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Tofacitinib in Hospitalized Patients With COVID-19 Pneumonia

Primary Purpose

Covid19

Status
Completed
Phase
Phase 3
Locations
Brazil
Study Type
Interventional
Intervention
Tofacitinib 10 mg
Placebo
Sponsored by
Hospital Israelita Albert Einstein
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Covid19

Eligibility Criteria

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

Inclusion Criteria:

  1. Male or female participants older than 18 years
  2. Laboratory-confirmed novel coronavirus (SARS-CoV-2) infection as determined by polymerase chain reaction (PCR) prior to Day 1.
  3. Evidence of pneumonia assessed by radiographic imaging (chest x-ray or chest CT scan).
  4. Hospitalized for less than 72 hours and receiving supportive care for COVID-19

Exclusion Criteria:

  1. Require non-invasive ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) on Day 1 at the time of randomization
  2. History of or known current thrombosis. Only if current thrombosis is suspected by the investigator, imaging testing is recommended (per local guidance) to exclude thrombosis.
  3. Have a personal or first-degree family history of blood clotting disorders.
  4. Participants who are immunocompromised, with known immunodeficiencies, or taking potent immunosuppressive agents (eg, azathioprine, cyclosporine).
  5. Participants with any current malignancy or lymphoproliferative disorders that requires active treatment
  6. Severe hepatic impairment, defined as Child-Pugh class C.
  7. Severe anemia (hemoglobin <8 g/dL).
  8. Absolute lymphocyte count <500 cells/mm;
  9. Absolute neutrophil count <1000 cells/mm.
  10. Known allergy to tofacitinib.
  11. Other medical or psychiatric condition including recent (within the past year) or active suicidal ideation/behavior or laboratory abnormality that may increase the risk associated with study participation or, in the investigator's judgment, make the participant inappropriate for the study.
  12. Suspected or known active systemic bacterial, fungal, or viral infections (with the exception of COVID-19) including but not limited to: active herpes zoster infection; known active tuberculosis or history of inadequately treated tuberculosis; known B hepatitis, C hepatitis, or HIV.
  13. Have received any of these within 4 weeks prior to the first dose of study intervention: any JAK inhibitors, potent immunosuppressants, or any biologic agents including IL-6 inhibitors (eg, tocilizumab) or IL-1 inhibitors (eg, anakinra) within the past 30 days; any potent cytochrome P450 inducer, such as rifampin, within the past 28 days or 5 half-lives, whichever is longer.
  14. Have received estrogen-containing contraception or treatment with herbal supplements within 48 hours prior to the first dose of study intervention.
  15. Have received treatment with corticosteroids equivalent to prednisone or methylprednisolone >20 mg/day for equal or more than 14 consecutive days prior to screening.
  16. Current participation in other trials.

Sites / Locations

  • Centro de Pesquisa Clínica do Coração
  • Hospital Universitário São Francisco de Assis Na Providência de Deu
  • Irmandade do Sr. Bom Jesus dos Passos da Santa Casa de Misericórdia de Bragança Paulista
  • Hospital do Coração do Brasil
  • Instituto de Pesquisa Clínica de Campinas
  • Hospital Regional do Litoral Norte
  • Unimed Fortaleza Sociedade Corporativa Médica LTD
  • Hospital Regional Jorge Rossmann
  • Hospital Bruno Born
  • Hospital São Vicente de Paulo
  • Hospital Israelita Albert Einstein
  • Fundação Faculdade Regional de Medicina de São José do Rio Preto
  • Hospital Regional de Registro
  • Hospital Regional de São José dos Campos
  • Beneficência Portuguesa
  • BP Mirante
  • Instituto do Coração

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Tofacitinib

Placebo

Arm Description

Tofacitinib 10mg twice daily for 14 days or until hospital discharge

Placebo twice daily for 14 days or until hospital discharge

Outcomes

Primary Outcome Measures

Death or respiratory failure until Day 28
1, 2 or 3 on the 8-point National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity. The minimum value is 1 (worst outcome) and the maximum value is 8 (best outcome). Death. Hospitalized, on invasive mechanical ventilation or ECMO. Hospitalized, on non-invasive ventilation or high-flow oxygen devices. Hospitalized, requiring supplemental oxygen. Hospitalized, not requiring supplemental oxygen - requiring ongoing medical care (COVID-19 related or otherwise). Hospitalized, not requiring supplemental oxygen - no longer requires ongoing medical care. Not hospitalized, limitation on activities and/or requiring home oxygen. Not hospitalized, with no limitations on activities.

Secondary Outcome Measures

National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity at Day 14
NIAID ordinal scale of disease severity
Status of alive and not on mechanical ventilation or ECMO at Day 14 and 28 NIAID ordinal scale of disease severity at Day 14
Categories 3 to 8 in the National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity at Day 14 and Day 28
Status of requiring supplemental oxygen at Day 28
Categories 1 to 4 in the National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity
Status of being alive and not hospitalized at Day 14 and 28
Categories 7 and 8 in the National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity
National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity at Day 14 NIAID ordinal scale of disease severity at Day 28
NIAID ordinal scale of disease severity
Number of patients with cure
Number of patients with resolution of fever, cough, and need for ventilatory or oxygen support.
Number of patients at the ICU or on ventilatory support at Day 28
Number of patients at the ICU or on ventilatory support
Number of days free from mechanical ventilation at 28 days
Number of days free from mechanical ventilation
Number of days in hospital
Number of days in hospital
Number of days in ICU
Number of days in ICU
Death or respiratory failure at Day 28
Categories 1 to 3 in the National Institute of Allergy and Infectious Diseases (NIAID)

Full Information

First Posted
July 10, 2020
Last Updated
August 2, 2021
Sponsor
Hospital Israelita Albert Einstein
Collaborators
Pfizer
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1. Study Identification

Unique Protocol Identification Number
NCT04469114
Brief Title
Tofacitinib in Hospitalized Patients With COVID-19 Pneumonia
Official Title
A Multicenter, Randomized, Double-blind, Placebo-controlled, Parallel-design Trial of Tofacitinib in Hospitalized Participants With COVID-19 Pneumonia
Study Type
Interventional

2. Study Status

Record Verification Date
July 2020
Overall Recruitment Status
Completed
Study Start Date
September 16, 2020 (Actual)
Primary Completion Date
January 9, 2021 (Actual)
Study Completion Date
January 9, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Hospital Israelita Albert Einstein
Collaborators
Pfizer

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Tofacitinib suppresses pro-inflammatory signaling that may be important pathogenetically to progression to more severe lung disease and acute respiratory distress syndrome (ARDS) in patients with COVID-19. The purpose of the study is to assess the safety and efficacy of tofacitinib plus standard pharmacologic and supportive measures in treating hospitalized participants with COVID-19 pneumonia.
Detailed Description
COVID-19 is a viral disease caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that can cause severe pneumonia and ARDS. Respiratory viral load may peak within 5 days after onset, while symptoms are still mild. Many patients rapidly (within 1 to 2 weeks of infection) develop dyspnea and pneumonia and require hospitalization for respiratory support. Preliminary clinical data from COVID-19 patients indicate that severe symptoms with SARS-CoV-2 infection are associated with an exaggerated immune response driven by interleukin (IL)-6 IL-10, tumor necrosis factor (TNF)α, and other cytokines. The ultimate result is progressive destruction of the alveolar epithelium leading to pneumonia and/or ARDS. Moreover, the exudative phase of ARDS is thought to be due to an influx of myeloid cells (neutrophils and macrophages) and elevations of inflammatory cytokines, with higher levels of both IL-6 and IL-8 levels being correlated with increased mortality. Therefore, immunomodulatory therapy may be beneficial in reducing the deleterious effects of lung inflammation and mitigating progressive lung injury. Tofacitinib is an inhibitor of Janus kinase (JAKs) 1 and 3, with partial selectivity to JAK 2. Tofacitinib suppresses pro-inflammatory signaling that may be important pathogenetically to progression to more severe lung disease and ARDS in patients with COVID-19. The purpose of the study is to assess the safety and efficacy of tofacitinib plus standard pharmacologic and supportive measures in treating hospitalized participants with COVID-19 pneumonia. Participants with laboratory confirmed SARS-CoV-2 infection as determined by a positive PCR, who have agreed to participate, will be screened within 72h hours after admission to the hospital to determine eligibility. Eligible participants will be randomized on Day 1 to the tofacitinib plus standard of care treatment group or the placebo plus standard of care treatment group in a 1:1 ratio, stratified by site. Participants will receive treatment for up to 14 days or until discharge from the hospital, whichever is earlier. Participants will be assessed daily (up to Day 28) while hospitalized for clinical, safety, and laboratory parameters. Follow-up visits will occur on Day 14 and on Day 28.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Covid19

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
289 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Tofacitinib
Arm Type
Experimental
Arm Description
Tofacitinib 10mg twice daily for 14 days or until hospital discharge
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo twice daily for 14 days or until hospital discharge
Intervention Type
Drug
Intervention Name(s)
Tofacitinib 10 mg
Intervention Description
Tofacitinib 10mg administered orally twice daily for 14 days or until hospital discharge
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Tofacitinib-matching placebo administered orally twice daily for 14 days or until hospital discharge
Primary Outcome Measure Information:
Title
Death or respiratory failure until Day 28
Description
1, 2 or 3 on the 8-point National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity. The minimum value is 1 (worst outcome) and the maximum value is 8 (best outcome). Death. Hospitalized, on invasive mechanical ventilation or ECMO. Hospitalized, on non-invasive ventilation or high-flow oxygen devices. Hospitalized, requiring supplemental oxygen. Hospitalized, not requiring supplemental oxygen - requiring ongoing medical care (COVID-19 related or otherwise). Hospitalized, not requiring supplemental oxygen - no longer requires ongoing medical care. Not hospitalized, limitation on activities and/or requiring home oxygen. Not hospitalized, with no limitations on activities.
Time Frame
28 days
Secondary Outcome Measure Information:
Title
National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity at Day 14
Description
NIAID ordinal scale of disease severity
Time Frame
14 days
Title
Status of alive and not on mechanical ventilation or ECMO at Day 14 and 28 NIAID ordinal scale of disease severity at Day 14
Description
Categories 3 to 8 in the National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity at Day 14 and Day 28
Time Frame
14 and 28 days
Title
Status of requiring supplemental oxygen at Day 28
Description
Categories 1 to 4 in the National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity
Time Frame
28 days
Title
Status of being alive and not hospitalized at Day 14 and 28
Description
Categories 7 and 8 in the National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity
Time Frame
14 and 28 days
Title
National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity at Day 14 NIAID ordinal scale of disease severity at Day 28
Description
NIAID ordinal scale of disease severity
Time Frame
28 days
Title
Number of patients with cure
Description
Number of patients with resolution of fever, cough, and need for ventilatory or oxygen support.
Time Frame
28 days
Title
Number of patients at the ICU or on ventilatory support at Day 28
Description
Number of patients at the ICU or on ventilatory support
Time Frame
28 days
Title
Number of days free from mechanical ventilation at 28 days
Description
Number of days free from mechanical ventilation
Time Frame
28 days
Title
Number of days in hospital
Description
Number of days in hospital
Time Frame
28 days
Title
Number of days in ICU
Description
Number of days in ICU
Time Frame
28 days
Title
Death or respiratory failure at Day 28
Description
Categories 1 to 3 in the National Institute of Allergy and Infectious Diseases (NIAID)
Time Frame
28 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female participants older than 18 years Laboratory-confirmed novel coronavirus (SARS-CoV-2) infection as determined by polymerase chain reaction (PCR) prior to Day 1. Evidence of pneumonia assessed by radiographic imaging (chest x-ray or chest CT scan). Hospitalized for less than 72 hours and receiving supportive care for COVID-19 Exclusion Criteria: Require non-invasive ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) on Day 1 at the time of randomization History of or known current thrombosis. Only if current thrombosis is suspected by the investigator, imaging testing is recommended (per local guidance) to exclude thrombosis. Have a personal or first-degree family history of blood clotting disorders. Participants who are immunocompromised, with known immunodeficiencies, or taking potent immunosuppressive agents (eg, azathioprine, cyclosporine). Participants with any current malignancy or lymphoproliferative disorders that requires active treatment Severe hepatic impairment, defined as Child-Pugh class C. Severe anemia (hemoglobin <8 g/dL). Absolute lymphocyte count <500 cells/mm; Absolute neutrophil count <1000 cells/mm. Known allergy to tofacitinib. Other medical or psychiatric condition including recent (within the past year) or active suicidal ideation/behavior or laboratory abnormality that may increase the risk associated with study participation or, in the investigator's judgment, make the participant inappropriate for the study. Suspected or known active systemic bacterial, fungal, or viral infections (with the exception of COVID-19) including but not limited to: active herpes zoster infection; known active tuberculosis or history of inadequately treated tuberculosis; known B hepatitis, C hepatitis, or HIV. Have received any of these within 4 weeks prior to the first dose of study intervention: any JAK inhibitors, potent immunosuppressants, or any biologic agents including IL-6 inhibitors (eg, tocilizumab) or IL-1 inhibitors (eg, anakinra) within the past 30 days; any potent cytochrome P450 inducer, such as rifampin, within the past 28 days or 5 half-lives, whichever is longer. Have received estrogen-containing contraception or treatment with herbal supplements within 48 hours prior to the first dose of study intervention. Have received treatment with corticosteroids equivalent to prednisone or methylprednisolone >20 mg/day for equal or more than 14 consecutive days prior to screening. Current participation in other trials.
Facility Information:
Facility Name
Centro de Pesquisa Clínica do Coração
City
Aracaju
Country
Brazil
Facility Name
Hospital Universitário São Francisco de Assis Na Providência de Deu
City
Bragança Paulista
Country
Brazil
Facility Name
Irmandade do Sr. Bom Jesus dos Passos da Santa Casa de Misericórdia de Bragança Paulista
City
Bragança Paulista
Country
Brazil
Facility Name
Hospital do Coração do Brasil
City
Brasilia
Country
Brazil
Facility Name
Instituto de Pesquisa Clínica de Campinas
City
Campinas
Country
Brazil
Facility Name
Hospital Regional do Litoral Norte
City
Caraguatatuba
Country
Brazil
Facility Name
Unimed Fortaleza Sociedade Corporativa Médica LTD
City
Fortaleza
Country
Brazil
Facility Name
Hospital Regional Jorge Rossmann
City
Itanhaem
Country
Brazil
Facility Name
Hospital Bruno Born
City
Lajeado
Country
Brazil
Facility Name
Hospital São Vicente de Paulo
City
Passo Fundo
Country
Brazil
Facility Name
Hospital Israelita Albert Einstein
City
Sao Paulo
Country
Brazil
Facility Name
Fundação Faculdade Regional de Medicina de São José do Rio Preto
City
São José Do Rio Preto
Country
Brazil
Facility Name
Hospital Regional de Registro
City
São José Dos Campos
Country
Brazil
Facility Name
Hospital Regional de São José dos Campos
City
São José Dos Campos
Country
Brazil
Facility Name
Beneficência Portuguesa
City
São Paulo
Country
Brazil
Facility Name
BP Mirante
City
São Paulo
Country
Brazil
Facility Name
Instituto do Coração
City
São Paulo
Country
Brazil

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
35695334
Citation
Kramer A, Prinz C, Fichtner F, Fischer AL, Thieme V, Grundeis F, Spagl M, Seeber C, Piechotta V, Metzendorf MI, Golinski M, Moerer O, Stephani C, Mikolajewska A, Kluge S, Stegemann M, Laudi S, Skoetz N. Janus kinase inhibitors for the treatment of COVID-19. Cochrane Database Syst Rev. 2022 Jun 13;6(6):CD015209. doi: 10.1002/14651858.CD015209.
Results Reference
derived
PubMed Identifier
34133856
Citation
Guimaraes PO, Quirk D, Furtado RH, Maia LN, Saraiva JF, Antunes MO, Kalil Filho R, Junior VM, Soeiro AM, Tognon AP, Veiga VC, Martins PA, Moia DDF, Sampaio BS, Assis SRL, Soares RVP, Piano LPA, Castilho K, Momesso RGRAP, Monfardini F, Guimaraes HP, Ponce de Leon D, Dulcine M, Pinheiro MRT, Gunay LM, Deuring JJ, Rizzo LV, Koncz T, Berwanger O; STOP-COVID Trial Investigators. Tofacitinib in Patients Hospitalized with Covid-19 Pneumonia. N Engl J Med. 2021 Jul 29;385(5):406-415. doi: 10.1056/NEJMoa2101643. Epub 2021 Jun 16.
Results Reference
derived

Learn more about this trial

Tofacitinib in Hospitalized Patients With COVID-19 Pneumonia

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