Early High-Titre Convalescent Plasma in Clinically Vulnerable Individuals With Mild COVID-19 (COVIC-19)
COVID-19
About this trial
This is an interventional treatment trial for COVID-19
Eligibility Criteria
Cohort 1: Elderly and high COVID-age population:
Inclusion criteria:
- SARS-CoV-2 RNA detected in a specimen, ≤ 7 days after onset of symptoms
- Symptoms of COVID-19 (so including but not limited to: fever; cough; breathlessness; chest pain; wheeze; sore throat; haemoptysis; runny nose; fatigue; muscle or joint pain; confusion; headache; seizures; nausea; vomiting; diarrhoea; abdominal pain; poor appetite; skin ulcers or rash; ear pain; conjunctivitis; anosmia; bleeding; lymphadenopathy. The attending clinician will determine if symptoms are consistent with COVID-19.
- Clinical status not requiring admission to hospital for COVID-19 disease and oxygen support
- Ability to transfuse (per randomisation) within 7 days after onset of symptoms
- Men or women, 70 years or older OR
- under 70 years with significant comorbidities (arterial hypertension, diabetes, obesity, asthma or other chronic pulmonary disease, cardiovascular disease, cerebrovascular disease, chronic kidney disease / dialysis, hemoglobinopathies, liver disease, chronic neurological disease, rheumatoid arthritis, lupus or psoriasis) resulting in a 'COVID-age' of 70 years or more according to the ALAMA risk calculator https://alama.org.uk/covid-19-medical-risk-assessment/
Exclusion Criteria:
- Age < 18 years (France and Germany only)
- Prior or concurrent treatment for COVID-19 (unless listed as authorized)
- History of COVID-19 disease in the last 90 days prior to enrollment
- Prior anti-SARS-CoV-2 immunization
- Contraindication to receiving CCP including previous history of transfusion-related acute lung injury (TRALI) or moderate or severe allergic reaction to blood components
- Known participant objection to receiving plasma products
- Primary or acquired immune deficiency listed below (see cohort 2)
- Refusal to participate expressed by patient or legally authorised representative
- Pregnancy
Cohort 2: High-risk immunocompromised population
Inclusion criteria:
- SARS-CoV-2 RNA detected in a specimen, ≤ 7 days after onset of symptoms
- Symptoms of COVID-19 (so including but not limited to: fever; cough; breathlessness; chest pain; wheeze; sore throat; haemoptysis; runny nose; fatigue; muscle or joint pain; confusion; headache; seizures; nausea; vomiting; diarrhoea; abdominal pain; poor appetite; skin ulcers or rash; ear pain; conjunctivitis; anosmia; bleeding; lymphadenopathy. The attending clinician will determine if symptoms are consistent with COVID-19.
- Clinical status not requiring admission to hospital for COVID-19 disease and oxygen support
- Ability to transfuse (per randomisation) within 7 days after onset of symptoms
Male or female with extremely high risk including:
a. Patients with at least one of the following acquired immune deficiencies
i. Lymphoid malignancies treated within the last 12 months ii. Lymphoid malignancies with persistent hypogammaglobulinaemia (IgG < 5g/L) iii. Myeloid malignancies treated by chemotherapy within the last 12 months iv. Myeloid malignancies treated by anti-BCL-2 drugs within the last 12 months v. Myeloid malignancies associated with prolonged neutropenia (≥ 6 weeks) vi. Solid tumour undergoing treatment with chemotherapy (until 3 months after completion of the last chemotherapy cycle) vii. Allogenic hematopoietic stem cell transplantation within the last 12 months or anytime if on-going treatment for chronic GVHD viii. Organ transplantation ix. Anti-B (CD20/CD19) MoAb and/or mycophenolate mofetil treatment within the last 12 months x. Anti-CD19/CD20 CAR-T cell treatment xi. ATG or alemtuzumab treatment within the last 6 months xii. AIDS
OR b. Patients with primary lymphoid immune deficiencies. i. B cell deficiencies (such as Bruton agammaglobulinemia) ii. T cell deficiencies (such as Wiskott Aldrich disease) iii. Combined deficiencies (such as Common variable immunodeficiency).
OR c. Patients without detectable seroconversion ≥ 3 weeks after complete vaccination schedule with an approved vaccine.
Exclusion Criteria:
- Age < 18 years (France and Germany only)
- Prior or concurrent treatment for COVID-19 (dexamethasone, anti-IL-6/IL6R, remdesivir) except for prophylactic administration of anti-SARS-CoV-2 monoclonal antibodies (pre or post exposure) and authorized specific treatment
- History of COVID-19 disease in the last 90 days prior to enrollment
- Contraindication to receiving CCP including previous history of transfusion-related acute lung injury (TRALI) or moderate or severe allergic reaction to blood components
- Known participant objection to receiving plasma products
- Refusal to participate expressed by patient or legally authorised representative
- Pregnancy
Sites / Locations
- CHU Besançon
- Stauferklinikum Schwäbisch GmündRecruiting
- Klinikum Stuttgart
- Diakonie-Klinikum StuttgartRecruiting
- Uniklinikum Tübingen
- Institut für Klinische Transfusionsmedizin (IKT)Recruiting
- Uniklinikum UlmRecruiting
- Universitätsklinikum Brandenburg
- Universitätsklinikum Frankfurt
- Elblandkliniken RiesaRecruiting
- Charité Medizinische Klinik IVRecruiting
- Klinikum Chemnitz gGmbHRecruiting
- Erasmus Medical CenterRecruiting
- NHS Blood and Transplant
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
Current standard of care
Current standard of care and convalescent plasma
Standard of care therapy may include anti-SARS-CoV-2 specific medication such as, but not limited to: Casirivimab Casirivimab / Imdevimab (REGN-COV2 or Ronapreve) Imdevimab Sotrovimab (Xevudy) Tixagevimab / Cilgavimab (Evusheld) Molnupiravir (MK-4482) Nirmatrevlir / Ritonavir (Paxlovid) Remdesivir Centres should ensure that medications used as standard of care are used similarly for patients in both treatment arms.
Current standard of care and the infusion of two plasma units collected from two different COVID-19 convalescent patients.