At present there is no approved drug treatment for Covid-19. In this study we plan to investigate if an experimental drug called IMU-838 (vidofludimus calcium) can improve your symptoms, prevent worsening that would initiate further treatments such as ventilation, and can lower your virus number if given in addition to your doctor's choice of standard therapy. We will also test if IMU-838 has any side effects and measure the level of IMU 838 in your blood. Experimental drug means that it is not yet authorized for marketing in your country. To date approximately 600 individuals have received IMU-838 (or a drug similar to IMU-838 that contains the same active substance as IMU-838) in research studies.
The trial consists of a Phase 2 proof-of-concept phase (Part 1) with the option to extend enrollment (without interruption) to Phase 3 (Expansion Phase, Part 2). This trial is a multicenter, double-blind, placebo-controlled, randomized, parallel-group trial to evaluate the safety and efficacy of IMU-838 as addition to investigator's choice of SoC treatment in patients with COVID-19. Eligible patients will be centrally randomized 1:1 to twice-daily (BID) oral 22.5 mg IMU-838 (45 mg/day + SoC) or placebo (+ SoC). Randomization will be stratified by age (\< or \>=65 years) and antiviral therapy (no antivirals, Hydroxychloroquine and Chloroquine, all other antivirals). Adaptive sequential trial design and overall trial design The trial uses an adaptive sequential design. An IDMC will review unblinded data and provide the Sponsor with recommendations regarding modifications of sample size and trial conduct. A 1st interim analysis (IA1) will be performed after approximately 200 patients have completed the trial (either as scheduled or prematurely), while enrollment continues. If no activity of IMU 838 is observed by the IDMC in this IA, further patient enrollment will be stopped, and a final analysis of Part 1 will be performed (FA1). It is expected that the final analysis of Part 1 will include approximately 230 patients. If the IA1 results indicate activity of IMU-838 in COVID-19, the trial may be extended to Part 2 with a revised sample size derived by the IDMC based on IA1 results and with possible other trial adjustments. If the trial is extended into Part 2, a 2nd IA (IA2) is planned after approximately two-thirds of patients (based on the overall global sample size \[Part 1 and Part 2 combined\]) have been enrolled to potentially adjust sample size and other trial features if needed. The final analysis of the trial (FA2) will then be done after all patients have completed Part 2. In addition, an early interim safety analysis will be performed and evaluated by the IDMC after 30 patients have been enrolled to assess unblinded safety data. Further safety analyses can be initiated at any time by the IDMC or Sponsor when new safety signals are identified within this or other trials of IMU-838. Screening Patients can be screened for a maximum of 2 days (from Day -2 to Day 0) and eligible patients will be randomized on Day 0 and treated with IMP + SoC for 14 days. It is encouraged to screen potential participants immediately at the day of hospitalization (including informed consent, assessment of inclusion/exclusion criteria, screening laboratory tests all done locally, assessment of clinical and blood gas criteria) and randomize patients on the same day (Day 0). To assess eligibility criteria, existing local laboratory values obtained within 48 hours of randomization can also be used, except for testing of positive status of SARS-CoV-2 infection where a 4-day window is allowed. IMP administration should start as quickly as possible after randomization and first IMP intended to be given in the evening of the screening day (Day 0). Blinded Treatment period (Day 0 to Day 13) and Day 14 (end-of-treatment) The first dose of IMP (2 tablets) should always be given on Day 0 (allowed range for first dose: 12:00 noon on Day 0 to 02:00 a.m.). All further IMP doses are 1 tablet each in the morning and evening. Information about the status and patient care are continuously obtained and documented once or twice daily. After the last IMP dose in the evening of Day 13, the end-of-treatment assessments will be done on Day 14. Blood sampling for IMU-838 trough values must be performed in the morning around the time the morning dose was usually taken by the respective patient. Patients may then continue to receive SoC without any further restrictions on concomitant medications as during the 14-day BT period . Day 28 Visit (EoS) The patient should return for the final trial visit on Day 28 (EoS). If IMP is prematurely discontinued for any reason, the EoS visit should always be conducted on Day 28 and no earlier EoS should be performed. If patients withdraw from IMP prematurely, they should be encouraged to allow the EoS visit as part of the follow-up. If the patient dies during the trial, the investigator should indicate that this visit was not performed. However, even if no EoS visit was performed, information about patient status should be reported on the EoS page in the case report form. If the patient refuses any EoS visit or the patient is lost to follow-up, it is permissive in this trial that the investigator contacts the patient, the family of the patient or the referring physician by phone or email to obtain status of life information, or is able to search in registers or publicly available information for such status of life information.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
234
Tablets will be taken BID with a glass of water (if possible); one tablet each in the morning (15 to 50 min before a meal if applicable), and in the evening (2 hours after any meal if applicable). If the patient is intubated for ventilation, IMP is to be given via a gastric tube. The tablet has no coating and a homogeneous content and can be crushed into smaller pieces (if necessary) for dosing via gastric tube.
Matching placebo, twice-daily administration BID as described for the test product, identical number of tablets as given for IMU-838
Military Medical Academy, Clinic of Infectious Diseases
Sofia, Bulgaria
UMHATEM N.I.Pirogov, Clinic of internal diseases
Sofia, Bulgaria
University Hospital Frankfurt, Infectious Diseases
Frankfurt, Germany
Clinic of the Hannover Medical School, Pneumology Clinic
Hanover, Germany
Proportion of Patients Without Any Need for INV Until EoS
Number of Participants Stratified as those With and Without the Need for INV Until End-of-study (EoS). For this outcome a worst case approach was used in which patients who were lost to follow-up or who discontinued the trial on or before Day 13 due to any other reason than death and discontinued with a last observed WHO clinical status no lower than that at Screening, and patients who died were considered as patients requiring INV.
Time frame: Throughout the Study (Day 0 to Day 28)
Days in ICU Department
Duration of ICU Treatment Until EoS for Only Patients Who Were Admitted to the ICU During the Trial.
Time frame: Throughout the Study (Day 0 to Day 28 )
All Cause Mortality (ITT Approach)
28-day All-cause Mortality (including lost to follow-up): 'all-cause-mortality' includes all confirmed deaths and patients who discontinued the trial before Day 28 and for whom no outcome (alive or dead) could be determined at EoS; 'actual death' includes only those patients for which a fatal outcome was confirmed by Day 28.
Time frame: Throughout the Study (Day 0 to Day 28 )
Time to Clinical Improvement
Defined as the time from first dose of investigational medicinal product (IMP) to an improvement of at least 2 points on the Modified WHO Ordinal Scale for Clinical Status (Modified WHO Ordinal Scale for Clinical Status), or live discharge from hospital without oxygen supplementation, whichever comes first. The 50% Kaplan-Meier quartile (median) of actual values per treatment arm is provided as outcome of this variable below.
Time frame: Throughout the Study (Day 0 to Day 28)
Days of Hospitalization
Duration of hospitalization (for US sites only: or treatment in special outpatient setting in lieu of hospitalization due to resource restraints)cacy:
Time frame: Throughout the Study (Day 0 to Day 28 )
Patients Free of Renal-replacement Therapy (RRT)* Until EoS
Number of Patients Both for All Patients and Surviving Patients Free of Renal-replacement Therapy (RRT)\* Until EoS
Time frame: Throughout the Study (Day 0 to Day 28 )
Patients Required ECMO Until EoS
Number and Percentage of patients both for all patients and surviving patients free from extracorporeal membrane oxygenation (ECMO)\* until EoS.
Time frame: Throughout the Study (Day 0 to Day 28 )
Patients Free of INV Until Day 14*
Number and persentage of patients free of INV until Day 14\*
Time frame: Throughout the Study (Day 0 to Day 14 )
Patients Free of RRT
Percentage of patients free of RRT until Day 14\*
Time frame: Day 0 to Day 14
Number of Patients Free of ECMO
Number of patients free of ECMO until Day 14.
Time frame: Day 0 to Day 14
Patients With Improvement of at Least 2 Points (From Randomization) on the 9-category WHO Ordinal scale1
Numbers of patients with improvement of at least 2 points (from randomization) on the 9-category WHO ordinal scale1( Modified WHO Ordinal Scale for Clinical Status)on Days 6, 14, and 28, where score 0 means no clinical or virological evidence of infection and score 8 is the worth outcome ( mens death).
Time frame: on Days 6, 14, and 28
Patients With Auxiliary Oxygen Therapy (Including All Types of Oxygen Therapy)
Percentage of Patients with auxiliary oxygen therapy (including all types of oxygen therapy) on Days 6, 14, and 28.
Time frame: on Days 6, 14, and 28
Patients With Clinical Recovery
Percentage of Patients With Clinical Recovery: Axillary Temp \<= 36.6 °C, or Oral Temp \<= 37.2 °C, or Rectal or Tympanic Temp \<= 37.8 °C and Respiratory Frequency \<= 24 Times/Min Without O2 Inhalation and O2 Saturation \>= 98% Without O2 Inhalation
Time frame: Throughout the Study (Day 0 to Day 28 )
Patients With Clinical Recovery
Percentage of Patients With Clinical Recovery Oxygen Saturation ≥98% Without Oxygen Inhalation
Time frame: Throughout the Study (Day 0 to Day 28 )
Patients With Clinical Improvement or Live Discharge From Hospital Without Oxygen Supplementation
Percentage of patients with clinical improvement, defined as the time from first dose of IMP to an improvement of at least 2 points on the WHO 9 category ordinal scale, or live discharge from hospital without oxygen supplementation, whichever comes first (Modified WHO Ordinal Scale for Clinical Status, where score 0 - for patient with no clinical or virological evidence of infections, score 9 - the worth scenario- death)
Time frame: Throughout the Study (Day 0 to Day 28 )
Percentage of Participants With WHO Status<=2
Clinical patient status on the 9-category WHO ordinal scale1 on Days 6, 14, and 28
Time frame: on Days 6, 14, and 28
Duration of INV
Duration of INV throughout the study. If no entry on the respective CRF page exists, the duration is set to 0 days for patients who performed Day 28 visit. Patients without Day 28 visit and without any entry on the respective CRF page are excluded from analysis.
Time frame: Throughout the Study (Day 0 to Day 28 )
Days on ECMO
Duration of ECMO in days (duration set to 0 for those who did not require ECMO). No participants required ECMO.
Time frame: Throughout the Study (Day 0 to Day 28)
Days on RRT
Duration of RRT in days (duration set to 0 for those who did not require RRT).No participants required RRT.
Time frame: Throughout the Study (Day 0 to Day 28)
Days of Auxiliary Oxygen Therapy
Duration of auxiliary oxygen therapy (including all types of oxygen therapy)
Time frame: Throughout the Study (Day 0 to Day 28)
Days of Hospitalization
Duration of hospitalization for survivors
Time frame: Throughout the Study (Day 0 to Day 28)
Participants With ICU Admission
Percentage of Participants with ICU Admission at different time point
Time frame: on Days 6, 14, and 28
Probability of Death
Probability of death derived from Kaplan Meier analyses
Time frame: Throughout the Study (Day 0 to Day 28)
Days to INV
Time to first prescription of invasive ventilation (INV). The time to first prescription of INV, only patients with actual INV or prescription for INV are considered.
Time frame: Throughout the Study (Day 0 to Day 28)
Days to RRT
Time to first prescription of RRT
Time frame: Throughout the Study (Day 0 to Day 28)
Days to ECMO
Time to first prescription of ECMO
Time frame: Throughout the Study (Day 0 to Day 28)
Days to INV, RRT and ECMO
Time to first prescription of INV, RRT, and ECMO. The time to first prescription of INV, only patients with actual INV or prescription for INV are considered.
Time frame: Throughout the Study (Day 0 to Day 28)
Probability of ICU Admission
Overall probability of ICU admission derived from Kaplan Meier analyses.
Time frame: Throughout the Study (Day 0 to Day 28)
Cumulative Dose
Cumulative Dose of Vasoactive Therapies and Days With Vasoactive Therapies (Daily Until Day 14)
Time frame: Day 0 to day 14
Time to Clinical Recovery
Time of first assessments of parameters contributing to clinical recovery
Time frame: Throughout the Study (Day 0 to EoS [Day 27 up to Day 42])
Plasma Levels of IMU-838
Morning trough plasma levels of IMU-838 on Days 0, 1, 2, 3, 6, 14, and 28
Time frame: on Days 0, 1, 2, 3, 6, 14, and 28
Correlation of Trough Levels (Quartiles) to Selected Clinical Outcomes
Kaplan-Meier analyses were used to investigate a potential relationship between trough plasma levels of IMU-838 and time to clinical improvement and time to clinical recovery. Estimates of the clinical outcomes were evaluated separately for patients within each of the four quartiles of IMU-838 trough levels at Day 14.
Time frame: Trough levels at Day 14; Clinical outcome: Day 0 to EoS (EoS = Day 27 up to Day 42)
Number of Participants With Adverse Events (AEs) and Serious AEs
Adverse events (AEs) and serious AEs. AEs-Hypertriglyceridemia,Increased glycosylated hemoglobin, Headache, Thrombocytosis, Hyperglycemia, AEs reported in ≥ 2.0% of patients in any treatment group included anemia, bradycardia, sinus bradycardia, tachycardia, pyrexia, hepatocellular injury, hematuria, hypertension and hypertensive crisis. SAEs- deep vein thrombosis,COVID-19 pneumonia, patient death.
Time frame: Throughout the Study (Day 0 to Day 28)
Vital Signs: Height
Safety Height in centimeters will be recorded without shoes. Changes in vital signs judged by the investigator as clinically significant will be reported as an AE.
Time frame: at Baseline
Vital Signs: Weight
Safety Weight in kilograms will be recorded without shoes. Changes in vital signs judged by the investigator as clinically significant will be reported as an AE.
Time frame: at Baseline
Vital Signs: Body Temperature (ºC)
Safety Body temperature can be measured axillary, oral, rectal or tympanic, but should be always measured by the same method for a patient. Changes in vital signs judged by the investigator as clinically significant will be reported as an AE.
Time frame: at Baseline
Albumin Concentration at Various Time Points
Clinical laboratory parameters: blood chemistry (Albumin concentration at various time points)
Time frame: Throughout the Study (Day 0 to Day 28)
Hematocrit Ratio at Various Time Points
Clinical laboratory parameters: hematology- Hematocrit ratio at various time points
Time frame: Throughout the Study (Day 0 to Day 28)
Urine Creatinine at Various Time Points
Clinical laboratory parameters: urinalysis- Urine creatinine at various time points
Time frame: Throughout the Study (Day 0 to Day 28)
Temperature
Temperature data at different time point.
Time frame: Throughout the Study (Day 0 to Day 28)
D-dimer
Disease markers
Time frame: Throughout the Study (Day 0 to Day 28)
Lactate Dehydrogenase (LDH)
Blood levels of disease markers
Time frame: Throughout the Study (Day 0 to Day 28)
C-reactive Protein
Blood levels of disease markers
Time frame: Throughout the Study (Day 0 to Day 28)
Troponin I
Bood levels of disease markers
Time frame: Throughout the Study (Day 0 to Day 28)
Procalcitonin
Blood levels of disease markers
Time frame: Throughout the Study (Day 0 to Day 28)
Correlation of Time to Clinical Improvement With Quartiles of D-Dimer Blood Levels at Day 6
Kaplan-Meier analyses were used to investigate a potential relationship between blood levels of D-Dimer and time to clinical improvement. Estimates of the clinical outcome were evaluated separately for patients within each of the four quartiles of D-Dimer levels at Day 6.
Time frame: D-Dimer levels at Day 6; Clinical outcome: Day 0 to EoS (EoS = Day 27 up to Day 42)
Changing in Log 10 Copies in Spontaneous Sputum and Nasopharyngeal Swab Samples at Various Time Points
Virologic markers: Severe Acute Respiratory Syndrome Coronavirus Virus (SARS-CoV-2) Mean Viral Load - log10 Copies in Spontaneous Sputum and Nasopharyngeal Swab Samples: changing of SARS-CoV-2 Viral Load in patients on Days 6,14,28
Time frame: Throughout the Study (Day 0 to Day 28)
Mean Viral Load - log10 Copies in Spontaneous Sputum and Nasopharyngeal Swab Samples
Virologic markers :Severe Acute Respiratory Syndrome Coronavirus Virus (SARS-CoV-2) mean viral load - log10 copies in spontaneous sputum and nasopharyngeal swab samples: Time course of SARS-CoV-2 viral load
Time frame: Throughout the Study (Day 0 to Day 28)
Number of Participants With 2 Consecutive Negative SARS-CoV-2 Reverse Transcriptase Polymerase Chain Reaction Tests at Least 24 Hours Apart
Virologic markers: Qualitative Virologic Clearance in Spontaneous Sputum and Nasopharyngeal Swab Samples (= 2 Consecutive Negative SARS-CoV-2 Reverse Transcriptase Polymerase Chain Reaction Tests at Least 24 Hours Apart)
Time frame: Throughout the Study (Day 0 to Day 28)
Rate of Conversion to a Negative SARS-CoV-2 (Qualitative) Test
Virologic markers: conversion to a negative SARS-CoV-2 (qualitative) test on Day 28.
Time frame: on Day 28
Time to Conversion to a Negative SARS-CoV-2 (Qualitative) Test
Virologic markers : Time to Conversion to a Negative SARS-CoV-2 (Qualitative) Test Throughout the study. Only patients with viral load measured from nasopharyngeal swab and results provided by the central laboratory (Covance) were included.Conversion to a negative SARS-CoV-2 status is only assumed if a negative test is confirmed by all available subsequent assessments. This means for Day 28/early termination visit no confirmation is needed. If no conversion to a negative status is documented, patients will be censored for survival analysis at the time of the last documented positive test result.
Time frame: Throughout the Study (Day 0 to Day 28)
Interleukin (IL)-17
The profiles of immune system biomarkers
Time frame: Day 0, 6, 14 and Day 28
Interleukin (IL)-1ß
The profiles of immune system biomarkers
Time frame: Day 0, 6, 14 and Day 28
Interleukin (IL)-6
The profiles of immune system biomarkers
Time frame: Day 0, 6, 14 and 28
Interferon Gamma (IFNγ)
The profiles of immune system biomarkers
Time frame: Day 0, 6, 14 and 28
Tumor Necrosis Factor Alpha
The profiles of immune system biomarkers
Time frame: Day 0, 6, 14 and 28
Immunoglobulin (Ig)A and/or IgG Antibodies Against SARS-CoV-2
Proportion of patients with IgA and/or IgG antibodies against SARS-CoV-2on at different time point
Time frame: Day 6, 14 and 28
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