Intervention: Brensocatib
Trial phase: Phase 3
SMILES: Cn1c(=O)oc2ccc(-c3ccc(C[C@@H](C#N)NC(=O)[C@@H]4CNCCCO4)cc3)cc21
Sex: All
Age groups: Child | Adult | Older Adult
Healthy volunteers: No
Participants at risk: 192
Group description: Brensocatib oral tablet, 25mg once per day for 28 days

Brensocatib: Selective, competitive, and reversible inhibitor of DPP1
Eligibility criteria:
Inclusion Criteria:

6.1. Inclusion criteria

• Male or female

≥16 years of age
SARS-CoV-2 infection (clinically suspected+ or laboratory confirmed*).
Admitted to hospital as in-patient less than 96 hours prior to randomisation^

Illness of any duration, and at least one of the following:

Radiographic infiltrates by imaging (e.g. chest x-ray, computed tomography (CT) scan) OR
Evidence of rales/crackles on physical examination OR
Peripheral capillary oxygen saturation (SpO2) ≤94% on room air prior to randomization OR
Requiring supplemental oxygen. OR
Lymphocyte count <1 x 109 cells per litre (L)
Participant (or legally authorized representative) provides written informed consent
Able to take oral medication

Participant (or legally authorised representative) understands and agrees to comply with planned trial procedures.

Laboratory-confirmed: SARS-CoV-2 infection as determined by polymerase chain reaction (PCR), or other commercial or public health assay in any specimen < 96 hours prior to randomization.

Clinically suspected: in general, SARS-CoV-2 infection should be suspected when a patient presents with (i) typical symptoms (e.g. influenza-like illness with fever and muscle pain, or respiratory illness with cough and shortness of breath); and (ii) compatible chest X-ray findings (consolidation or ground-glass shadowing); and (iii) alternative causes have been considered unlikely or excluded (e.g. heart failure, influenza). However, the diagnosis remains a clinical one based on the opinion of the managing doctor

Where a patient has been admitted to hospital for a non COVID-19 reason and develops COVID-19 symptoms whilst an in-patient, randomisation may occur up to 96 hours from onset of symptoms.

Exclusion Criteria:

Alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) > 5 times the upper limit of normal, result within 72 hours of randomization (the result closest to randomization should be used if several results are available).
History of severe liver disease
Stage 4 severe chronic kidney disease or requiring dialysis (i.e. estimated Glomerular Filtration Rate < 30), result within 72 hours of randomization (the result closest to randomization should be used if several results are available)
Absolute neutrophil count less than 1.0 x 109 cells per L within 72 hours of randomization (the result closest to randomization should be used if several results are available)
Current treatments with potent Cyp3A4 inducers/inhibitors (e.g Itraconazole, Ketoconazole, diltiazem, verapamil, phenytoin or rifampicin)
HIV treatments - current treatment with protease/integrase inhibitors or non-nucleoside reverse transcriptase inhibitors*
Pregnant or breast feeding.
Anticipated transfer to another hospital which is not a trial site within 24 hours.
Allergy to Brensocatib
Use of any investigational drug within five times of the elimination half-life after the last trial dose or within 30 days, whichever is longer. Co-enrolment with COVID-19 trials is allowed as per co-enrolment agreements and/or individual decision by the Chief Investigator.

Women of child-bearing potential must be willing to have pregnancy testing prior to trial entry.

*The Liverpool HIV checker (https://www.hiv-druginteractions.org/checker) should be used to check for any HIV drug interactions. Simvastatin could be used as a surrogate for Brensocatib as it metabolised similarly by CYP 3A4 pathway.

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