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The Safety and Efficacy of Pyronaridine-artesunate (Pyramax® or Artecom®)in COVID-19 Patients (PROVIDENCE)

Primary Purpose

Covid19

Status
Unknown status
Phase
Phase 2
Locations
Philippines
Study Type
Interventional
Intervention
Artecom® (pyronaridine-artesunate)
Placebo
Sponsored by
Shin Poong Pharmaceutical Co. Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Covid19 focused on measuring Pyramax, COVID-19, pyronaridine-artesunate, SARS-CoV-2, Artecom

Eligibility Criteria

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

Inclusion Criteria:

  1. Male and female adults age (≥19 years at the time of informed consent)
  2. Body weight (≥ 45 kg at Screening)
  3. Participants must be confirmed as having COVID-19 using real-time reverse transcription polymerase chain reaction (RT-PCR) test and specimens collected from upper airway (nasopharyngeal specimen) within 96 hours prior to randomization.
  4. Females must be non-pregnant and non-lactating, and must use an acceptable, highly effective double contraception from Screening until study completion, including the follow-up period. Males must be surgically sterile (>30 days since vasectomy with no viable sperm), abstinent, or if engaged in sexual relations with a woman of childbearing potential (WOCBP), the participant and his partner must be surgically sterile (e.g., tubal occlusion, hysterectomy, bilateral salpingectomy, bilateral oophorectomy) or using an acceptable, highly effective contraceptive method from Screening until study completion, including the follow-up period.

    • Hormonal contraception (with approved oral contraceptives, long-acting implantable hormones, injectable hormones), intra uterine device, condoms , sterilization (vasectomy, tubal occlusion, etc.)

Exclusion Criteria:

  1. Participants with clinically significant cardiovascular disease (including arrhythmia, corrected QT interval prolongation [QTcF> 470 msec for females, or >450 msec for males, at Screening])
  2. Participants with clinically significant anemia (Hemoglobin <8.0 g/dL)
  3. Participants who have hypersensitivity to main ingredients (pyronaridine tetraphosphate, artesunate) and any excipient in the IP
  4. Participants who have gastrointestinal disease or surgical participant that may affect absorption, distribution, metabolism and excretion of drugs, current active gastritis, gastrointestinal /rectal bleeding, gastric ulcers, pancreatic abnormalities such as pancreatitis, etc. (simple appendectomy or hernia surgery not excluded)
  5. Participants who have received antiviral drugs for the treatment of COVID-19 infection or other indications within 28 days prior to participation in the study or who have not had sufficient wash-out period of the antiviral drugs
  6. Participants with severe renal impairment (estimated glomerular filtration rate ≤30 mL/min/1.73 m2)
  7. Participants with severe hepatic impairment (Alanine aminotransferase or Aspartate aminotransferase ≥5x upper limit of normal) or have symptoms of abdominal pain or vomiting associated with Jaundice or Child-Pugh Stage B or C
  8. Viral infections other than COVID-19 that requires administration of other antiviral agents (for example but not limited to human immunodeficiency virus, hepatitis B virus, hepatitis C virus)
  9. Participants requiring mechanical ventilation (e.g. non-invasive ventilation, invasive mechanical ventilation, extracorporeal membrane oxygenation etc.). However, those who can be given oral administration are not exdluded.
  10. Participants with chronic underlying diseases (such as uncontrolled diabetes, chronic kidney disease, chronic liver disease, chronic lung disease [including asthma, chronic obstructive pulmonary disease and tuberculosis], chronic cardiovascular disease, blood cancer, cancer participants with anti-cancer treatment, participants taking immunosuppressants, etc.), participants with high obesity (BMI > 40), dialysis participants, transplant participants whom are inadequate to participate in clinical trials based on the Investigator's discretion.
  11. Pregnant or lactating at Screening or planning to become pregnant (self or partner) at any time during the study, including the follow-up period.
  12. Participants who participated in another clinical trial / medical device clinical trial within 28 days from the date of signing the consent and received drug / operated medical device for clinical trial.
  13. Participants who the Investigator has deemed inappropriate for inclusion in this study for any other reason.
  14. Prior or ongoing medical conditions, medical history, physical findings, or laboratory abnormality that, in the Investigator's (or delegate's) opinion, could adversely affect the safety of the participant.

Sites / Locations

  • De La Salle University Medical CenterRecruiting
  • The Medical City
  • Lung Center of the PhilippinesRecruiting
  • Philippine General HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Artecom® (pyronaridine-artesunate)

Placebo

Arm Description

Artecom® is treated orally once a day for 3 consecutive days.

Placebo is treated orally once a day for 3 consecutive days.

Outcomes

Primary Outcome Measures

Proportion of participants with clinical improvement as defined by an improvement of categories on the WHO Ordinal Scale of clinical status until Days 28.
* WHO Ordinal scale: 0. No clinical or virological evidence of infection No limitation of activities Limitation of activities Hospitalized, no oxygen therapy Oxygen by mask or nasal prongs Non-invasive ventilation or high-flow oxygen Intubation and mechanical ventilation Ventilation + additional organ support - Pressers, Renal replacement therapy (RRT), extracorporeal membrane oxygenation (ECMO) Death

Secondary Outcome Measures

Time to clinical improvement was defined as time from randomization to an improvement of categories on the WHO Ordinal Scale of clinical status.
Clinical improvement within 28 days since start of treatment, defined as a decrease of at least 2 point from baseline of a nine-point WHO ordinal scale.
Changes in the WHO Ordinal Scale for Clinical Improvement until Days 28 compared to Baseline.
Compare statistical results of an increase or decrease in a nine-point WHO ordinal scale between two groups.
Changes in National Early Warning Score (NEWS) until Days 28 compared to Baseline.
NEWS determines the degree of illness of a patient and promotes critical care intervention. The score range from 0-20, with a higher score representing a higher risk of morbidity. Compare statistical results of an increase or decrease in NEWS between two groups.
Proportion of participants with negative for COVID-19 as determined by real-time RT-PCR test until Days 14.
Proportion of subjects who are RT-PCR negative for COVID-19
Changes in viral load until Days 14 compared to Baseline.
Viral load reduction of COVID-19 until Days 14 compared to the baseline.
The time to body temperature normalization after the administration of investigational Product (IP).
Maintaining underarm ≤36.7 °C, or oral ≤36.9°C, or rectal ≤37.3°C, or eardrum ≤37.2°C, for at least 24 hours without administering fever reducing medication after the administration of IP.
The time to respiratory rate normalization after the administration of IP.
Maintain 12/min ≤ respiratory rate ≤ 20/min for at least 24 hours.
The time to oxygen saturation (SpO2) normalization after the administration of IP.
SpO2 ≥95% for at least 24 hours.
Mortality rate at Day 28.
Compare the mortality rate between two groups.
Duration of hospitalization (Day 1 to Day 28).
Number of days the subject from the start of treatment to hospital discharge.
The incidence of adverse events (AEs).
The incidence rate of adverse events
The incidence of serious adverse events (SAEs).
The incidence rate of serious adverse events

Full Information

First Posted
January 6, 2021
Last Updated
September 28, 2021
Sponsor
Shin Poong Pharmaceutical Co. Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT04701606
Brief Title
The Safety and Efficacy of Pyronaridine-artesunate (Pyramax® or Artecom®)in COVID-19 Patients
Acronym
PROVIDENCE
Official Title
A Multi-center, Randomized, Double-blind, Placebo-controlled Phase 2/3 Clinical Trial to Evaluate the Safety and Efficacy of Pyronaridine-artesunate (Artecom®) in COVID-19 Patients
Study Type
Interventional

2. Study Status

Record Verification Date
September 2021
Overall Recruitment Status
Unknown status
Study Start Date
March 29, 2021 (Actual)
Primary Completion Date
April 15, 2022 (Anticipated)
Study Completion Date
April 15, 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Shin Poong Pharmaceutical Co. Ltd.

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
This is a multi-center, randomized, Phase 2/3 study to evaluate the safety and efficacy of pyronaridine-artesunate in participants with corona virus disease 2019 (COVID-19). Pyronaridine-artesunate has been approved in Europe, Asia and Africa under brand name of Pyramax® or Artecom® as a treatment for malaria. The study will be conducted in two stages: open-label (Stage 1) and double-blind (Stage 2). Up to approximately 402 participants (20 participants in Stage 1 and 382 participants in Stage 2) are planned to be enrolled in the study and will be randomized to receive either Artecom® or matching placebo at a ratio of 1:1 in Stage 2. The dose of Artecom® will be determined by the participant's body weight, according to previously established guidelines. An independent Drug Safety Monitoring Board (DSMB) will be established to review the safety at regular intervals during the conduct of the trial. The DSMB will be subject to a Charter and will review after 20 participants have been recruited, and thereafter when 191 participants have been recruited. Ad-hoc DSMB meetings may be held at any time during the study if there are any major safety concerns. A final DSMB will be conducted when all participants have been recruited in the trial.
Detailed Description
<Stage 1> In Stage 1, the trial will be conducted in 20 participants for 28 days in a single arm, open-label design. Artecom® will be administered orally once a day for 3 consecutive days. All subjects will be evaluated for efficacy and safety for 28 days. After the completion of the final participant in Stage 1, the DSMB will review the safety data from Stage 1 and determine whether to proceed to Stage 2. <Stage 2> In Stage 2, a total of 382 participants will be enrolled and randomized in a double blinded manner to receive either Artecom® or placebo (1:1 ratio) orally once a day for 3 consecutive days. All subjects will be evaluated for efficacy and safety for 28 days. A second DSMB meeting and review of all available blinded safety data will occur after 191 participants have completed Day 28. A final DSMB meeting will be held after the completion of a study assessment by the last participant.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Covid19
Keywords
Pyramax, COVID-19, pyronaridine-artesunate, SARS-CoV-2, Artecom

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Parallel Assignment
Model Description
Stage 1: Single Group (Experimental drug only) Stage 2: Parallel (Placebo control and Experimental drug)
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
402 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Artecom® (pyronaridine-artesunate)
Arm Type
Experimental
Arm Description
Artecom® is treated orally once a day for 3 consecutive days.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo is treated orally once a day for 3 consecutive days.
Intervention Type
Drug
Intervention Name(s)
Artecom® (pyronaridine-artesunate)
Other Intervention Name(s)
Pyramax® (pyronaridine-artesunate)
Intervention Description
* Participant body weight (Artecom® dose) ≥ 65kg (Artecom® 4 tablets: Pyronaridine 720mg/ Artesunate 240mg) ≥ 45kg and < 65kg (Artecom® 3 tablets: Pyronaridine 540mg/ Artesunate 180mg)
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
* Participant body weight (Placebo dose) ≥ 65kg (Placebo 4 tablets) ≥ 45kg and < 65kg (Placebo 3 tablets)
Primary Outcome Measure Information:
Title
Proportion of participants with clinical improvement as defined by an improvement of categories on the WHO Ordinal Scale of clinical status until Days 28.
Description
* WHO Ordinal scale: 0. No clinical or virological evidence of infection No limitation of activities Limitation of activities Hospitalized, no oxygen therapy Oxygen by mask or nasal prongs Non-invasive ventilation or high-flow oxygen Intubation and mechanical ventilation Ventilation + additional organ support - Pressers, Renal replacement therapy (RRT), extracorporeal membrane oxygenation (ECMO) Death
Time Frame
follows up to 28 days
Secondary Outcome Measure Information:
Title
Time to clinical improvement was defined as time from randomization to an improvement of categories on the WHO Ordinal Scale of clinical status.
Description
Clinical improvement within 28 days since start of treatment, defined as a decrease of at least 2 point from baseline of a nine-point WHO ordinal scale.
Time Frame
follows up to 28 days
Title
Changes in the WHO Ordinal Scale for Clinical Improvement until Days 28 compared to Baseline.
Description
Compare statistical results of an increase or decrease in a nine-point WHO ordinal scale between two groups.
Time Frame
follows up to 28 days
Title
Changes in National Early Warning Score (NEWS) until Days 28 compared to Baseline.
Description
NEWS determines the degree of illness of a patient and promotes critical care intervention. The score range from 0-20, with a higher score representing a higher risk of morbidity. Compare statistical results of an increase or decrease in NEWS between two groups.
Time Frame
follows up to 28 days
Title
Proportion of participants with negative for COVID-19 as determined by real-time RT-PCR test until Days 14.
Description
Proportion of subjects who are RT-PCR negative for COVID-19
Time Frame
follows up to 14 days
Title
Changes in viral load until Days 14 compared to Baseline.
Description
Viral load reduction of COVID-19 until Days 14 compared to the baseline.
Time Frame
follows up to 14 days
Title
The time to body temperature normalization after the administration of investigational Product (IP).
Description
Maintaining underarm ≤36.7 °C, or oral ≤36.9°C, or rectal ≤37.3°C, or eardrum ≤37.2°C, for at least 24 hours without administering fever reducing medication after the administration of IP.
Time Frame
follows up to 28 days
Title
The time to respiratory rate normalization after the administration of IP.
Description
Maintain 12/min ≤ respiratory rate ≤ 20/min for at least 24 hours.
Time Frame
follows up to 28 days
Title
The time to oxygen saturation (SpO2) normalization after the administration of IP.
Description
SpO2 ≥95% for at least 24 hours.
Time Frame
follows up to 28 days
Title
Mortality rate at Day 28.
Description
Compare the mortality rate between two groups.
Time Frame
Day 28
Title
Duration of hospitalization (Day 1 to Day 28).
Description
Number of days the subject from the start of treatment to hospital discharge.
Time Frame
follows up to 28 days
Title
The incidence of adverse events (AEs).
Description
The incidence rate of adverse events
Time Frame
follows up to 28 days
Title
The incidence of serious adverse events (SAEs).
Description
The incidence rate of serious adverse events
Time Frame
follows up to 28 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
19 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male and female adults age (≥19 years at the time of informed consent) Body weight (≥ 45 kg at Screening) Participants must be confirmed as having COVID-19 using real-time reverse transcription polymerase chain reaction (RT-PCR) test and specimens collected from upper airway (nasopharyngeal specimen) within 96 hours prior to randomization. Females must be non-pregnant and non-lactating, and must use an acceptable, highly effective double contraception from Screening until study completion, including the follow-up period. Males must be surgically sterile (>30 days since vasectomy with no viable sperm), abstinent, or if engaged in sexual relations with a woman of childbearing potential (WOCBP), the participant and his partner must be surgically sterile (e.g., tubal occlusion, hysterectomy, bilateral salpingectomy, bilateral oophorectomy) or using an acceptable, highly effective contraceptive method from Screening until study completion, including the follow-up period. Hormonal contraception (with approved oral contraceptives, long-acting implantable hormones, injectable hormones), intra uterine device, condoms , sterilization (vasectomy, tubal occlusion, etc.) Exclusion Criteria: Participants with clinically significant cardiovascular disease (including arrhythmia, corrected QT interval prolongation [QTcF> 470 msec for females, or >450 msec for males, at Screening]) Participants with clinically significant anemia (Hemoglobin <8.0 g/dL) Participants who have hypersensitivity to main ingredients (pyronaridine tetraphosphate, artesunate) and any excipient in the IP Participants who have gastrointestinal disease or surgical participant that may affect absorption, distribution, metabolism and excretion of drugs, current active gastritis, gastrointestinal /rectal bleeding, gastric ulcers, pancreatic abnormalities such as pancreatitis, etc. (simple appendectomy or hernia surgery not excluded) Participants who have received antiviral drugs for the treatment of COVID-19 infection or other indications within 28 days prior to participation in the study or who have not had sufficient wash-out period of the antiviral drugs Participants with severe renal impairment (estimated glomerular filtration rate ≤30 mL/min/1.73 m2) Participants with severe hepatic impairment (Alanine aminotransferase or Aspartate aminotransferase ≥5x upper limit of normal) or have symptoms of abdominal pain or vomiting associated with Jaundice or Child-Pugh Stage B or C Viral infections other than COVID-19 that requires administration of other antiviral agents (for example but not limited to human immunodeficiency virus, hepatitis B virus, hepatitis C virus) Participants requiring mechanical ventilation (e.g. non-invasive ventilation, invasive mechanical ventilation, extracorporeal membrane oxygenation etc.). However, those who can be given oral administration are not exdluded. Participants with chronic underlying diseases (such as uncontrolled diabetes, chronic kidney disease, chronic liver disease, chronic lung disease [including asthma, chronic obstructive pulmonary disease and tuberculosis], chronic cardiovascular disease, blood cancer, cancer participants with anti-cancer treatment, participants taking immunosuppressants, etc.), participants with high obesity (BMI > 40), dialysis participants, transplant participants whom are inadequate to participate in clinical trials based on the Investigator's discretion. Pregnant or lactating at Screening or planning to become pregnant (self or partner) at any time during the study, including the follow-up period. Participants who participated in another clinical trial / medical device clinical trial within 28 days from the date of signing the consent and received drug / operated medical device for clinical trial. Participants who the Investigator has deemed inappropriate for inclusion in this study for any other reason. Prior or ongoing medical conditions, medical history, physical findings, or laboratory abnormality that, in the Investigator's (or delegate's) opinion, could adversely affect the safety of the participant.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Belen L Dofitas, MD, PhD
Phone
+63-917-629-4329
Email
belendofitas@gmail.com
First Name & Middle Initial & Last Name or Official Title & Degree
Byung Su Kim, MS
Phone
+82-31-348-9354
Email
135kbs@shinpoong.co.kr
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Belen L Dofitas, MD, PhD
Organizational Affiliation
Philippine General Hospital, University of the Philippines
Official's Role
Principal Investigator
Facility Information:
Facility Name
De La Salle University Medical Center
City
Dasmariñas
State/Province
Gov, D. Mangubat St, 4114 Cavite
Country
Philippines
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Oscar Ferdinand D Feliciano, MD. PhD
First Name & Middle Initial & Last Name & Degree
Oscar Ferdinand D Feliciano, MD. PhD
Facility Name
The Medical City
City
Pasig City
State/Province
Ortigas Avenue, Barangay Ugong, Metro Manila
Country
Philippines
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Manuel Hector U Silos, MD. PhD
First Name & Middle Initial & Last Name & Degree
Manuel Hector U Silos, MD. PhD
Facility Name
Lung Center of the Philippines
City
Quezon City
State/Province
Quezon Avenue, Quezon City, 1100 Philippines
Country
Philippines
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lawrence O Raymond, MD, PhD
First Name & Middle Initial & Last Name & Degree
Lawrence O Raymond, MD, PhD
Facility Name
Philippine General Hospital
City
Manila
State/Province
Taft Ave, Ermita, Manila, 1000 Metro
Country
Philippines
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Belen L Dofitas, MD, PhD
First Name & Middle Initial & Last Name & Degree
Belen L Dofitas, MD, PhD

12. IPD Sharing Statement

Plan to Share IPD
No

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The Safety and Efficacy of Pyronaridine-artesunate (Pyramax® or Artecom®)in COVID-19 Patients

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