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FLARE: Favipiravir +/- Lopinavir: A RCT of Early Antivirals (FLARE)

Primary Purpose

COVID-19

Status
Completed
Phase
Phase 2
Locations
United Kingdom
Study Type
Interventional
Intervention
Favipiravir
Lopinavir/ Ritonavir
Favipiravir Placebo
Lopinavir/ Ritonavir Placebo
Sponsored by
University College, London
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for COVID-19

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Any adult with the following:

    • Symptoms compatible with COVID-19 disease (Fever >37.8oC on at least one occasion AND either cough and/ or anosmia) within the first 5 days of symptom onset
    • OR ANY symptoms compatible with COVID-19 disease (may include, but are not limited to fever, cough, shortness of breath, malaise, myalgia, headache, coryza) and tested positive for SARS-CoV-2 within the first 7 days of symptom onset
    • OR no symptoms but tested positive for SARS-CoV-2 within the last 48 hours (date/time of test must be within 48 hours of enrolment)
  2. Male or female aged 18 years to 70 years old inclusive at screening
  3. Willing and able to take daily saliva samples
  4. Able to provide full informed consent and willing to comply with trial-related procedures

Exclusion Criteria:

  1. Known hypersensitivity to any of the active ingredients or excipients in favipiravir and matched placebo, and in lopinavir/ritonavir and matched placebo
  2. Chronic liver disease at screening (known cirrhosis of any aetiology, chronic hepatitis (e.g. autoimmune, viral, steatohepatitis), cholangitis or any known elevation of liver aminotransferases with AST or ALT > 3 X ULN)*
  3. Chronic kidney disease (stage 3 or beyond) at screening: eGFR < 60 ml/min/1.73m2*
  4. HIV infection, if untreated, detectable viral load or on protease inhibitor therapy
  5. Any clinical condition which the investigator considers would make the participant unsuitable for the trial
  6. Concomitant medications known to interact with favipiravir and matched placebo, and with lopinavir/ritonavir and matched placebo, and carry risk of toxicity for the participant
  7. Current severe illness requiring hospitalisation
  8. Pregnancy and/ or breastfeeding
  9. Eligible female participants of childbearing potential and male participants with a partner of childbearing potential not willing to use highly effective contraceptive measures during the trial and within the time point specified following last trial treatment dose.
  10. Participants enrolled in any other interventional drug or vaccine trial (co-enrolment in observational studies is acceptable).

    • Considering the importance of early treatment of COVID-19 to impact viral load, the absence of chronic liver/ kidney disease will be confirmed verbally by the participant during pre-screening and Screening/Baseline visit. Safety blood samples will be collected at Screening/Baseline visit (Day 1) and test results will be examined as soon as they become available within 24 hours.

Sites / Locations

  • Royal Free Hospital
  • University College London Hospital (UCLH)

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Placebo Comparator

Arm Label

Favipiravir + Lopinavir/ritonavir (LPV/r)

Favipiravir + Lopinavir/ritonavir (LPV/r) placebo

Favipiravir placebo + Lopinavir/ritonavir (LPV/r)

Favipiravir placebo + Lopinavir/ritonavir (LPV/r) placebo

Arm Description

Oral favipiravir at 1800 mg twice daily on Day 1, followed by 400 mg four (4) times daily from Day 2 to Day 7 PLUS Lopinavir/ritonavir (LPV/r) at 400mg/100 mg twice daily on Day 1, followed by 200mg/50mg four (4) times daily from Day 2 to Day 7

Oral favipiravir at 1800 mg twice daily on Day 1, followed by 400 mg four (4) times daily from Day 2 to Day 7 PLUS Lopinavir/ritonavir (LPV/r) matched placebo at 400mg/100mg twice daily on Day 1, followed by 200mg/50mg four (4) times daily from Day 2 to Day 7.

Oral favipiravir matched placebo at 1800 mg twice daily on Day 1, by 400 mg four (4) times daily from Day 2 to Day 7 PLUS Lopinavir/ritonavir (LPV/r) at 400mg/100mg twice daily on Day 1, followed by 200mg/50mg four (4) times daily from Day 2 to Day 7.

Oral favipiravir matched placebo at 1800 mg twice daily on Day 1, by 400 mg four (4) times daily from Day 2 to Day 7 PLUS Lopinavir/ritonavir (LPV/r) matched placebo at 400mg/100mg twice daily on Day 1, followed by 200mg/50mg four (4) times daily from Day 2 to Day 7.

Outcomes

Primary Outcome Measures

Upper respiratory tract viral load at Day 5
Quantitative polymerase chain reaction (PCR) performed on saliva samples at Day 5 of therapy

Secondary Outcome Measures

Percentage of participants with undetectable upper respiratory tract viral load after 5 days of therapy
Quantitative polymerase chain reaction (PCR) performed on saliva samples at Day 5 of therapy
Proportion of participants with undetectable stool viral load after 7 days of therapy.
Quantitative polymerase chain reaction (PCR) performed on stool samples at Day 7
Rate of decrease in upper respiratory tract viral load during 7 days of therapy
PCR performed on daily saliva samples collected between Day 1 and Day 7 post-randomisation
Duration of fever following commencement of medication
Daily body temperature records between Day 1 and Day 7 post-randomisation
Proportion of participants with hepatotoxicity after 7 days of therapy
Standard diagnostic laboratory assays for liver transaminases, alkaline phosphatase and bilirubin
Proportion of participants with other medication-related toxicity after 7 days of therapy and 14 days post-randomisation
Determination of medication-related adverse events by investigators at Day 7 and Day 14 post-randomisation
Proportion of participants admitted to hospital with COVID-19 related illness
Participant self-report, review of hospital records and discharge summaries within 28 days of randomisation
Proportion of participants admitted to ICU with COVID-19 related illness
Participant self-report, review of hospital records and discharge summaries within 28 days of randomisation
Proportion of participants who have died with COVID-19 related illness
Participant self-report, review of hospital records and discharge summaries within 28 days of randomisation
Pharmacokinetics of favipiravir as measured by Clearance (CL)
Assess pharmacokinetics of favipiravir as measured by Clearance (CL)
Pharmacokinetics of favipiravir as measured by Volume of distribution (V)
Assess pharmacokinetics of favipiravir as measured by Volume of distribution (V)
Pharmacokinetics of favipiravir as measured by Absorption rate constant (Ka)
Assess pharmacokinetics of favipiravir as measured by Absorption rate constant (Ka)
Pharmacokinetics of favipiravir as measured by Maximum concentration (Cmax)
Assess pharmacokinetics of favipiravir as measured by Maximum concentration (Cmax)
Pharmacokinetics of favipiravir as measured by Time to maximum concentration (Tmax)
Assess pharmacokinetics of favipiravir as measured by Time to maximum concentration (Tmax)
Pharmacokinetics of favipiravir as measured by Elimination rate constant (Ke)
Assess pharmacokinetics of favipiravir as measured by Elimination rate constant (Ke)
Pharmacokinetics of favipiravir as measured by Area Under the Curve extrapolated to infinity (AUC (0-inf)
Assess pharmacokinetics of favipiravir as measured by Area Under the Curve extrapolated to infinity (AUC (0-inf)
Pharmacodynamics of favipiravir as measured by Rate of viral load decline (delta)
Assess pharmacodynamics of favipiravir as measured by Rate of viral load decline (delta)
Pharmacodynamics of favipiravir as measured by Maximum increase in viral load under drug treatment (Emax)
Assess pharmacodynamics of favipiravir as measured by Maximum increase in viral load under drug treatment (Emax)
Pharmacodynamics of favipiravir as measured by Concentration to achieve half the maximum possible effect (EC50)
Assess pharmacodynamics of favipiravir as measured by Concentration to achieve half the maximum possible effect (EC50)
Proportion of participants with deleterious or resistance-conferring mutations in SARS-CoV-2 by Day 7 of treatment
Deep sequencing of virus and bioinformatic analysis

Full Information

First Posted
June 16, 2020
Last Updated
December 12, 2022
Sponsor
University College, London
Collaborators
LifeArc
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1. Study Identification

Unique Protocol Identification Number
NCT04499677
Brief Title
FLARE: Favipiravir +/- Lopinavir: A RCT of Early Antivirals
Acronym
FLARE
Official Title
Favipiravir, Lopinavir/Ritonavir or Combination Therapy: a Randomised, Double Blind, 2x2 Factorial Placebo-controlled Trial of Early Antiviral Therapy in COVID-19
Study Type
Interventional

2. Study Status

Record Verification Date
December 2021
Overall Recruitment Status
Completed
Study Start Date
September 24, 2020 (Actual)
Primary Completion Date
December 1, 2021 (Actual)
Study Completion Date
January 17, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University College, London
Collaborators
LifeArc

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 current pandemic of SARS-CoV-2 causing COVID-19 disease is an unprecedented global emergency. COVID-19 appears to be a disease with an early phase where the virus replicates, coinciding with first presentation of symptoms, followed by a later 'inflammatory' phase which results in severe disease in some individuals. It is known from other rapidly progressive infections such as sepsis and influenza that early treatment with antimicrobials is associated with better outcome. Antiviral medications are most likely to be effective when administered soon after infection. There is therefore an urgent need to study subjects who have recently developed symptoms, or have recently been tested positive with or without symptoms, and who can be sampled frequently to understand changes in viral load. This cohort will allow us to collect detailed trajectory data on early disease and understand how pharmacological interventions may affect this. The objective of the FLARE trial is to assess whether early antiviral therapy with either favipiravir + Lopinavir/ritonavir (LPV/r), LPV/r or favipiravir is associated with a decrease in viral load compared with placebo. The hypothesis is that this holds for COVID-19 and that early antiviral treatment may prevent progression to the later phase of the disease.
Detailed Description
FLARE is a phase IIA randomised, double-blind, 2x2 factorial placebo-controlled, interventional trial in which 240 participants, aged 18 years (≥ 18 years) to 70 years old inclusive will be recruited. Participants will be adults who have developed the early symptoms of COVID-19 within the first 5 days, or tested positive for SARS-CoV-2 within the first 7 days of symptom onset, or not presenting symptoms but tested positive within the last 48 hours (date/time of test must be within 48 hours of enrolment). Eligible participants will be randomised 1:1:1:1 to receive one of the following combinations: Favipiravir + Lopinavir/ritonavir (LPV/r) (both active); Favipiravir active + Lopinavir/ritonavir (LPV/r) placebo; Favipiravir placebo + Lopinavir/ritonavir (LPV/r) active; Favipiravir placebo + Lopinavir/ritonavir (LPV/r) placebo; All participants will be enrolled and followed up for 28 days. A saliva sample for virological analysis and safety blood samples will be collected at baseline, as well as a diagnostic nose and throat swab, if the participant hasn't been tested for COVID-19 yet. Following randomisation, participants will take trial medication for 7 days and during this period will take a daily saliva sample and complete a symptoms diary including four daily temperature measurements. Participants will have two follow-up visits at Day 7 and Day 14 where they will be assessed and undergo blood tests for toxicity and pharmacokinetic assessment (on Day 7 only) and provide stool samples. Participants will have a telephone follow up three (3) weeks after their last day of treatment (Day 7) and further information will be collected through a questionnaire.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
COVID-19

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Factorial Assignment
Model Description
Randomised, double-blind, 2x2 factorial placebo-controlled
Masking
ParticipantCare ProviderInvestigator
Masking Description
Double-blind
Allocation
Randomized
Enrollment
240 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Favipiravir + Lopinavir/ritonavir (LPV/r)
Arm Type
Experimental
Arm Description
Oral favipiravir at 1800 mg twice daily on Day 1, followed by 400 mg four (4) times daily from Day 2 to Day 7 PLUS Lopinavir/ritonavir (LPV/r) at 400mg/100 mg twice daily on Day 1, followed by 200mg/50mg four (4) times daily from Day 2 to Day 7
Arm Title
Favipiravir + Lopinavir/ritonavir (LPV/r) placebo
Arm Type
Experimental
Arm Description
Oral favipiravir at 1800 mg twice daily on Day 1, followed by 400 mg four (4) times daily from Day 2 to Day 7 PLUS Lopinavir/ritonavir (LPV/r) matched placebo at 400mg/100mg twice daily on Day 1, followed by 200mg/50mg four (4) times daily from Day 2 to Day 7.
Arm Title
Favipiravir placebo + Lopinavir/ritonavir (LPV/r)
Arm Type
Experimental
Arm Description
Oral favipiravir matched placebo at 1800 mg twice daily on Day 1, by 400 mg four (4) times daily from Day 2 to Day 7 PLUS Lopinavir/ritonavir (LPV/r) at 400mg/100mg twice daily on Day 1, followed by 200mg/50mg four (4) times daily from Day 2 to Day 7.
Arm Title
Favipiravir placebo + Lopinavir/ritonavir (LPV/r) placebo
Arm Type
Placebo Comparator
Arm Description
Oral favipiravir matched placebo at 1800 mg twice daily on Day 1, by 400 mg four (4) times daily from Day 2 to Day 7 PLUS Lopinavir/ritonavir (LPV/r) matched placebo at 400mg/100mg twice daily on Day 1, followed by 200mg/50mg four (4) times daily from Day 2 to Day 7.
Intervention Type
Drug
Intervention Name(s)
Favipiravir
Other Intervention Name(s)
Avigan
Intervention Description
Dosage and method of administration: Day 1: 1800 mg twice daily; Day 2 to Day 7: 400 mg four (4) times daily.
Intervention Type
Drug
Intervention Name(s)
Lopinavir/ Ritonavir
Other Intervention Name(s)
Kaletra
Intervention Description
Dosage and method of administration: Day 1: 400mg/100 mg twice daily; Day 2 to Day 7: 200mg/50mg four (4) times daily
Intervention Type
Other
Intervention Name(s)
Favipiravir Placebo
Intervention Description
Dosage and method of administration: Day 1: 1800 mg twice daily; Day 2 to Day 7: 400 mg four (4) times daily.
Intervention Type
Other
Intervention Name(s)
Lopinavir/ Ritonavir Placebo
Intervention Description
Dosage and method of administration: Day 1: 1800 mg twice daily; Day 2 to Day 7: 400 mg four (4) times daily.
Primary Outcome Measure Information:
Title
Upper respiratory tract viral load at Day 5
Description
Quantitative polymerase chain reaction (PCR) performed on saliva samples at Day 5 of therapy
Time Frame
Day 5 from randomisation
Secondary Outcome Measure Information:
Title
Percentage of participants with undetectable upper respiratory tract viral load after 5 days of therapy
Description
Quantitative polymerase chain reaction (PCR) performed on saliva samples at Day 5 of therapy
Time Frame
5 days from randomisation
Title
Proportion of participants with undetectable stool viral load after 7 days of therapy.
Description
Quantitative polymerase chain reaction (PCR) performed on stool samples at Day 7
Time Frame
7 days from randomisation
Title
Rate of decrease in upper respiratory tract viral load during 7 days of therapy
Description
PCR performed on daily saliva samples collected between Day 1 and Day 7 post-randomisation
Time Frame
7 days
Title
Duration of fever following commencement of medication
Description
Daily body temperature records between Day 1 and Day 7 post-randomisation
Time Frame
7 days
Title
Proportion of participants with hepatotoxicity after 7 days of therapy
Description
Standard diagnostic laboratory assays for liver transaminases, alkaline phosphatase and bilirubin
Time Frame
7 days from randomisation
Title
Proportion of participants with other medication-related toxicity after 7 days of therapy and 14 days post-randomisation
Description
Determination of medication-related adverse events by investigators at Day 7 and Day 14 post-randomisation
Time Frame
Day 7 and Day 14 from randomisation
Title
Proportion of participants admitted to hospital with COVID-19 related illness
Description
Participant self-report, review of hospital records and discharge summaries within 28 days of randomisation
Time Frame
28 days
Title
Proportion of participants admitted to ICU with COVID-19 related illness
Description
Participant self-report, review of hospital records and discharge summaries within 28 days of randomisation
Time Frame
28 days
Title
Proportion of participants who have died with COVID-19 related illness
Description
Participant self-report, review of hospital records and discharge summaries within 28 days of randomisation
Time Frame
28 days
Title
Pharmacokinetics of favipiravir as measured by Clearance (CL)
Description
Assess pharmacokinetics of favipiravir as measured by Clearance (CL)
Time Frame
Day 7 from randomisation
Title
Pharmacokinetics of favipiravir as measured by Volume of distribution (V)
Description
Assess pharmacokinetics of favipiravir as measured by Volume of distribution (V)
Time Frame
Day 7 from randomisation
Title
Pharmacokinetics of favipiravir as measured by Absorption rate constant (Ka)
Description
Assess pharmacokinetics of favipiravir as measured by Absorption rate constant (Ka)
Time Frame
Day 7 from randomisation
Title
Pharmacokinetics of favipiravir as measured by Maximum concentration (Cmax)
Description
Assess pharmacokinetics of favipiravir as measured by Maximum concentration (Cmax)
Time Frame
Day 7 from randomisation
Title
Pharmacokinetics of favipiravir as measured by Time to maximum concentration (Tmax)
Description
Assess pharmacokinetics of favipiravir as measured by Time to maximum concentration (Tmax)
Time Frame
Day 7 from randomisation
Title
Pharmacokinetics of favipiravir as measured by Elimination rate constant (Ke)
Description
Assess pharmacokinetics of favipiravir as measured by Elimination rate constant (Ke)
Time Frame
Day 7 from randomisation
Title
Pharmacokinetics of favipiravir as measured by Area Under the Curve extrapolated to infinity (AUC (0-inf)
Description
Assess pharmacokinetics of favipiravir as measured by Area Under the Curve extrapolated to infinity (AUC (0-inf)
Time Frame
Day 7 from randomisation
Title
Pharmacodynamics of favipiravir as measured by Rate of viral load decline (delta)
Description
Assess pharmacodynamics of favipiravir as measured by Rate of viral load decline (delta)
Time Frame
Day 7 from randomisation
Title
Pharmacodynamics of favipiravir as measured by Maximum increase in viral load under drug treatment (Emax)
Description
Assess pharmacodynamics of favipiravir as measured by Maximum increase in viral load under drug treatment (Emax)
Time Frame
Day 7 from randomisation
Title
Pharmacodynamics of favipiravir as measured by Concentration to achieve half the maximum possible effect (EC50)
Description
Assess pharmacodynamics of favipiravir as measured by Concentration to achieve half the maximum possible effect (EC50)
Time Frame
Day 7 from randomisation
Title
Proportion of participants with deleterious or resistance-conferring mutations in SARS-CoV-2 by Day 7 of treatment
Description
Deep sequencing of virus and bioinformatic analysis
Time Frame
Day 7 from randomisation

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Any adult with the following: Symptoms compatible with COVID-19 disease (Fever >37.8oC on at least one occasion AND either cough and/ or anosmia) within the first 5 days of symptom onset OR ANY symptoms compatible with COVID-19 disease (may include, but are not limited to fever, cough, shortness of breath, malaise, myalgia, headache, coryza) and tested positive for SARS-CoV-2 within the first 7 days of symptom onset OR no symptoms but tested positive for SARS-CoV-2 within the last 48 hours (date/time of test must be within 48 hours of enrolment) Male or female aged 18 years to 70 years old inclusive at screening Willing and able to take daily saliva samples Able to provide full informed consent and willing to comply with trial-related procedures Exclusion Criteria: Known hypersensitivity to any of the active ingredients or excipients in favipiravir and matched placebo, and in lopinavir/ritonavir and matched placebo Chronic liver disease at screening (known cirrhosis of any aetiology, chronic hepatitis (e.g. autoimmune, viral, steatohepatitis), cholangitis or any known elevation of liver aminotransferases with AST or ALT > 3 X ULN)* Chronic kidney disease (stage 3 or beyond) at screening: eGFR < 60 ml/min/1.73m2* HIV infection, if untreated, detectable viral load or on protease inhibitor therapy Any clinical condition which the investigator considers would make the participant unsuitable for the trial Concomitant medications known to interact with favipiravir and matched placebo, and with lopinavir/ritonavir and matched placebo, and carry risk of toxicity for the participant Current severe illness requiring hospitalisation Pregnancy and/ or breastfeeding Eligible female participants of childbearing potential and male participants with a partner of childbearing potential not willing to use highly effective contraceptive measures during the trial and within the time point specified following last trial treatment dose. Participants enrolled in any other interventional drug or vaccine trial (co-enrolment in observational studies is acceptable). Considering the importance of early treatment of COVID-19 to impact viral load, the absence of chronic liver/ kidney disease will be confirmed verbally by the participant during pre-screening and Screening/Baseline visit. Safety blood samples will be collected at Screening/Baseline visit (Day 1) and test results will be examined as soon as they become available within 24 hours.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David Lowe
Organizational Affiliation
Institute of Immunity and Transplantation, University College London
Official's Role
Principal Investigator
Facility Information:
Facility Name
Royal Free Hospital
City
London
ZIP/Postal Code
NW3 2QG
Country
United Kingdom
Facility Name
University College London Hospital (UCLH)
City
London
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
No plan to share IPD has been made at this time.
Citations:
PubMed Identifier
36260627
Citation
Lowe DM, Brown LK, Chowdhury K, Davey S, Yee P, Ikeji F, Ndoutoumou A, Shah D, Lennon A, Rai A, Agyeman AA, Checkley A, Longley N, Dehbi HM, Freemantle N, Breuer J, Standing JF; FLARE Investigators. Favipiravir, lopinavir-ritonavir, or combination therapy (FLARE): A randomised, double-blind, 2 x 2 factorial placebo-controlled trial of early antiviral therapy in COVID-19. PLoS Med. 2022 Oct 19;19(10):e1004120. doi: 10.1371/journal.pmed.1004120. eCollection 2022 Oct.
Results Reference
derived
PubMed Identifier
33685502
Citation
Brown LK, Freemantle N, Breuer J, Dehbi HM, Chowdhury K, Jones G, Ikeji F, Ndoutoumou A, Santhirakumar K, Longley N, Checkley AM, Standing JF, Lowe DM. Early antiviral treatment in outpatients with COVID-19 (FLARE): a structured summary of a study protocol for a randomised controlled trial. Trials. 2021 Mar 8;22(1):193. doi: 10.1186/s13063-021-05139-2.
Results Reference
derived
Links:
URL
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004120
Description
trial results
URL
https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-021-05139-2
Description
Initial trial Protocol

Learn more about this trial

FLARE: Favipiravir +/- Lopinavir: A RCT of Early Antivirals

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