Study of Sargramostim in Patients With COVID-19

The purpose of this research is to find out if a drug (sargramostim) also known as Leukine® could help patient recover faster from COVID-19. Sargramostim may help the lungs recover from the effects of COVID-19, and this research study will help to find this out.

This Phase 2 study is designed as a proof of concept study and will randomize 2:1 approximately 120 patients with COVID-19 associated acute hypoxemia: of which 80 patients will receive sargramostim plus standard of care, and 40 patients who will receive standard of care alone. The aim of the study is to determine if inhaled sargramostim, as an adjunct to institutional standard of care, improves clinical outcomes in patients with COVID-19-associated acute hypoxemia. All patients on the sargramostim arm will be treated with 125 mcg inhaled sargramostim twice daily for 5 days, in addition to institutional standard of care. If required, upon progression to an invasive mechanical ventilator, administration of sargramostim may be delivered by intravenous infusion to complete a total of 5 days (including days delivered via inhalation).

GM-CSF is a critical cytokine for healthy pulmonary function and is necessary for the maturation and maintenance of alveolar macrophages. Preclinical studies have shown GM-CSF confers resistance to influenza by enhancing innate immune mechanisms that depend on alveolar macrophages for their health and normal functioning. Clinical studies of sargramostim in patients with severe sepsis and respiratory dysfunction or acute respiratory distress syndrome have shown improvements in oxygenation and lung compliance.

Eligibility Criteria:
Inclusion Criteria:

* Patients aged ≥ 18 years
* Patients (or legally authorized decision maker) must provide informed consent
* Test positive for SARS-CoV-2 virus by PCR
* Admitted to hospital
* Presence of acute hypoxemia defined as (either or both)

  * saturation below 93% on ≥ 2 L/min oxygen supplementation
  * PaO2/FiO2 below 350

Exclusion Criteria:

* Patients requiring invasive (mechanical ventilation) or non-invasive (CPAP, BiPAP for hypoxemia) ventilation or ECMO (Note: oxygen supplementation using high flow oxygen systems or low flow oxygen systems would not exclude patients from this study)
* Intractable metabolic acidosis
* Cardiogenic pulmonary edema
* Hypotension requiring use of vasopressors
* Hyperferritinemia (serum ferritin ≥2,000 mcg/L)
* White blood cell count \> 50,000/mm3
* Participation in another interventional clinical trial for COVID-19 therapy
* Highly immunosuppressive therapy or anti-cancer combination chemotherapy within 24 hours prior to first dose of sargramostim
* Known or suspected intolerance or hypersensitivity to sargramostim, or any component of the product
* Previous experience of severe and unexplained side effects during aerosol delivery of any kind of medical product
* Presence of any preexisting illness that, in the opinion of the Investigator, would place the patient at an unreasonably increased risk through participation in this study
* Pregnant or breastfeeding females
* Severe or uncontrolled pulmonary comorbid conditions, including systemic steroid dependent asthma, systemic steroid dependent COPD, oxygen dependent COPD, lung transplant, known interstitial lung disease, or cystic fibrosis