Effects of mTOR Inhibition With Sirolimus (RAPA) in Patients With COVID-19 to Moderate the Progression of ARDS

The University of Texas Health Science Center at San Antonio

Overview

This study assesses the clinical effectiveness of mammalian target of rapamycin (mTOR) inhibition with rapamycin in minimizing or decreasing the severity of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) in participants infected with mild to moderate COVID-19 virus.

This is a single center, double-blind, placebo-controlled, randomized clinical trial in which each participant, after admission to hospital with a diagnosis of mild to moderate COVID-19 infection, will be administered either a dose of rapamycin or the placebo daily. Each subject will receive the assigned treatment until hospital discharge or death. Evaluations will be performed at the beginning of the clinical trial and then daily up to 4 weeks.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Conditions

Acute Lung Injury/Acute Respiratory Distress Syndrome (ARDS)Respiratory Failure Sars-CoV2

Interventions

RapamycinDRUG

Daily administration of a dose of investigational drug for up to 4 weeks while hospitalized

PlaceboDRUG

Administration of investigational drug placebo for up to 4 weeks while hospitalized

Eligibility

Sex: ALLMin age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Over 60 years of age clinically judged to require hospitalization 2. SARS-CoV2 infection documented by positive RT-PCR nasopharyngeal swab 3. Mild to Moderate clinical status defined as clinical symptoms with or without pneumonia on imaging, with or without fever who are judged to require hospital admission 1. Elevated ferritin 2. Lymphopenia 3. Bilateral opacities on chest x-ray 4. Low pro-calcitonin 5. Clinical signs suggestive of symptoms of mild illness with COVID-19 that could include fever, cough, sore throat, malaise, headache, muscle pain, gastrointestinal symptoms, without shortness of breath or dyspnea or moderate illness with CoVID-19, such as respiratory rate ≥ 20 breaths per minute, saturation of oxygen (SpO2) \> 93% on room air at sea level, heart rate ≥ 90 beats per minute. Exclusion Criteria: 1. Known or suspected allergy to RAPA 2. High pro-calcitonin 3. SARS-CoV2 documented by negative RT-PCR nasopharyngeal swab 4. Treatment with contraindicated concomitant medications: currently receiving immunosuppressants, including steroids, prior to enrollment, or with immunomodulators or immunosuppressant drugs, including but not limited to Inter leukin (IL)-6 inhibitors, Tumor necrosis factor (TNF) inhibitors, anti-IL-1 agents and Janus kinase (JAK) inhibitors within 5 half-lives or 30 days (whichever is longer) prior to randomization. 5. Currently receiving immunosuppressants, including steroids, prior to enrollment 6. Serious underlying disease including but not limited to cardiac, pulmonary, renal, hepatic (bilirubin \>1.5x Upper normal limit (ULN) or Aspartate Aminotransferase (AST)\>ULN but bilirubin ≤ ULN), endocrine (diabetes) or psychiatric disorders judged to be at risk in participating by the inpatient attending physician or team 7. Suspected or confirmed history of alcohol or substance abuse disorder 8. Having participated in other drug trials in the past month 9. Deemed otherwise unsuitable for the study by researchers 10. Clinically judged to not require hospital admission

Locations (2)

University Hospital System

San Antonio, Texas, United States

Audie L Murphy Memorial Veterans Hospital

San Antonio, Texas, United States

Outcomes

Primary Outcomes

Survival rate

The proportion of participants who survive without respiratory failure

Time frame: 4 weeks

Secondary Outcomes

Change in Clinical Status assessed by the World Health Organization (WHO) scale

The WHO ordinal scale is a measure of clinical improvement using a scale score of 0-8, where 0 indicates a better outcome and 8 indicates death: Uninfected, no clinical oor virological evidence of infection 0 Ambulatory, no limitation of activities 1 Ambulatory, limitation of activities 2 Hospitalized Mild disease, no oxygen therapy 3 Hospitalized mild disease, oxygen by mask or nasal prongs 4 Hospitalized Severe Disease, non-invasive ventilation 5 Hospitalized severe disease, intubation and mechanical ventilation 6 Hospitalized severe disease, ventilation+organ support 7 Death 8

Time frame: Baseline to 4 weeks

Change in Clinical Status assessed by the National Institute of Allergy and Infectious Disease (NIAID) scale

An ordinal scale for clinical improvement scored from 1 to 8, where 1 represents death and 8 represents recovery to discharge from hospital with no limitation on activities: Death (1) Hospitalized, on invasive mechanical ventilation of extracorporeal membrane oxygenation (ECMO) (2) Hospitalized, on non-invasive ventilation or high flow oxygen devices (3) Hospitalized, requiring supplemental oxygen (4) Hospitalized, not requiring supplemental oxygen or ongoing medical care (6) Not hospitalized, limitation on activities \&/or requiring supplemental home oxygen (7) Not hospitalized, no limitation on activities (8)

Time frame: Baseline to 4 weeks

Data from ClinicalTrials.gov

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