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Ruxolitinib in Covid-19 Patients With Defined Hyperinflammation (RuxCoFlam)

Primary Purpose

Covid-19

Status
Completed
Phase
Phase 2
Locations
Germany
Study Type
Interventional
Intervention
Ruxolitinib
Sponsored by
University of Jena
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Covid-19

Eligibility Criteria

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

Inclusion Criteria:

  • 1. Patient or guardian must provide written informed consent (and assent if applicable) before any study assessment is performed.
  • 2. Male and female patients aged ≥ 18 years.
  • 3. Patients with temperature > 37.3°C
  • 4. Patients with respiratory symptoms and/or hypoxia SpO2 < 93%
  • 5. Patients with Covid-19 stage II and stage III
  • 6. Patients with lung imaging showing bi-pulmonary infiltrates (chest X-ray or CT scan).
  • 7. Patients, with a Covid Inflammation Score ≥ 10

Exclusion Criteria:

  • 1. History of hypersensitivity to any drugs or metabolites of similar chemical classes as ruxolitinib.
  • 2. Uncontrolled active bacterial, fungal, viral, or other infection (besides COVID-19).
  • 3. Active Tuberculosis infection.
  • 4. Known Positivity for HBV, HCV or HIV.
  • 5. Patients who are on long-term use of oral anti-rejection or immunomodulatory drugs
  • 6. Participating in any other interventional clinical trial for COVID-19.
  • 7. Treatment with cytokine-directed agents such as anti-IL6 or anti-IL1R directed antibodies (i.e. tocilizumab, anakinra). Other treatment modalities used in locally adapted SOPs (corticosteroids, chloroquine, hydroxychloroquine, lopinavir-ritonavir) may be given with daily documentation of dose and schedule.
  • 8. ALT or AST > 5 x ULN detected within 24 hours at screening (according to local laboratory reference ranges).
  • 9. ANC < 500/µL at screening (according to local laboratory reference ranges).
  • 10. Platelet count < 50,000/µL at screening (according to local laboratory reference ranges).
  • 11. Hemoglobin < 6 g/dl (3.73mmol/l)
  • 12. Pregnant or nursing (lactating) women.
  • 13. Female patients of childbearing potential (e.g. are menstruating) and male patients who do not agree to abstinence or, if sexually active, do not agree to the use of highly effective contraception as defined below, throughout the study and for up to 90 days after stopping treatment, OR Female patients of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using highly effective methods of contraception as defined below, throughout the study and for up to 90 days after stopping treatment.

Highly effective contraception methods include:

  • Total abstinence (when this is in line with the preferred and usual lifestyle of the patient). Periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception.
  • Female sterilization (have had surgical bilateral oophorectomy with or without hysterectomy), total hysterectomy or tubal ligation at least six weeks before taking study treatment. In case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment.
  • Male sterilization (at least 6 months prior to screening). The vasectomized male partner should be the sole partner for that patient.
  • Use of oral, injected or implanted hormonal methods of contraception. Placement of an intrauterine device (IUD) or intrauterine system (IUS) or other forms of hormonal contraception that have comparable efficacy (failure rate <1%), for example hormone vaginal ring or transdermal hormone contraception (in case of oral contraception, patients should have been using the same pill on a stable dose for a minimum of 3 months before Screening).

Women are considered post-menopausal and not of child bearing potential if they have had 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile (e.g. age appropriate, history of vasomotor symptoms) or have had surgical bilateral oophorectomy (with or without hysterectomy), total hysterectomy or tubal ligation at least six weeks ago. In the case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment is she considered not of child bearing potential.

Sites / Locations

  • SRH Wald-Klinikum Gera GmbH
  • University Hospital Jena
  • UKSH, Campus Lübeck
  • Klinikum der Landeshauptstadt Stuttgart gKöR
  • Universitätsklinikum Ulm
  • Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Ruxolitinib

Arm Description

2 x 10mg Ruxolitinib with defined response adapted dose escalation up to 2 x 20mg for a duration of 7 days

Outcomes

Primary Outcome Measures

overall response rate in reversal of hyperinflammation
Patients achieving 25% reduction in hyperinflammation score (CIS) compared to baseline at day 7

Secondary Outcome Measures

Full Information

First Posted
April 7, 2020
Last Updated
August 12, 2021
Sponsor
University of Jena
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1. Study Identification

Unique Protocol Identification Number
NCT04338958
Brief Title
Ruxolitinib in Covid-19 Patients With Defined Hyperinflammation
Acronym
RuxCoFlam
Official Title
A Phase-II Clinical Trial for First Line Treatment of Stage II/III Covid-19 Patients to Treat Hyperinflammation
Study Type
Interventional

2. Study Status

Record Verification Date
August 2021
Overall Recruitment Status
Completed
Study Start Date
April 22, 2020 (Actual)
Primary Completion Date
July 15, 2021 (Actual)
Study Completion Date
July 15, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Jena

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
RuxCoFlam is a single arm, non-randomized open phase II trial for front line treatment of Covid-19 patients with defined hyperinflammation.
Detailed Description
RuxCoFlam is a single arm, non-randomized open phase II trial for front line treatment of Covid-19 patients with defined hyperinflammation. Purpose of the study is the reversal of hyperinflammation to improve pulmonary function, reduce respiratory dependency and reduce mortality. Patients with a hyperinflammation Score 10/16 without a clinical diagnosis of sepsis will be treated with 2 x 10mg Ruxolitinib with defined response adapted dose escalation up to 2 x 20mg for a duration of 7 days with clinical and/or radiographic response assessment. Inflammation assessment will be performed every other day (day 3, 5,7) using the CIS. In patients with unaffected CIS alteration < 25% or increasing CIS > 25% dose escalation by 5mg steps (15mg, day3; 20mg day 5) at the investigator´s discretion. Treatment can be extended up to 28 days if clinically indicated and the benefits of treatment outweigh the risks. Primary endpoint of the study is the overall response rate in reversal of hyperinflammation at day 7 compared to baseline. Secondary endpoints are total use of assisted oxygenation dependency (duration (days) of invasive/non-invasive ventilation or duration (days) of high-flow Oxygen support), radiologic response (reversal of pulmonary Covid-signs, Lung-XRay/CT), day 15 clinical status and day 15 and day 29 mortality. Patients aged ≥18 years hospitalized with COVID-19 pneumonia (demonstrated by CXRAY or chest CT), with a study specific Covid Inflammation Score ≥ 10 are eligible. Patients with active tuberculosis or uncontrolled bacterial, fungal, viral, or other infection (besides SARS-CoV-2 virus) will be excluded from the study.

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
Single Group Assignment
Model Description
single arm, non-randomized
Masking
None (Open Label)
Allocation
N/A
Enrollment
193 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Ruxolitinib
Arm Type
Experimental
Arm Description
2 x 10mg Ruxolitinib with defined response adapted dose escalation up to 2 x 20mg for a duration of 7 days
Intervention Type
Drug
Intervention Name(s)
Ruxolitinib
Intervention Description
2 x 10mg Ruxolitinib with defined response adapted dose escalation up to 2 x 20mg for a duration of 7 days with clinical and/or radiographic response assessment
Primary Outcome Measure Information:
Title
overall response rate in reversal of hyperinflammation
Description
Patients achieving 25% reduction in hyperinflammation score (CIS) compared to baseline at day 7
Time Frame
day 7 after start of therapy

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: 1. Patient or guardian must provide written informed consent (and assent if applicable) before any study assessment is performed. 2. Male and female patients aged ≥ 18 years. 3. Patients with temperature > 37.3°C 4. Patients with respiratory symptoms and/or hypoxia SpO2 < 93% 5. Patients with Covid-19 stage II and stage III 6. Patients with lung imaging showing bi-pulmonary infiltrates (chest X-ray or CT scan). 7. Patients, with a Covid Inflammation Score ≥ 10 Exclusion Criteria: 1. History of hypersensitivity to any drugs or metabolites of similar chemical classes as ruxolitinib. 2. Uncontrolled active bacterial, fungal, viral, or other infection (besides COVID-19). 3. Active Tuberculosis infection. 4. Known Positivity for HBV, HCV or HIV. 5. Patients who are on long-term use of oral anti-rejection or immunomodulatory drugs 6. Participating in any other interventional clinical trial for COVID-19. 7. Treatment with cytokine-directed agents such as anti-IL6 or anti-IL1R directed antibodies (i.e. tocilizumab, anakinra). Other treatment modalities used in locally adapted SOPs (corticosteroids, chloroquine, hydroxychloroquine, lopinavir-ritonavir) may be given with daily documentation of dose and schedule. 8. ALT or AST > 5 x ULN detected within 24 hours at screening (according to local laboratory reference ranges). 9. ANC < 500/µL at screening (according to local laboratory reference ranges). 10. Platelet count < 50,000/µL at screening (according to local laboratory reference ranges). 11. Hemoglobin < 6 g/dl (3.73mmol/l) 12. Pregnant or nursing (lactating) women. 13. Female patients of childbearing potential (e.g. are menstruating) and male patients who do not agree to abstinence or, if sexually active, do not agree to the use of highly effective contraception as defined below, throughout the study and for up to 90 days after stopping treatment, OR Female patients of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using highly effective methods of contraception as defined below, throughout the study and for up to 90 days after stopping treatment. Highly effective contraception methods include: Total abstinence (when this is in line with the preferred and usual lifestyle of the patient). Periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception. Female sterilization (have had surgical bilateral oophorectomy with or without hysterectomy), total hysterectomy or tubal ligation at least six weeks before taking study treatment. In case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment. Male sterilization (at least 6 months prior to screening). The vasectomized male partner should be the sole partner for that patient. Use of oral, injected or implanted hormonal methods of contraception. Placement of an intrauterine device (IUD) or intrauterine system (IUS) or other forms of hormonal contraception that have comparable efficacy (failure rate <1%), for example hormone vaginal ring or transdermal hormone contraception (in case of oral contraception, patients should have been using the same pill on a stable dose for a minimum of 3 months before Screening). Women are considered post-menopausal and not of child bearing potential if they have had 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile (e.g. age appropriate, history of vasomotor symptoms) or have had surgical bilateral oophorectomy (with or without hysterectomy), total hysterectomy or tubal ligation at least six weeks ago. In the case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment is she considered not of child bearing potential.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Andreas Hochhaus, Prof. Dr.
Organizational Affiliation
University Hospital Jena
Official's Role
Principal Investigator
Facility Information:
Facility Name
SRH Wald-Klinikum Gera GmbH
City
Gera
ZIP/Postal Code
07548
Country
Germany
Facility Name
University Hospital Jena
City
Jena
ZIP/Postal Code
07747
Country
Germany
Facility Name
UKSH, Campus Lübeck
City
Lübeck
ZIP/Postal Code
23538
Country
Germany
Facility Name
Klinikum der Landeshauptstadt Stuttgart gKöR
City
Stuttgart
ZIP/Postal Code
70174
Country
Germany
Facility Name
Universitätsklinikum Ulm
City
Ulm
ZIP/Postal Code
89081
Country
Germany
Facility Name
Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH
City
Villingen-Schwenningen
ZIP/Postal Code
78052
Country
Germany

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
32518419
Citation
La Rosee F, Bremer HC, Gehrke I, Kehr A, Hochhaus A, Birndt S, Fellhauer M, Henkes M, Kumle B, Russo SG, La Rosee P. The Janus kinase 1/2 inhibitor ruxolitinib in COVID-19 with severe systemic hyperinflammation. Leukemia. 2020 Jul;34(7):1805-1815. doi: 10.1038/s41375-020-0891-0. Epub 2020 Jun 9.
Results Reference
derived

Learn more about this trial

Ruxolitinib in Covid-19 Patients With Defined Hyperinflammation

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