Clinical trial NCT04380961: A Study to Evaluate the Efficacy and Safety of Sirukumab in Confirmed Severe or Critical Confirmed Coronavirus Disease (COVID)-19
Official title: Phase 2, Randomized, Double-blind, Placebo-controlled Study to Evaluate the Efficacy and Safety of Sirukumab in Confirmed Severe or Critical COVID-19 Disease
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Critical Confirmed Coronavirus Disease (COVID)-19
Lead sponsor: Janssen Pharmaceutica N.V., Belgium
Sponsor class: INDUSTRY
First posted: 2020-05-08
Enrollment: 212
Sex: ALL
Minimum age (years): 18
Maximum age (years): 84
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to evaluate the clinical response of sirukumab (administered as a single intravenous dose) plus standard of care (SOC) compared to placebo plus SOC in COVID-19.

Detailed description: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), is an enveloped, positive-sense, single-stranded ribonucleic acid (RNA) betacoronavirus. Symptoms of COVID-19 infection may appear from 2 to 14 days following exposure, with the spectrum of illnesses ranging from mild symptoms to severe illness or death. The identification of SARS-CoV-2 follows the emergence of 2 other novel betacoronaviruses: SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV). Current management of COVID-19 is supportive, and respiratory failure from acute respiratory distress syndrome (ARDS) is the leading cause of mortality. While an understanding of the epidemiology and clinical spectrum of COVID-19 is still evolving during the ongoing pandemic, the current knowledge of the disease burden highlights the urgent medical need to develop a treatment. Sirukumab (also known as CNTO136) is a human anti-interleukin (IL)-6 immunoglobulin G1 kappa (IgG1k) monoclonal antibody (mAb). Sirukumab binds with high affinity and specificity to human IL-6 and as a result inhibits IL-6-mediated signaling and the biological effects of IL-6. The study will include a Screening Phase (up to 1 Day), a Treatment Phase (Day 1 to Day 28) and a Follow-up Phase (post Day 28, follow-up phone calls on Week 8, Week 12 and Week 16). Safety evaluations will include monitoring of adverse events and serious adverse events, physical examinations, vital sign measurements, electrocardiograms, clinical laboratory tests, pregnancy testing, and checking of vital status. The entire study duration for each participant will be 16 weeks.

Eligibility criteria: Inclusion Criteria:

* Hospitalized
* Has laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as determined by real time-polymerase chain reaction (PCR) at any time before randomization
* Evidence of infiltrates by chest X-ray, chest computed tomography (CT), lung ultrasound, or chest auscultation (rales, crackles)
* Informed consent must be obtained from the participant indicating that he or she understands the purpose of, and procedures required for, the study and is willing to participate in the study
* Critical COVID-19 disease, defined as: Requires supplemental oxygen delivered by nonrebreather mask or high-flow nasal cannula or use of non-invasive or invasive ventilation or requiring treatment in an intensive care unit

  1. AND corresponding to category 4 on the 6-point ordinal recovery scale, that is: requires one of the above modalities to sustain a peripheral capillary oxygen saturation (SpO2) greater than (\>) 93 percent (%) with a fraction of inspired oxygen (FiO2) of 50% or higher. Note, the use of other devices may fit with category 4 if the FiO2 is 50% or higher.
  2. OR, corresponding to category 5 on the 6-point ordinal recovery scale, that is partial pressure of oxygen in arterial per percentage of inspired oxygen (PaO2/FiO2) ratio \< 300 millimeter of mercury (mmHg) while on invasive mechanical ventilation or veno-venous extracorporeal membrane oxygenation (ECMO) for less than 48 hours prior to screening

Exclusion Criteria:

* On invasive mechanical ventilation or on veno-venous ECMO for \>48 hours at time of screening
* Received an investigational intervention (including investigational vaccines) or used an invasive investigational medical device within 30 days before the planned dose of study intervention. Note: the investigator must ensure that the participant is not enrolled in another COVID-19 study with an investigational intervention (apart from the exception specified below) prior to completion of Day 28 of the current study. Exception: participation in a single arm study, a non-blinded controlled study, expanded access, compassionate use program or any other program that is not a blinded study is allowed if it is conducted with one of the following: agents with demonstrated in vitro-effect against SARSCoV- 2, as mentioned in the center of disease control and prevention (CDC) guidelines and convalescent plasma
* Current confirmed or high suspicion for pulmonary embolus, hemodynamic significant pericardial effusion, myocarditis, or Class 3 or 4 congestive heart failure as defined by the New York Heart Association Functional Classification AND/OR Current evidence of active cardiac ischemia
* Has a history of respiratory condition (that is, asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, fibrotic lung disease) that requires home oxygen supplementation, supportive non-invasive ventilation or, is status/post lung volume reduction surgery (LVRS). Exception: Participants with sleep apnea using supportive non-invasive ventilation (continuous positive airway pressure \[CPAP\]) at screening may be included
* On renal replacement therapy (defined as peritoneal dialysis or hemodialysis)
* Screening laboratory test result as follows: absolute neutrophil count (ANC) \<1.0\*10\^3 cells/microliter; Platelet count \<50\*10\^3 cells/microliter; estimated glomerular filtration rate (eGFR) \<=30 milliliter per minute per 1.73 square meter (mL/min/1.73 m\^2); Bilirubin \>2\* upper limit of normal (ULN) unless bilirubin rise is due to Gilbert's syndrome or of non-hepatic origin; alanine aminotransferase/ aspartate aminotransferase (ALT) \>5\*ULN; Prothrombin time (PT)/international normalized ratio (INR) \>1.5\*ULN or activated partial thromboplastin time (aPTT) \>1.5\*ULN related to known coagulopathy or bleeding disorder (the participant can receive anticoagulant therapies for underlying conditions, or as systematic thromboprophylaxis due to COVID-19, or as part of the treatment of complications of COVID-19, but cannot participate in a clinical study with anticoagulants for COVID-19)
* Pregnant or breastfeeding, unless in the opinion of the investigator, the benefit outweighs the risks
* Has active hepatitis B or C infection or has human immunodeficiency virus infection or acquired immune deficiency syndrome (HIV/AIDS) based on medical history and/or concomitant medication
* Known active or latent tuberculosis (TB), history of incompletely treated TB, suspected or known extrapulmonary TB based on medical history and/or concomitant medication
* Evidence of active bacterial (including but not limited to bacterial pneumonia), fungal, viral or opportunistic infection (other than SARS-CoV-2)
* Currently active clinically significant (example, causing hemodynamic instability and/or causing hypoxemia) and uncontrolled arrhythmia

Primary outcomes:
measure: Time to Sustained Improvement of at Least 2 Categories on 6-point Ordinal Clinical Recovery Scale (CRS): Primary Analysis Set
timeFrame: Up to Day 28
Secondary outcomes:
measure: Percentage of Participants With an Improvement of At Least 2 Categories Compared to Baseline on 6-point Ordinal CRS
timeFrame: Day 28
measure: Percentage of Participants With All-cause Mortality Up to 28 Days
timeFrame: Up to 28 days
measure: Time to Sustained Improvement of at Least 2 Categories on 6-point Ordinal CRS: Intent-to-Treat (ITT) Set
timeFrame: Up to Day 28
measure: Percentage of Participants With an Improvement of at Least 2 Categories Compared to Baseline on 6-point Ordinal CRS: ITT Set
timeFrame: Day 28
measure: Percentage of Participants With All-cause Mortality: ITT Set
timeFrame: Day 28
measure: Percentage of Participants With Serious Adverse Events (SAEs) (Treatment Phase)
timeFrame: Up to Day 28
measure: Percentage of Participants With Related Adverse Events (AEs)
timeFrame: Up to Day 28
measure: Percentage of Participants With Severe or Life-threatening, Bacterial, Invasive Fungal, Viral or Opportunistic Infections
timeFrame: Up to Day 28
measure: Percentage of Participants With Grade 3 and 4 Neutropenia and Lymphocytopenia
timeFrame: Up to Day 28
measure: Percentage of Participants With Increased Alanine Transaminase (ALT) Greater Than or Equal to (>=)3*Upper Limit Normal (ULN) Combined With Increased Bilirubin Greater Than (>)2*ULN
timeFrame: Up to Day 28
measure: Time to Sustained Improvement of at Least 1 Category on 6-point Ordinal CRS: Primary Analysis Set
timeFrame: Up to Day 28
measure: Time to Sustained Improvement of at Least 1 Category on 6-point Ordinal CRS: ITT Set
timeFrame: Up to Day 28
measure: Percentage of Participants With an Improvement of at Least 1 Category Compared to Baseline on 6-point Ordinal CRS: Primary Analysis Set
timeFrame: Day 28
measure: Percentage of Participants With an Improvement of at Least 1 Category on 6-point Ordinal CRS: ITT Set
timeFrame: Day 28
measure: Time From Study Intervention Administration to End of Oxygen Supplementation
timeFrame: Up to Day 28
measure: Time From Study Intervention Administration to Hospital Discharge Among the Surviving Participants
timeFrame: Up to Day 28
measure: Total Length of Hospitalization Among the Surviving Participants
timeFrame: Up to Day 28
measure: Number of Ventilation Free Days
timeFrame: Up to Day 28
measure: Percentage of Participants With Clinical Status as Assessed by 6-point Ordinal CRS: Primary Analysis Set
timeFrame: On Day 7, 14, 21, 28
measure: Percentage of Participants With Clinical Status as Assessed by 6-point Ordinal CRS: ITT Set
timeFrame: On Days 7, 14, 21, 28
measure: Total Time on Invasive Mechanical Ventilation
timeFrame: Up to Day 28
measure: Percentage of Participants With a Worse Category Relative to Baseline on the 6-point Ordinal CRS
timeFrame: From Day 5 up to Day 28
measure: Percentage of Participants With Extracorporeal Membrane Oxygenation (ECMO) Over Time
timeFrame: From Day 1 up to Day 28
measure: Total Time on ECMO
timeFrame: Up to Day 28
measure: Percentage of Alive Participants at Day 28, Week 8, and Week 16
timeFrame: On Day 28, Week 8 and Week 16
measure: Percentage of Alive Participants That Required Readmission at Week 8, and Week 16
timeFrame: Week 8 and Week 16
measure: Percentage of Participants With SAEs (Follow-up Phase)
timeFrame: From Week 4 up to Week 16
Other outcomes:
Locations:
city: Long Beach
country: United States
facility: MemorialCare Research Miller Children's and Women's Hospital Long Beach
state: California
city: Newport Beach
country: United States
facility: Hoag Memorial Hospital
state: California
city: Fort Lauderdale
country: United States
facility: Holy Cross Hospital - Michael and Dianne Bienes Comprehensive Cancer Center
state: Florida
city: Chicago
country: United States
facility: Great Lakes Clinical Trials
state: Illinois
city: Maywood
country: United States
facility: Loyola University Medical Center
state: Illinois
city: Peoria
country: United States
facility: University of Illinois College of Medicine at Peoria
state: Illinois
city: New Orleans
country: United States
facility: Louisiana State University Health Sciences Center
state: Louisiana
city: Detroit
country: United States
facility: Henry Ford Hospital
state: Michigan
city: Royal Oak
country: United States
facility: Beaumont Health Systems
state: Michigan
city: Saint Louis
country: United States
facility: Washington University School of Medicine
state: Missouri
city: Butte
country: United States
facility: Mercury Street Medical Group, PLLC
state: Montana
city: Newark
country: United States
facility: Saint Michaels Medical Center - Infectious Disease
state: New Jersey
city: Syracuse
country: United States
facility: SUNY Upstate Medical University
state: New York
city: Greenville
country: United States
facility: East Carolina University
state: North Carolina
city: Dallas
country: United States
facility: Baylor Scott & White Research Institute
state: Texas
city: Fort Worth
country: United States
facility: Baylor All Saints Medical Center at Fort Worth
state: Texas
Study officials:
affiliation: Janssen Pharmaceutica N.V., Belgium
name: Janssen Pharmaceutica N.V., Belgium Clinical Trial
role: STUDY_DIRECTOR
References: