
- Known history for HIV, hepatitis B or C infection. Patients with serologic evidence of hepatitis B vaccination (hepatitis B surface antibody without the presence of hepatitis B surface antigen) will be allowed to participate
- History of a past or current medical condition that in the opinion of the treating physician would compromise patient safety (e.g. uncontrolled HIV) by participation in the study
Sites / Locations
- The University of Kansas Medical Center
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Placebo Comparator
Arm Label
ATI-450
Placebo
Arm Description
Treated with 50 mg dose of ATI-450, orally, twice daily for 14 days
Treated with matched placebo, orally, twice daily for 14 days
Outcomes
Primary Outcome Measures
Respiratory failure-free survival in participants with moderate-severe COVID-19 who are treated with ATI-450
Participants medical record
Secondary Outcome Measures
Change in 7 point-ordinal scale
Using World Health Organization (WHO) COVID-19 Ordinal scale measuring: Proportion and time to participants with greater than 2 point improvement on the 7 point categorical scale. This scale measures illness severity over time and has a range of 0-7.
0- Uninfected: No clinical or virological evidence of infection.
1- Ambulatory: No limitation of activities.
2- Ambulatory: Limitation of activities.
3- Hospitalized, mild disease: Hospitalized, no oxygen.
4- Hospitalized, mild disease: Oxygen by mask or nasal prongs.
5- Hospitalized, severe disease: Non- invasive ventilation or high- flow oxygen.
6- Hospitalized, severe disease: Intubation and mechanical ventilation.
7- Hospitalized, severe disease: Ventilation + organ support; pressors, Renal Replacement Therapy (RRT), Extracorporeal Membrane Oxygenation (ECMO).
Change in oxygen saturation-normalization
Peripheral capillary pulse oximeter to measure: Oxygen Saturation (SpO2)/Fraction of Inspired Oxygen (FiO2) ratio over time, sustainment of normalization in 24 hours, and relative shifts in SpO2/FiO2 categories (<235, between 235 and 315, greater than 315) over time
Need for advanced respiratory care
Derived from medical record
All-cause mortality
Noted in participant medical record
Percentage of adverse events (AEs)
CTCAE v5.0
Percentage of serious adverse events (SAEs)
CTCAE v5.0
Proportion of participants with normalization of fever for 24 hours
Standard daily temperature measurement and obtained from participant medical record
Number of participants who develop new bacterial infection
Noted in participant medical record
Number of participants who develop new fungal infection
Noted in participant medical record
Incidence of Adult Respiratory distress Syndrome (ARDS2)
Noted in participant medical record
Change in serum cytokine Interleukin (IL)-6
Serum collected from blood and assayed on Luminex panel performed by University of Kansas Medical Center (KUMC) Biobanking and Biomarker Validation (BBV) Core
Change in serum cytokine IL-8
Serum collected from blood and assayed on Luminex panel performed by KUMC BBV Core
Change in serum cytokines IL-1β
Serum collected from blood and assayed on Luminex panel performed by KUMC BBV Core
Change in serum cytokine Tumor Necrosis Factor (TNF-α)
Serum collected from blood and assayed on Luminex panel performed by KUMC BBV Core
Full Information
NCT ID
NCT04481685
First Posted
July 15, 2020
Last Updated
June 22, 2021
Sponsor
University of Kansas Medical Center
1. Study Identification
Unique Protocol Identification Number
NCT04481685
Brief Title
A Trial of Aclaris Therapeutics, Inc. (ATI)-450 in Patients With Moderate-severe Novel Coronavirus Disease 2019 (COVID-19)
Official Title
A Double-blind, Randomized, Controlled Trial of ATI-450 in Patients With Moderate-severe COVID-19
Study Type
Interventional
2. Study Status
Record Verification Date
May 2020
Overall Recruitment Status
Completed
Study Start Date
July 20, 2020 (Actual)
Primary Completion Date
February 25, 2021 (Actual)
Study Completion Date
June 1, 2021 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Kansas Medical Center
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
COVID-19 morbidity and mortality has been associated with Cytokine Release Syndrome (CRS) and Acute Respiratory Distress Syndrome (ARDS).
ATI-450 is an oral small molecule MAPKAPK2 (MK2) inhibitor that potently inhibits multiple inflammatory cytokines.
The investigator hypothesizes that MK2 pathway blockade during active COVID-19 infection in hospitalized participants will result in improvement in respiratory-failure free survival.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Covid19
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare Provider
Allocation
Randomized
Enrollment
20 (Actual)
8. Arms, Groups, and Interventions
Arm Title
ATI-450
Arm Type
Active Comparator
Arm Description
Treated with 50 mg dose of ATI-450, orally, twice daily for 14 days
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Treated with matched placebo, orally, twice daily for 14 days
Intervention Type
Drug
Intervention Name(s)
ATI-450
Intervention Description
50 mg (as determined from Phase I study) per dose. (100 mg per day). Up to a maximum of 14 days while inpatient. Patients discharged home or transferred to the intensive care unit (ICU) will be discontinued off drug permanently.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo pill will be taken twice daily preferably spaced 12 hours apart.
Primary Outcome Measure Information:
Title
Respiratory failure-free survival in participants with moderate-severe COVID-19 who are treated with ATI-450
Description
Participants medical record
Time Frame
Study day 14
Secondary Outcome Measure Information:
Title
Change in 7 point-ordinal scale
Description
Using World Health Organization (WHO) COVID-19 Ordinal scale measuring: Proportion and time to participants with greater than 2 point improvement on the 7 point categorical scale. This scale measures illness severity over time and has a range of 0-7.
0- Uninfected: No clinical or virological evidence of infection.
1- Ambulatory: No limitation of activities.
2- Ambulatory: Limitation of activities.
3- Hospitalized, mild disease: Hospitalized, no oxygen.
4- Hospitalized, mild disease: Oxygen by mask or nasal prongs.
5- Hospitalized, severe disease: Non- invasive ventilation or high- flow oxygen.
6- Hospitalized, severe disease: Intubation and mechanical ventilation.
7- Hospitalized, severe disease: Ventilation + organ support; pressors, Renal Replacement Therapy (RRT), Extracorporeal Membrane Oxygenation (ECMO).
Time Frame
Baseline, Day 7, Day 14, Day 28 and follow-up up to 9 months
Title
Change in oxygen saturation-normalization
Description
Peripheral capillary pulse oximeter to measure: Oxygen Saturation (SpO2)/Fraction of Inspired Oxygen (FiO2) ratio over time, sustainment of normalization in 24 hours, and relative shifts in SpO2/FiO2 categories (<235, between 235 and 315, greater than 315) over time
Time Frame
Baseline and continuous throughout hospitalization up to 14 days
Title
Need for advanced respiratory care
Description
Derived from medical record
Time Frame
Baseline and continuous throughout hospitalization up to 14 days
Title
All-cause mortality
Description
Noted in participant medical record
Time Frame
Baseline and through day 60
Title
Percentage of adverse events (AEs)
Description
CTCAE v5.0
Time Frame
Baseline through day 14 or at discharge <day 14, at day 28, day 45 and day 60
Title
Percentage of serious adverse events (SAEs)
Description
CTCAE v5.0
Time Frame
Baseline through day 14 or at discharge <day 14, at day 28, day 45 and day 60
Title
Proportion of participants with normalization of fever for 24 hours
Description
Standard daily temperature measurement and obtained from participant medical record
Time Frame
Baseline through day 14 or at discharge <day 14
Title
Number of participants who develop new bacterial infection
Description
Noted in participant medical record
Time Frame
Continuous throughout hospitalization up to 14 days
Title
Number of participants who develop new fungal infection
Description
Noted in participant medical record
Time Frame
Continuous throughout hospitalization up to 14 days
Title
Incidence of Adult Respiratory distress Syndrome (ARDS2)
Description
Noted in participant medical record
Time Frame
From day 1 though day 14 or at discharge <day 14
Title
Change in serum cytokine Interleukin (IL)-6
Description
Serum collected from blood and assayed on Luminex panel performed by University of Kansas Medical Center (KUMC) Biobanking and Biomarker Validation (BBV) Core
Time Frame
Baseline, day 3, day 7 (or discharge <day 7), day 14 (or discharge >day 7 and <day 14)
Title
Change in serum cytokine IL-8
Description
Serum collected from blood and assayed on Luminex panel performed by KUMC BBV Core
Time Frame
Baseline, day 3, day 7 (or discharge <day 7), day 14 (or discharge >day 7 and <day 14)
Title
Change in serum cytokines IL-1β
Description
Serum collected from blood and assayed on Luminex panel performed by KUMC BBV Core
Time Frame
Baseline, day 3, day 7 (or discharge <day 7), day 14 (or discharge >day 7 and <day 14)
Title
Change in serum cytokine Tumor Necrosis Factor (TNF-α)
Description
Serum collected from blood and assayed on Luminex panel performed by KUMC BBV Core
Time Frame
Baseline, day 3, day 7 (or discharge <day 7), day 14 (or discharge >day 7 and <day 14)
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Able to comprehend and be willing to sign the Institutional Review Board (IRB)-approved subject informed consent form (ICF) prior to administration of any study-related procedures, or consent from surrogate decision maker when the above criteria cannot be met
Male or non-pregnant female adult ≥18 years of age at time of enrollment; female patients must have a negative serum pregnancy test at study enrollment
Has laboratory-confirmed COVID-19 coronavirus infection as determined by polymerase chain reaction (PCR), or other commercial or public health assay in oropharyngeal or nasopharyngeal testing within 14 days of hospitalization. An additional 24-hour COVID-19 PCR test will be performed at KUMC. Patients outside of KUMC will have their samples sent to KUMC as a Central Lab for test processing
Hospitalized as a result of symptoms and signs related to COVID-19 infection, and ≤14 days since positive test
Evidence of hypoxic respiratory failure: SpO2≤93% on room air, or SpO2 >93% requiring ≥ 2 Liters (L) O2, or Pa02/Fi02 ratio <300 Millimeter of Mercury (mmHg), or tachypnea (respiratory rate > 30 breaths/min)
Evidence of pulmonary involvement by: chest imaging or pulmonary exam
Previous use of hydroxychloroquine or chloroquine is allowed in this study
Adequate organ function per laboratory tests
Females of child-bearing potential and males with partners of child-bearing potential must agree to practice sexual abstinence or to use the forms of contraception listed in Child-Bearing Potential/Pregnancy section for the duration of study participation and for 30 Days for females and 90 days for males following completion of therapy
Exclusion Criteria:
Known hypersensitivity to ATI-450
History or evidence of active or latent tuberculosis or recent exposure (within last 30d) to a person with active Tb
Evidence of active, untreated bacterial infection. Patients who are treated with antibiotics for at least 72 hours, will become eligible for rescreening for trial enrollment
Active use of immunosuppressant medication(s) (i.e. anti-rejection ,immunomodulators or immunosuppressant drugs, including but not limited to IL-6 inhibitors, TNF inhibitors, anti-IL-1 agents and Janus kinase (JAK) inhibitors within 5 half-lives or 30 days (whichever is longer) prior to randomization. (Use of hydroxychloroquine/chloroquine should be discontinued)
Oncology patients who are on active chemotherapy or immunotherapy. However, oncology patients who come off active therapy prior to enrollment and have absolute neutrophil count (ANC) ≥1500/mmc are eligible for enrollment
Active participation in a concurrent COVID-19 clinical trial with investigative medical drug therapies. However, co-enrollment for non-investigative drug therapies will be allowed; use or re-purposing of FDA approved treatments will be considered at the discretion of the medical monitor
In the opinion of the investigator, unlikely to survive for at least 48 hours from screening or anticipate mechanical ventilation within 48 hours
Pregnancy or breast feeding
Prisoner
Intubation and ventilation at time of enrollment
Known history for HIV, hepatitis B or C infection. Patients with serologic evidence of hepatitis B vaccination (hepatitis B surface antibody without the presence of hepatitis B surface antigen) will be allowed to participate
History of a past or current medical condition that in the opinion of the treating physician would compromise patient safety (e.g. uncontrolled HIV) by participation in the study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gregory Gan, MD, PhD
Organizational Affiliation
The University of Kansas
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Deepika Polineni, MD, PhD
Organizational Affiliation
The University of Kansas
Official's Role
Principal Investigator
Facility Information:
Facility Name
The University of Kansas Medical Center
City
Kansas City
State/Province
Kansas
ZIP/Postal Code
66160
Country
United States
12. IPD Sharing Statement
Learn more about this trial
A Trial of Aclaris Therapeutics, Inc. (ATI)-450 in Patients With Moderate-severe Novel Coronavirus Disease 2019 (COVID-19)
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