Treatment of SARS-CoV-2 Virus Disease (COVID-19) in Humans With Hemopurifier® Device

Study Overview
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Brief Summary
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This is an Early Feasibility Study (EFS) investigating the use of the Hemopurifier® in the treatment of SARS-CoV-2 Virus Disease (COVID-19).

Detailed Description
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Up to 40 ICU patients with severe or critical illness due to confirmed COVID-19 infection will be enrolled in up to 20 investigational sites. Patients will receive a four to six-hour treatment with the Hemopurifier® extracorporeal therapy daily for up to four days until discontinued because of clinical improvement or deterioration or upon the decision of the Principal Investigator. The patients will be monitored closely with vital signs and for hemodynamic stability. Patients will be followed for adverse events and device deficiencies. Blood work will be obtained.

Official Title
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Treatment of SARS-CoV-2 Virus Disease (COVID-19) in Humans With Hemopurifier® Device

Conditions
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COVID-19

Intervention / Treatment
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* Device: Hemopurifier


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Laboratory diagnosis of COVID-19 infection with any of the following disease characteristics: i. Early acute lung injury (ALI)/early acute respiratory distress syndrome (ARDS) ii. Severe disease, defined as: dyspnea, respiratory frequency ≥ 30/min, blood oxygen saturation ≤ 93%,, partial pressure of arterial oxygen to fraction of inspired oxygen ratio of <300 and/or lung infiltrates >50% within 24 to 48 hours; iii. Life-threatening disease, defined as: respiratory failure, septic shock, and/or multiple organ dysfunction or failure. Admission to the ICU or area of the hospital repurposed to function as an ICU for surge capacity management Subject has maintained a MAP of > or = 65 without an increased dose of vasopressors for at least 2 hours and has clinical evidence of adequate volume status per investigative site criteria Informed consent from the patient or legally authorized representative Age > 18 Exclusion Criteria: Stroke (known or suspected) within the last 3 months. Severe congestive heart failure (NYHA III and IV classes). Biopsy proven cancer not in remission. Acute (an international normalized ratio (INR) of greater than 1.5, and any degree of mental alteration (encephalopathy) in a patient without preexisting cirrhosis and with an illness of less than 26weeks' duration or chronic (Child Pugh C) liver disease. Known pre-existing non-COVID-19 related hypercoagulability or other coagulopathy Terminal illness with a life expectancy of < 28 days or for whom a decision of withdrawal of care is in place or imminently anticipated or patients who have received prior extracorporeal therapy and had persistent, unstable hypotension. Patients with known hypersensitivity to any component of the Hemopurifier. Advance directive indicating to withhold life-sustaining treatment (except Cardiopulmonary Resuscitation). Contraindications to extracorporeal blood purification therapy such as: i. Clinically relevant bleeding disorder, ii. Contraindication to anti-coagulation, iii. Pregnancy, iv. Inability to establish functional vascular access, v. Participation in another competing investigational drug, device or vaccine trial vi. Administration of an angiotensin converting enzyme (ACE) inhibitor in the previous 14 days. vii. Platelet count < 50,000 cells/microliter

Ages Eligible for Study
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Minimum Age: 18 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
Intervention Model: Single Group Assignment
Interventional Model Description: This trial will evaluate the use of the Hemopurifier in patients with SARS-CoV-2 Virus Disease (COVID-19). The Hemopurifier is an extracorporeal device device that combines plasma filtration, size exclusion and affinity binding of mannosylated structures including enveloped viruses and exosomes. The study will evaluate whether the device is safe in COVID-19 patients along with clearing virus and improving outcomes in infected patients. Subjects will receive a four to six hour treatment with the Hemopurifier® extracorporeal therapy daily for up to four days until discontinued because of clinical improvement or deterioration or upon decision of the Principal Investigator.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Hemopurifier®<br>The Hemopurifier® will be placed within the extracorporeal circuit, all connections secured, treatment will utilize a blood pump at a flow rate of up to 200mL/min. The patients will be monitored for adverse events, device deficiencies and the development of hemodynamic instability. The treatment session will be for 4-6 hours once daily for 4 consecutive days. | Device: Hemopurifier<br>* Hemopurifier treatments will be one four to six hour treatment session daily for up to 4 days<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of treatment emergent adverse events | Safety and tolerability | Day 1 (Date of Consent) to Day 28 | 
| Incidence of device related adverse events | Safety and tolerability with adverse event graded at 2 or higher | Day 1 (Date of Consent) to Day 14 | 
| Incidence of serious adverse events | Safety and tolerability | Day 1 (Date of Consent) to Day 28 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Length if Stay in ICU | Length of ICU stay in days | Day 1 (Date of Consent) to Day 28 | 
| In-hospital mortality | Number of deaths during hospitalization | Day 1 (Date of Consent) to Day 28 | 
| Days free of ventilatory dependency | Number of days without ventilatory support | Day 1 (Date of Consent) to Day 28 | 
| Vasopressor-free days | Number of days without vasopressor support | Day 1 (Date of Consent) to Day 28 | 
| Sequential Organ Failure Assessment (SOFA) | SOFA scoring system predicts the clinical outcome of critically ill patients. | Before first daily filter treatment and after the last daily filter treatment (i.e. 4 days or more) | 
| Acute Physiology and Chronic Health Evaluation (APACHE) | Measures the severity of disease for adult patients admitted to an ICU | Before first daily filter treatment and after the last daily filter treatment (i.e. 4 days or more) | 
| SARS CoV-2 RNA levels in plasma and nasopharyngeal samples | Measures viral exposure and levels of circulating virus | Before each filter treatment, every 2 hours during filter treatment and immediately after filter discontinued | 
| Total lymphocyte count | Measurement of lymphocytes as there seems to be a correlation with the disease severity and lymphopenia. | Before first daily filter treatment and after the last daily filter treatment (i.e. at 4 days or more) | 
| C-reactive protein (CRP), IL-1, IL-6, and TNF alpha Tests | Measurement of inflammatory marker levels play a role in systemic vasculitis and cytokine mediated coagulation disorders as the principal actors of multi organ failure in patients with severe COVID-19 complication. | Before first daily filter treatment and after the last daily filter treatment (i.e. at 4 days or more) | 
| D-dimer | Measurement of D-dimer levels as levels are elevated in patients with COVID-19 and correlate with disease severity, are a reliable prognostic marker for in-hospital mortality. | Before first daily filter treatment and after the last daily filter treatment (i.e. at 4 days or more) | 
| Troponin-T | Measurement of Troponin-T as high levels of troponin is found in COVID-19 patients. | Before first daily filter treatment and after the last daily filter treatment (i.e. at 4 days or more) | 
| Evaluation of SARS-CoV-2 RNA levels post-treatment Hemopurifier cartridges | Measures the levels of SARS-CoV-2 RNA captured in the filter | Until study completion, 1 week or for the duration of ICU admission | 
| Evaluation of viral particle load post-treatment Hemopurifier cartridges | Measures the levels of viral particles captured in the filter | Until study completion, 1 week or for the duration of ICU admission | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hemopurifier, SARS-CoV-2, COVID-19, exosomes, plasmapheresis