Best Supportive Care With or Without Low Dose Whole Lung Radiation Therapy for the Treatment of COVID-19

Emory University14 enrolled

Overview

This phase III trial compares low dose whole lung radiation therapy to best supportive care plus physicians choice in treating patients with COVID-19 infection. Low dose whole lung radiation therapy may work better than the current best supportive care and physician's choice in improving patients' clinical status, the radiographic appearance of their lungs, or their laboratory blood tests.

PRIMARY OBJECTIVE: I. Intubation-free survival (IFS) and (2) time to clinical recovery (TTCR) based on weaning off supplementary oxygenation or hospital discharge in COVID 19 patients. SECONDARY OBJECTIVES: I. To investigate (1) other clinical, (2) radiographic, (3) serologic markers, and (4) immune marker response to best supportive care plus provider's choice of pharmaceutical treatment either with or without whole-lung LD-RT II. Secondary clinical improvements will look at time to hospital discharge, prevention of ICU admissions, and overall survival. OUTLINE: Patients are blindly randomized to 1 of 2 arms. ARM I: Patients receive best supportive care plus physician choice of treatment ARM II: Patients receive best supportive care plus LDRT (experimental arm). After completion of study, patients are followed up for 14 days.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Pneumonia Severe Acute Respiratory Syndrome Symptomatic COVID-19 Infection Laboratory-Confirmed

Interventions

Best PracticeOTHER

Receive standard of care

Low Dose Radiation TherapyRADIATION

Undergo LDRT

Eligibility

Sex: ALLMin age: 50 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Be age 50 or over; Not pregnant (will undergo pregnancy testing if below age 55); * Have had a positive PCR-based test confirming the diagnosis of COVID-19 within 5 days (+/-2 day)of study enrollment\* * Have had clinical signs of severe acute respiratory syndrome or pneumonia (ie. dyspnea, cough,fever) that primary team feels like patient needs rescuing with LD-RT.\*\* * Have visible bilateral consolidations/ground glass opacities on chest imaging * Require supplemental oxygen at the time of enrollment, defined by inability to wean from supplemental oxygen within 24 hours prior to enrollment. * Not require intubation within 12 hours of randomization (ie, not screen fail). Intubation after enrollment but within 12 hours of randomization will be defined as a screen failure for both the LD-RT and control cohorts. * Be enrolled within 5 days (+/- 2) of first hospitalization for COVID-19. Prior hospitalization for COVID-19 will be an exclusion criteria (prior ED visits are permissible). * Willingness and ability of the subject to comply with scheduled visits, protocol-specified laboratory tests, other study procedures, and study restrictions * Evidence of a signed informed consent/assent indicating that the subject is aware of the infectious nature of the disease and has been informed of the procedures to be followed, potential risks and discomforts, potential benefits, and other pertinent aspects of study participation Exclusion Criteria: * Pregnant and/or planned to be pregnant within in next 6 months * Age 49 or younger at time of enrollment * Prior inpatient hospitalization for COVID-19 (prior emergency department \[ED\] visits are not an exclusion criteria) * Prior enrollment on a separate COVID-19-related therapeutric trial (subsequent co-enrollment is permitted for patinets randomized to the control arm). * Notably, concurrent use of COVID-directed therapies is no longer an exclusion criteria for this trial. This includes azithromycin, dexamethasone, remdesevir, convalescent plasma, or any other COVIDdirected drug therapy.

Locations (1)

Emory University Hospital/Winship Cancer Institute

Atlanta, Georgia, United States

Outcomes

Primary Outcomes

Time to clinical recovery

Will be measured by improvements on oxygenation need prior to intervention compared with after intervention and/or hospital discharge.

Time frame: Up to follow-up day 14 after study start

Secondary Outcomes

Freedom from ICU admission

The rates from both cohort will be reported.

Time frame: Up to follow-up day 14 after study start; This may be extended up to 28 days after preplanned interim analysis.

Temperature

Temperature in degrees (F)

Time frame: Up to follow-up day 14 after study start

Heart rate

Heart rate in beats per minutes

Time frame: Up to follow-up day 14 after study start

Systolic Blood pressure

Systolic blood pressure in mm Hg

Time frame: Up to follow-up day 14 after study start

Oxygen saturation

Oxygen saturation in percentage

Time frame: Up to follow-up day 14 after study start

Supplemental oxygenation need

Oxygen saturation in percentage

Time frame: Up to follow-up day 14 after study start

Respiratory rate

Respiratory rate in breaths per minute.

Time frame: Up to follow-up day 14 after study start

Data from ClinicalTrials.gov

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