IMATINIB IN COVID-19 DISEASE IN AGED PATIENTS.

Study Overview
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Brief Summary
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High-throughput screening studies identified Abl kinase inhibitors (including imatinib) as inhibitors of coronaviruses SARS and MERS. The SARS-CoV-2 coronavirus depend on Abl2 kinase activity to fuse and enter into the cells. Pharmacokinetic studies demonstrated that IC50 of imatinib for ABL1, BCR-ABL1 and ABL2 kinase inhibition is less than 1 microM (around 0.3 microM) below the expected trough plasmatic concentrations of imatinib 400 mg/day (1.7 microM). The EC50 of imatinib for the inhibition of the virus is under investigation but we now have a first estimates with EC50 close to 2.5 microM. This plasmatic concentration is achievable with imatinib 800 mg/d. We hypothesize that clinically achievable imatinib concentration will block the first round of cell to cell virus infection and therefore stop or prevent from SARS-CoV-2 infection in human. Based on our 20 years' experience of prescribing imatinib in patients, we expect that most of the adverse events and pharmacological interactions of imatinib can be anticipated and corrected. The eligible population will be aged (>70y) patients hospitalized for a non-severe COVID-19 disease for less than 7 days. Patients will be randomized 1/1 between standard of care and imatinib 800 mg per day during 14 days. The primary endpoint will be the death rate by 30 days. Secondary endpoint will include progression to severe CIVID-19 disease, safety, outcome at 3 months. We plan to randomize 90 patients in order to show a 10% benefit in term of death rate reduction from 16% to 6%.

Official Title
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A RANDOMIZED NON-COMPARATIVE PHASE 2 PILOT STUDY TESTING THE VALUE OF IMATINIB MESYLATE AS AN EARLY TREATMENT OF COVID-19 DISEASE IN AGED HOSPITALIZED PATIENTS.

Conditions
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SARS Virus

Intervention / Treatment
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* Drug: Experimental drug


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria:. Patient aged > 70y 2. Patient with a documented COVID-19 disease by SARS-CoV-2 RT-PCR (if no test is available, suspected COVID-19 disease on CT SCAN). 3. Initial phase (≤ 7 days) of COVID-19 disease 4. Non severe COVID-19 disease 5. Signed informe consent Exclusion Criteria: Patient in palliative care Severe COVID-19 disease (SpO2 ≤ 94% with O2 ≥ 5 l/min) Contra-indication to imatinib Therapy with Warfarin (Heparin allowed) Stage II to IV congestive heart failure (CHF) as determined by the New York Heart Association (NYHA) Peripheral edema grade > 2 Known HBV, HBC or HIV infection Known hepatic failure Patient under legal protection

Ages Eligible for Study
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Minimum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Expérimental ARM<br>800mg/d IMATINIB during 14days | Drug: Experimental drug<br>* Imatinib 800mg/d during 14days<br>|
| No Intervention: Comparator ARM<br>Standard of care | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To evaluate the benefit of early imatinib therapy to prevent severe COVID-19 disease in hospitalized aged patients. | To evaluate the 30 days mortality rate in aged patients hospitalized with COVID-19 | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To evaluate the feasibility of imatinib therapy. | Drop out rate of imatinib mesylate therapy | Day 14 | 
| To evaluate safety of imatinib therapy | Adverse events related to imatinib mesylate therapy | 3 months | 
| To evaluate the clinical evolution | Clinical (WHO COVID scale) and geriatric scores (GIR, ADL and IADL) modification | 3 months | 
| To evaluate the progression rate to severe COVID-19 disease | Clinical (WHO COVID scale) and geriatric scores (GIR, ADL and IADL) modification | 3 months | 
| To evaluate mortality | number of death | 14 days | 
| To evaluate mortality | number of death | 60 days | 
| To evaluate mortality | number of death | 90 days | 
| To evaluate viral load | Viral load by SARS-CoV-2 PCR | 14 days | 
| To evaluate plasmatic levels of imatinib | Imatinib trough level | 14 days |