Clinical trial NCT06960928: Low Dose Sirolimus in People With Post-Acute Sequelae of COVID-19 (PASC) Long COVID-19
Official title: Low Dose Sirolimus in People With Post-Acute Sequelae of COVID-19 (PASC) Long COVID-19
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: PHASE3
Conditions: Long COVID-19
Keywords: Long COVID-19
Post-Acute Sequelae of COVID-19 (PASC)
Sirolimus
Rapamycin
Lead sponsor: Icahn School of Medicine at Mount Sinai
Sponsor class: OTHER
Collaborators: name: PolyBio Research Foundation
name: The Anlyan Center
First posted: 2025-05-07
Enrollment: 80
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The study is conducted in New York, New York at The Cohen Center for Recovery from Complex Chronic Illness at Mount Sinai.

This is an IND-exempt, off-label, multi-ascending, randomized, placebo-controlled clinical trial of sirolimus (also known as rapamycin) in adults with Long COVID. There are 2 arms: Sirolimus and Placebo.

This study aims to evaluate the efficacy of Sirolimus in adults with Long COVID. Efficacy will be evaluated by measuring patient-reported outcomes in response to Sirolimus.


Eligibility criteria: Inclusion Criteria:

* Provision of signed and dated informed consent form
* Any sex, aged 18+
* Must be able to attend all study visits located at 5 East 98th St, New York, NY
* Diagnosed with:

  * Long COVID

    * Documented clinical history of confirmed or suspected acute SARS-CoV-2 infection a minimum of 6 months prior to contact with the study team
    * Formal diagnosis of Long COVID from a physician
    * At least a six-month history of one of the following symptoms following SARSCoV-2 infection:

      * headache, memory loss, insomnia, mood disturbance, chest pain, palpitations, shortness of breath, cough, muscle pains, joint pains, or GI upset
      * AND at least moderate fatigue (measured by Fatigue Severity Score)
      * AND at least moderate post-exertional malaise (PEM) (measured by DePaul PEM screener)
      * Participants who are willing and able to comply with all data collection, treatment plan, laboratory tests, lifestyle considerations, and other study procedures.
      * Baseline EQ-VAS ≤70; EQ-VAS before the index infection ≥80 (this information is collected before randomization as part of the baseline survey)

Exclusion Criteria:

* Pre-existing conditions including, but not limited to:

  * Autoimmune conditions such as Chronic EBV, Multiple Sclerosis, Hashimoto's Disease, etc. which would impact the immunological profiling analysis.
  * A pre-2020 diagnosis of another Post-Acute Infectious Syndrome such as Chronic Lyme disease, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, etc.
  * Documented history of vaccine injury
  * History of lung or liver transplant
  * Known hepatic or renal impairment
  * Weighing less than 40 kg
  * Or any other chronic condition that has the potential to impact on immunological profiling, at the discretion of the research physician
* Current use of sirolimus
* Taking a medication with known interactions to sirolimus:

  * Strong CYP3A4 Inhibitors - clarithromycin, telithromycin, nefazodone, itraconazole, ketoconazole, atazanavir, darunavir, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir, tipranavir, such that dose reduction may be necessary
  * Strong CYP3A4 Inducers - carbamazepine, dexamethasone, ethosuximide, glucocorticoids, griseofulvin, phenytoin, primidone, progesterone, rifabutin, rifampin, nafcillin, nelfinavir, nevirapine, oxcarbazepine, phenobarbital, phenylbutazone, rofecoxib (mild), St John's wort, sulfadimidine, sulfinpyrazone, troglitazone, and grapefruit, such that dose increase may be necessary.
  * Drugs that may increase concentration when given with sirolimus - Verapamil, such that dose reduction may be necessary
  * Other drugs that have the potential to increase sirolimus blood concentrations include (but are not limited to): fluconazole, clotrimazole, troleandomycin, nicardipine, cisapride, and metoclopramide
  * Concomitant use of angiotensin-converting enzyme (ACE) inhibitors may increase the risk of developing angioedema.
* Febrile illness within the last 3 months of planned baseline evaluation
* Treatment with another investigational drug or other investigational intervention within 3 months of planned baseline evaluation
* Prophylactic use of aspirin (325 mg daily) for cardiovascular indications will be permitted in participants. All other medications for chronic medical conditions should be initiated at least two months prior to enrollment.
* Uncontrolled diabetes, unstable ischemic heart disease, clinically significant underlying pulmonary disease, history of an immunodeficiency or receiving immunosuppressive therapy; history of coagulopathy or medication condition requiring long-term anticoagulation; history of hepatic impairment; taking angiotensin-converting enzyme (ACE) inhibitors
* Participants who are planning to be or are pregnant
* Participants who are nursing

Primary outcomes:
measure: European Quality of Life-Visual Analogue Scale (EQ-VAS)
timeFrame: Baseline (Week 0) and Post-treatment (Week 12 and Week 24)
Secondary outcomes:
measure: The EuroQol Five-Dimensional Health Questionnaire (EQ-5D-5L)
timeFrame: Baseline (Week 0) and Post-treatment (Week 12 and Week 24)
measure: Patient-Reported Outcomes Measurement Information System 29 (PROMIS-29)
timeFrame: Baseline (Week 0) and Post-treatment (Week 12 and Week 24)
measure: General Symptom Questionnaire (GSQ-30)
timeFrame: Baseline (Week 0) and Post-treatment (Week 12 and Week 24)
measure: Patient Health Questionnaire (PHQ-9)
timeFrame: Baseline (Week 0) and Post-treatment (Week 12 and Week 24)
measure: Generalized Anxiety Disorder (GAD-7)
timeFrame: Baseline (Week 0) and Post-treatment (Week 12 and Week 24)
measure: Neuro-QoL™ v2.0 Cognitive Function-Short Form
timeFrame: Baseline (Week 0) and Post-treatment (Week 12 and Week 24)
measure: Single-item Sleep Quality Scale (SQS)
timeFrame: Baseline (Week 0) and Post-treatment (Week 12 and Week 24)]
measure: Fatigue Severity Scale
timeFrame: Baseline (Week 0) and Post-treatment (Week 12 and Week 24)
measure: Fatigue Visual Analogue Scale [F-VAS])
timeFrame: Baseline (Week 0) and Post-treatment (Week 12 and Week 24)
measure: DePaul Post-Exertional Malaise Questionnaire (DSQ)
timeFrame: Baseline (Week 0) and Post-treatment (Week 12 and Week 24)
measure: Composite Autonomic Symptom Score 31(COMPASS-31)
timeFrame: Baseline (Week 0) and Post-treatment (Week 12 and Week 24)
measure: Pain (P-VAS)
timeFrame: Baseline (Week 0) and Post-treatment (Week 12 and Week 24)]
measure: University of California-Los Angeles (UCLA) Loneliness Scale (3-item)
timeFrame: Baseline (Week 0) and Post-treatment (Week 12 and Week 24)
measure: Adapted Berkman-Syme Social Network/Connection Index
timeFrame: Baseline (Week 0) and Post-treatment (Week 12 and Week 24)
Other outcomes:
Locations:
city: New York
country: United States
facility: Icahn School of Medicine at Mount Sinai
state: New York
Study officials:
affiliation: Icahn School of Medicine at Mount Sinai
name: David Putrino, PT, PhD
role: PRINCIPAL_INVESTIGATOR
References: