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An Adaptive Study of Favipiravir Compared to Standard of Care in Hospitalized Patients With COVID-19

Primary Purpose

COVID-19

Status
Unknown status
Phase
Phase 2
Locations
Russian Federation
Study Type
Interventional
Intervention
Favipiravir
Standard of Care
Sponsored by
Chromis LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for COVID-19 focused on measuring SARS-CoV-2, 2019-nCoV

Eligibility Criteria

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

Inclusion Criteria:

  1. Signed Patient Information Sheet and Informed Consent form to participate in the study.
  2. Men and women aged 18 years and older.
  3. Patients hospitalized with a diagnosis of COVID-19.
  4. The diagnosis of COVID-19 was confirmed by positive reverse transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2, performed no earlier than 7 days before hospitalization or at screening.
  5. Moderate severity of COVID-19 with pneumonia with at least 1 of the following symptoms:

    • Fever above 38 °C;
    • Cough;
    • Shortness of breath during physical exertion;
    • C reactive protein (CRP) of blood serum > 10 mg/l;
    • SpO2 < 95%
  6. The capability of oral drug administration.
  7. The patients' consent to use adequate contraception methods during the study (condom with spermicide) and for 3 months following completion.

Exclusion Criteria:

  1. Severe type of disease, with at least one of the following criteria:

    • Frequency of breath > 35 per minute, which does not decrease after the body temperature drops to normal or subfebrile values;
    • Blood oxygen saturation (SpO2) < 90% at rest;
    • Partial pressure of oxygen in arterial blood (PaO2) < 60 mm Hg;
    • Oxygenation index (RaO2/FiO2) ≤ 200 mm Hg;
    • Partial pressure of CO2 in arterial blood (PaCO2) < 60 mm Hg;
    • Septic shock.
  2. Patients treated with lopinavir/ritonavir, ribavirin, arbidol, chloroquine, hydroxychloroquine, mefloquine, favipiravir within 7 days prior to screening.
  3. Severe cardiovascular diseases currently or 6 months prior to randomization, including: New York Heart Association (NYHA) Class III or IV chronic heart failure, clinically significant ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation), unstable angina, myocardial infarction, heart and coronary vessel surgery, significant valvular heart disease, uncontrolled arterial hypertension with systolic blood pressure > 180 mm Hg and diastolic blood pressure > 110 mm Hg, pulmonary embolism or deep vein thrombosis.
  4. Severe chronic renal impairment (GFR < 30 ml / min) or continuous renal replacement therapy, hemodialysis or peritoneal dialysis.
  5. A history of cirrhosis or an increase in alanine aminotransferase (ALT) and / or aspartate aminotransferase (AST) > 5 times × upper limit of normal (ULN).
  6. Severe diseases of the central nervous system, including seizures in history or conditions that may lead to their development; stroke or transient ischemic attack within 12 months prior to screening; head injuries or loss of consciousness within 12 months prior to screening; a brain tumor.
  7. Significant uncontrolled concomitant disease, e.g. neurological, renal, hepatic, endocrinological or gastrointestinal disorder which according to the Investigator, could prevent the patient from participating in the study
  8. Malignancies that require chemotherapy within 6 months prior to screening.
  9. Known HIV infection
  10. Hypersensitivity to any component of the study drug.
  11. Participation in other clinical studies or taking other study drugs within 28 days prior to screening.
  12. Pregnant or lactating women or women planning to get pregnant during the clinical study; women of child-bearing potential (including non-sterilized by surgical means and during the post-menopause period less than 2 years) who do not use adequate contraception methods.
  13. Inability to read or write, unwillingness to understand and follow procedures of study protocol, as well as any other concomitant medical or serious mental conditions that make the patient unfit to participate in the study, limit the legality of obtaining informed consent or can affect patient's ability to participate in the study.

Sites / Locations

  • Republican Clinical Hospital
  • "K+31" Clinic
  • "Khaven" Llc
  • Central Clinical Hospital with Polyclinic
  • Central Research Institute of Epidemiology
  • City Clinical Hospital n.a. O.M. Filatov
  • City Clinical Hospital named after S.S. Yudin
  • City Clinical Hospital No. 24
  • City Clinical Hospital No. 51
  • First Moscow State Medical University n.a. I.M. Sechenov
  • Moscow State University n.a. M. V. Lomonosov
  • National Medical and Surgical Center named after N.I. Pirogov
  • City Hospital № 33 of the Leninsky region of Nizhny Novgorod
  • Infectious clinical hospital No.2 of Nizhny Novgorod
  • Ryazan State Medical University named after I.P. Pavlov
  • Military Medical Academy named after S.M. Kirova
  • Saratov State Medical University named after V.I. Razumovsky
  • Clinical hospital No.1
  • Regional Clinic Hospital
  • Bashkir State Medical University
  • Yakutsk City Clinical Hospital
  • Yaroslavl Regional Clinical Hospital for War Veterans

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm Type

Experimental

Experimental

Active Comparator

Experimental

Active Comparator

Arm Label

Favipiravir, lower dose (pilot stage)

Favipiravir, higher dose (pilot stage)

Standard of care (pilot stage)

Favipiravir, selected dose (pivotal stage)

Standard of care (pivotal stage)

Arm Description

1600mg BID on the 1st day followed by 600mg BID for 13 days

1800mg BID on the 1st day followed by 800mg BID for 13 days

Based on approved clinical recommendations for treatment of COVID-19 in the Russian Federation (but not Favipiravir). Might include hydroxychloroquine, chloroquine, lopinavir/ritonavir or other recommended schemes.

The dose will be selected based on pilot study results.

Based on approved clinical recommendations for treatment of COVID-19 in the Russian Federation (but not Favipiravir). Might include hydroxychloroquine, chloroquine, lopinavir/ritonavir or other recommended schemes.

Outcomes

Primary Outcome Measures

Rate of viral elimination by Day 10 [pilot stage, dose selection]
Percent of patients with undetectable SARS-CoV-2 RNA level on Day 10
Time to viral elimination [pivotal stage]
Median time to reach undetectable SARS-CoV-2 RNA level
Time to clinical improvement [pivotal stage]
Median time reach clinical improvement (2 points of the Ordinal Scale for Clinical Improvement) or discharge from the hospital

Secondary Outcome Measures

Rate of viral elimination
Percent of patients with undetectable SARS-CoV-2 RNA level
Time to normalization of clinical symptoms
Median time [days] to reach normal levels of clinical indicators (body temperature, SpO2, breathing rate)
Duration of oxygen therapy
Mean duration of oxygen therapy [days]
Change in the level of lung damage according to CT
Change of lung damage level according to CT comparing to baseline [% of patients]
Rate of transfer to the intensive care unit
Percent of patients transferred to the intensive care unit [% of patients]
Rate of the use of non-invasive lung ventilation
Percent of patients undergoing non-invasive lung ventilation [% of patients]
Rate of the use of mechanical ventilation
Percent of patients undergoing mechanical ventilation [% of patients]
Mortality
Percent of patients died within 28-days period [% of patients]
Peak plasma concentration (Cmax)
Determination of Cmax [ng/ml]
Time to peak plasma concentration (Tmax)
Determination of Tmax [h]
Area under the plasma concentration versus time curve (AUC0-t)
Determination of AUC0-t [ng*h/ml]
Trough plasma concentration (Ctrough)
Determination of Ctrough [ng/ml]

Full Information

First Posted
June 13, 2020
Last Updated
June 15, 2020
Sponsor
Chromis LLC
Collaborators
Chemical Diversity Research Institute
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1. Study Identification

Unique Protocol Identification Number
NCT04434248
Brief Title
An Adaptive Study of Favipiravir Compared to Standard of Care in Hospitalized Patients With COVID-19
Official Title
An Adaptive, Multicenter, Randomized, Open-label, Comparative Clinical Study to Assess Efficacy and Safety of Favipiravir in Hospitalized Patients With COVID-19
Study Type
Interventional

2. Study Status

Record Verification Date
June 2020
Overall Recruitment Status
Unknown status
Study Start Date
April 23, 2020 (Actual)
Primary Completion Date
July 2020 (Anticipated)
Study Completion Date
July 2020 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Chromis LLC
Collaborators
Chemical Diversity Research Institute

4. Oversight

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

5. Study Description

Brief Summary
The study is Phase II/III and consists of pilot and pivotal stages. The objective of the pilot stage is to conduct a preliminary assessment of the efficacy and safety of Favipiravir, and to select the optimal dosing regimen to study during the pivotal stage. The objective of the pivotal stage is to assess the efficacy and safety of Favipiravir compared with the Standard of care (SOC) in hospitalized patients with moderate to severe COVID-19 pneumonia.
Detailed Description
At the pilot stage: upon signing the informed consent form and screening, 60 eligible patients with polymerase chain reaction (PCR) confirmed COVID-19 pneumonia are randomized at a 1:1:1 ratio to receive either Favipiravir 1600 mg twice a day (BID) on Day 1 followed by 600 mg BID on Days 2-14 (1600/600 mg), or Favipiravir 1800 mg BID on Day 1 followed by 800 mg BID on Days 2-14 (1800/800 mg), or SOC. At the pivotal stage: additional 270 eligible patients are randomized at a 1:1 ratio to receive either Favipiravir (the dose regimen depends of the subject's weight) or SOC.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
COVID-19
Keywords
SARS-CoV-2, 2019-nCoV

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Sequential Assignment
Model Description
This is an adaptive, multicenter, open-label, randomized clinical study of Favipiravir versus standard of care (SOC) in hospitalized patients with moderate to severe COVID-19 pneumonia.
Masking
None (Open Label)
Allocation
Randomized
Enrollment
330 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Favipiravir, lower dose (pilot stage)
Arm Type
Experimental
Arm Description
1600mg BID on the 1st day followed by 600mg BID for 13 days
Arm Title
Favipiravir, higher dose (pilot stage)
Arm Type
Experimental
Arm Description
1800mg BID on the 1st day followed by 800mg BID for 13 days
Arm Title
Standard of care (pilot stage)
Arm Type
Active Comparator
Arm Description
Based on approved clinical recommendations for treatment of COVID-19 in the Russian Federation (but not Favipiravir). Might include hydroxychloroquine, chloroquine, lopinavir/ritonavir or other recommended schemes.
Arm Title
Favipiravir, selected dose (pivotal stage)
Arm Type
Experimental
Arm Description
The dose will be selected based on pilot study results.
Arm Title
Standard of care (pivotal stage)
Arm Type
Active Comparator
Arm Description
Based on approved clinical recommendations for treatment of COVID-19 in the Russian Federation (but not Favipiravir). Might include hydroxychloroquine, chloroquine, lopinavir/ritonavir or other recommended schemes.
Intervention Type
Drug
Intervention Name(s)
Favipiravir
Other Intervention Name(s)
Avifavir
Intervention Description
200 mg coated tablets
Intervention Type
Drug
Intervention Name(s)
Standard of Care
Other Intervention Name(s)
Hydroxychloroquine, chloroquine, lopinavir/ritonavir, etc.
Intervention Description
Standard of Care will be prescribed in accordance with the recommended treatment regimens presented in the Russian guidelines for the prevention, diagnosis and treatment of COVID-19 according to the decision of the Investigator.
Primary Outcome Measure Information:
Title
Rate of viral elimination by Day 10 [pilot stage, dose selection]
Description
Percent of patients with undetectable SARS-CoV-2 RNA level on Day 10
Time Frame
10 Days
Title
Time to viral elimination [pivotal stage]
Description
Median time to reach undetectable SARS-CoV-2 RNA level
Time Frame
28 Days
Title
Time to clinical improvement [pivotal stage]
Description
Median time reach clinical improvement (2 points of the Ordinal Scale for Clinical Improvement) or discharge from the hospital
Time Frame
28 Days
Secondary Outcome Measure Information:
Title
Rate of viral elimination
Description
Percent of patients with undetectable SARS-CoV-2 RNA level
Time Frame
Days 3, 5, 7, 9, and 11
Title
Time to normalization of clinical symptoms
Description
Median time [days] to reach normal levels of clinical indicators (body temperature, SpO2, breathing rate)
Time Frame
28 Days
Title
Duration of oxygen therapy
Description
Mean duration of oxygen therapy [days]
Time Frame
28 Days
Title
Change in the level of lung damage according to CT
Description
Change of lung damage level according to CT comparing to baseline [% of patients]
Time Frame
Days 15, 22, and 29
Title
Rate of transfer to the intensive care unit
Description
Percent of patients transferred to the intensive care unit [% of patients]
Time Frame
28 days
Title
Rate of the use of non-invasive lung ventilation
Description
Percent of patients undergoing non-invasive lung ventilation [% of patients]
Time Frame
28 days
Title
Rate of the use of mechanical ventilation
Description
Percent of patients undergoing mechanical ventilation [% of patients]
Time Frame
28 days
Title
Mortality
Description
Percent of patients died within 28-days period [% of patients]
Time Frame
28 days
Title
Peak plasma concentration (Cmax)
Description
Determination of Cmax [ng/ml]
Time Frame
Day 1
Title
Time to peak plasma concentration (Tmax)
Description
Determination of Tmax [h]
Time Frame
Day 1
Title
Area under the plasma concentration versus time curve (AUC0-t)
Description
Determination of AUC0-t [ng*h/ml]
Time Frame
10 days
Title
Trough plasma concentration (Ctrough)
Description
Determination of Ctrough [ng/ml]
Time Frame
10 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Signed Patient Information Sheet and Informed Consent form to participate in the study. Men and women aged 18 years and older. Patients hospitalized with a diagnosis of COVID-19. The diagnosis of COVID-19 was confirmed by positive reverse transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2, performed no earlier than 7 days before hospitalization or at screening. Moderate severity of COVID-19 with pneumonia with at least 1 of the following symptoms: Fever above 38 °C; Cough; Shortness of breath during physical exertion; C reactive protein (CRP) of blood serum > 10 mg/l; SpO2 < 95% The capability of oral drug administration. The patients' consent to use adequate contraception methods during the study (condom with spermicide) and for 3 months following completion. Exclusion Criteria: Severe type of disease, with at least one of the following criteria: Frequency of breath > 35 per minute, which does not decrease after the body temperature drops to normal or subfebrile values; Blood oxygen saturation (SpO2) < 90% at rest; Partial pressure of oxygen in arterial blood (PaO2) < 60 mm Hg; Oxygenation index (RaO2/FiO2) ≤ 200 mm Hg; Partial pressure of CO2 in arterial blood (PaCO2) < 60 mm Hg; Septic shock. Patients treated with lopinavir/ritonavir, ribavirin, arbidol, chloroquine, hydroxychloroquine, mefloquine, favipiravir within 7 days prior to screening. Severe cardiovascular diseases currently or 6 months prior to randomization, including: New York Heart Association (NYHA) Class III or IV chronic heart failure, clinically significant ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation), unstable angina, myocardial infarction, heart and coronary vessel surgery, significant valvular heart disease, uncontrolled arterial hypertension with systolic blood pressure > 180 mm Hg and diastolic blood pressure > 110 mm Hg, pulmonary embolism or deep vein thrombosis. Severe chronic renal impairment (GFR < 30 ml / min) or continuous renal replacement therapy, hemodialysis or peritoneal dialysis. A history of cirrhosis or an increase in alanine aminotransferase (ALT) and / or aspartate aminotransferase (AST) > 5 times × upper limit of normal (ULN). Severe diseases of the central nervous system, including seizures in history or conditions that may lead to their development; stroke or transient ischemic attack within 12 months prior to screening; head injuries or loss of consciousness within 12 months prior to screening; a brain tumor. Significant uncontrolled concomitant disease, e.g. neurological, renal, hepatic, endocrinological or gastrointestinal disorder which according to the Investigator, could prevent the patient from participating in the study Malignancies that require chemotherapy within 6 months prior to screening. Known HIV infection Hypersensitivity to any component of the study drug. Participation in other clinical studies or taking other study drugs within 28 days prior to screening. Pregnant or lactating women or women planning to get pregnant during the clinical study; women of child-bearing potential (including non-sterilized by surgical means and during the post-menopause period less than 2 years) who do not use adequate contraception methods. Inability to read or write, unwillingness to understand and follow procedures of study protocol, as well as any other concomitant medical or serious mental conditions that make the patient unfit to participate in the study, limit the legality of obtaining informed consent or can affect patient's ability to participate in the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Elena Pavlikova, MD,PhD,Prof
Organizational Affiliation
Moscow State University n.a. M.V. Lomonosov
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Nikita Lomakin, MD,PhD
Organizational Affiliation
Central Clinical Hospital with Polyclinic
Official's Role
Principal Investigator
Facility Information:
Facility Name
Republican Clinical Hospital
City
Makhachkala
Country
Russian Federation
Facility Name
"K+31" Clinic
City
Moscow
Country
Russian Federation
Facility Name
"Khaven" Llc
City
Moscow
Country
Russian Federation
Facility Name
Central Clinical Hospital with Polyclinic
City
Moscow
Country
Russian Federation
Facility Name
Central Research Institute of Epidemiology
City
Moscow
Country
Russian Federation
Facility Name
City Clinical Hospital n.a. O.M. Filatov
City
Moscow
Country
Russian Federation
Facility Name
City Clinical Hospital named after S.S. Yudin
City
Moscow
Country
Russian Federation
Facility Name
City Clinical Hospital No. 24
City
Moscow
Country
Russian Federation
Facility Name
City Clinical Hospital No. 51
City
Moscow
Country
Russian Federation
Facility Name
First Moscow State Medical University n.a. I.M. Sechenov
City
Moscow
Country
Russian Federation
Facility Name
Moscow State University n.a. M. V. Lomonosov
City
Moscow
Country
Russian Federation
Facility Name
National Medical and Surgical Center named after N.I. Pirogov
City
Moscow
Country
Russian Federation
Facility Name
City Hospital № 33 of the Leninsky region of Nizhny Novgorod
City
Nizhny Novgorod
Country
Russian Federation
Facility Name
Infectious clinical hospital No.2 of Nizhny Novgorod
City
Nizhny Novgorod
Country
Russian Federation
Facility Name
Ryazan State Medical University named after I.P. Pavlov
City
Ryazan
Country
Russian Federation
Facility Name
Military Medical Academy named after S.M. Kirova
City
Saint Petersburg
Country
Russian Federation
Facility Name
Saratov State Medical University named after V.I. Razumovsky
City
Saratov
Country
Russian Federation
Facility Name
Clinical hospital No.1
City
Smolensk
Country
Russian Federation
Facility Name
Regional Clinic Hospital
City
Tver
Country
Russian Federation
Facility Name
Bashkir State Medical University
City
Ufa
Country
Russian Federation
Facility Name
Yakutsk City Clinical Hospital
City
Yakutsk
Country
Russian Federation
Facility Name
Yaroslavl Regional Clinical Hospital for War Veterans
City
Yaroslavl
Country
Russian Federation

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
32770240
Citation
Ivashchenko AA, Dmitriev KA, Vostokova NV, Azarova VN, Blinow AA, Egorova AN, Gordeev IG, Ilin AP, Karapetian RN, Kravchenko DV, Lomakin NV, Merkulova EA, Papazova NA, Pavlikova EP, Savchuk NP, Simakina EN, Sitdekov TA, Smolyarchuk EA, Tikhomolova EG, Yakubova EV, Ivachtchenko AV. AVIFAVIR for Treatment of Patients With Moderate Coronavirus Disease 2019 (COVID-19): Interim Results of a Phase II/III Multicenter Randomized Clinical Trial. Clin Infect Dis. 2021 Aug 2;73(3):531-534. doi: 10.1093/cid/ciaa1176.
Results Reference
derived

Learn more about this trial

An Adaptive Study of Favipiravir Compared to Standard of Care in Hospitalized Patients With COVID-19

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