This is a pilot study to investigate the safety and feasibility of rhDNase1 and its impact on neutrophil extracellular traps (NETs) in COVID-19 infected patients.
It has been reported that elevated numbers of neutrophils (PMNs) in the blood predicts poor outcomes and severity in patients with COVID-19 infections. Acute inflammation results in formation of neutrophil extracellular traps (NETs) by PMNs and NK cells. Pre-clinical studies showed that NETs are critically involved in the pathophysiology of ARDS and increased capacity of PMNs to form NETs was shown to correlated with increased severity and mortality in patients with ARDS after community-acquired pneumonia. In early reports, patients with severe COVID-19 infections were also found to have radiological and clinical findings of Acute Respiratory Distress Syndrome (ARDS). NETs can be degraded by DNase1 for which there is a human recombinant equivalent rhDNase1. This study proposes: 1. to evaluate the safety and feasibility of inhaled rhDNase1 in severely ill COVID-19 patients requiring admission; 2. to evaluate the impact of rhDNase1 in limiting progression of disease and COVID-19 related complications in these patients; 3. and to investigate NETs as possible therapeutic targets in severe COVID-19 patients by quantifying levels of circulating NETs in the blood and sputum and correlating these with oxygen requirements, need for mechanical ventilation, duration of mechanical ventilation, radiological progression of ARDS, secondary bacterial infections (pneumonia, bacteremia and other), renal dysfunction, duration of ICU admission, and time to discharge or mortality.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
15
Inhaled nebulisations
Hamilton General Hospital, Hamilton Health Sciences
Hamilton, Ontario, Canada
McGill University Health Centre
Montreal, Quebec, Canada
Safety of inhaled rhDNase1 in non-ventilated COVID-19 patients by reporting of adverse events
Rate of all adverse events, rate of serious adverse events, rate of grade 3/4/5 adverse events, rate of drug-related adverse events.
Time frame: 9 months
Time to first study participant enrolment
Time elapsed between the study opening date and the first patient enrolment date.
Time frame: Up to 2 weeks
Enrolment rate
Number of patients enrolled per week following the start of the study.
Time frame: Up to 9 months
Eligible patient consent rate
Number of patients meeting eligibility through inclusion and exclusion criteria that are consented and enrolled into the study, as compared to the total number of patients meeting criteria (enrolled and non-enrolled).
Time frame: Up to 9 months
Completeness of drug delivery
Percentage of doses missed compared to completed, including reasons for missed doses, per patient.
Time frame: Up to 9 months
Completeness of study-specific tests or procedures
Percentage of tests or procedures missed compared to completed, per patient.
Time frame: Up to 9 months
Completeness of data collection
Percentage of missed data compared to completed data, per patient.
Time frame: Up to 9 months
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Hypoxia rate
Extent of hypoxia rate is defined as the number of patients requiring supplemental oxygen, categorized by type of oxygen requirement.
Time frame: Up to 9 months
Supplemental oxygen requirement type
Type of oxygen in FiO2 requirements needed by each patient in the study, if applicable.
Time frame: Up to 9 months
Progression to mechanical ventilation rate
Number of patients progressing to requiring intubation and mechanical ventilation.
Time frame: Up to 9 months
Duration of mechanical ventilation
Duration in days, for patients requiring intubation and mechanical ventilation, if applicable.
Time frame: Up to 9 months
Radiological progression
Number of patients who show progression on imaging suggestive of ARDS such as bilateral lung involvement, as reviewed by study's thoracic radiologist.
Time frame: Up to 9 months
Renal dysfunction rate
Number of patients with renal dysfunction, classified by stage (1, 2 or 3).
Time frame: Up to 9 months
Renal dysfunction extent
Extent of change in creatinine from baseline.
Time frame: Up to 9 months
Secondary bacterial infections rate
Number of patients contracting secondary bacterial infections (pneumonia, bacteremia and other).
Time frame: Up to 9 months
Duration of ICU admission
In days, length of stay in the ICU.
Time frame: Up to 9 months
Time to hospital discharge or in-hospital mortality
Time elapsed between enrolment into the study (at admission), and endpoint (discharge from ICU or in-hospital mortality).
Time frame: Up to 9 months