A Prospective, Phase II Study to Evaluate Safety of 101-PGC-005 ('005) for Moderate to Severe COVID-19 Disease Along With Standard of Care

In December 2019, a novel pneumonia caused by a previously unknown pathogen emerged in Wuhan, China. The pathogen was soon identified as a novel coronavirus (SARS-CoV-2), which is closely related to severe acute respiratory syndrome CoV (SARS-CoV) COVID-19, caused by the SARS-CoV-2 virus, leading to a major global public health threat. Many COVID-19 patients develop acute respiratory distress syndrome (ARDS) leading to death. The recent RECOVERY Trial demonstrated the success of dexamethasone in treating late-stage COVID-19 patients. However, use of dexamethasone increases mortality in the early stage of the disease, and dexamethasone is further limited because the therapeutic dose and duration is insufficient to safely and effectively treat most COVID-19 patients. As the majority of cells have glucocorticoid receptors to which dexamethasone binds, highly toxic doses would be needed to effectively treat COVID-19, which results in increased mortality as well as decreased natural immunity (via T-cell and other immune cell modulation). The investigational product 101-PGC-005 ('005) - a prodrug of dexamethasone that is targeted to only activated macrophages - will address the many safety and efficacy issues that limit dexamethasone. '005 can achieve much higher anti-inflammatory doses and avoid all undesirable immunosuppressive activities caused by standard dexamethasone administration, resulting in an even greater reduction in mortality among hospitalized patients and significantly reducing long term morbidity in patients who survive.

This prospective Phase IIa study will evaluate the safety of '005 for moderate to severe COVID-19 disease along with Standard of Care (SOC) treatment. The Nineteen (19) eligible patients will be enrolled to receive '005 + SOC, 10 additional patients will be enrolled to a control group receiving the SOC together with placebo.

At the first open-label stage, 3+3+3 design will be implemented. Three (3) patients will be enrolled to receive 10mg '005 together with SOC, three (3) patients will receive 20mg'005 together with SOC, and three (3) patients will receive 30mg '005 together with SOC if no safety concerns are identified the second stage will be initiated.

At the second double blind stage neither the participants nor the investigator will know which treatment participants are receiving until the clinical trial is over \[20 patients will be enrolled and randomly allocated in a 1:1 ratio to the treatment (SOC +'005) or placebo group (SOC + placebo)\]. The treatment dose will be chosen based on the first stage safety results.

NOTE: '005 will be administered daily for three (3) consecutive days starting from the day of enrollment.

Standard of Care will be administered as long as required, per Investigator's judgment, institutional practice, or local, national, or international guidelines for COVID-19 management.

A screening period of up to 7 days (Day-7 to Day-1) prior to enrollment will be followed by a study period of 28 days. Patients will be administered '005 daily from Day-1 to Day 3.

Total duration of study participation will not exceed 35 days.

Eligibility Criteria:
Inclusion Criteria:

* Patients willing and able to provide voluntary written informed consent and to follow the protocol specific requirements.
* Male or female patients over 18 years old.
* Patients with positive RT-PCR test for SARS-CoV-2 in nasopharyngeal or oropharyngeal swabs (sample collected within 7 days prior to enrollment) who are admitted or being admitted to the hospital for a primary diagnosis of COVID-19.
* In the case of female patients of child-bearing potential, a negative blood pregnancy test prior to beginning the therapy.
* Patients intended to be hospitalized to receive SOC including dexamethasone treatment for COVID-19.

Exclusion Criteria:

Exclusion Criteria:

* Patients with evidence of other serious infections.
* Malignancy.
* Background disease which, in the opinion of the investigator prevents the patient from participating in the study such as:

  * Presence of serious chronic infectious.
  * A condition resulting in immunodeficiency.
  * Participants with glucose levels upon admission ≥ 250 mg/dL
  * Acute psychosis
* Patients in a critical stage of COVID-19 disease that require mechanical ventilation.
* Pregnant and lactating women.
* Patients that are currently or have participated in other clinical studies with investigational drug, biological agent, or device within 1 month or within 5 half-lives (of the drug/biologic) prior to enrollment (whichever is longer).
* Patient currently receiving chemotherapy or immunosuppressive agents not including dexamethasone within 30 days before the screening.