The principal objective of the CONFIDENT trial is to assess the efficacy of two units (400-500 mL in total) of convalescent plasma, as compared to Standard of Care (SoC), to reduce day-28 mortality in patients with SARS-CoV-2 pneumonia who require mechanical ventilation.
Design : multicenter randomized openlabel, phase II trial. Number of patients to include : 500 (250 with plasma, 250 without plasma). The principal objective is to assess the efficacy of the treatment to reduce day-28 mortality in patients with SARS-CoV-2 pneumonia who require mechanical ventilation. Hypothesis: Passive immunization with plasma collected from patients having contracted COVID-19 and developed specific antibodies may alleviate symptoms and viral load of SARS-CoV-2 and reduce mortality. The patients will receive currently accepted standard of care for both COVID-19 and usual organ dysfunctions observed in such cases. half the patients will be administered either Convalescent plasma, depending on the randomization process. All patients will be followed-up for one year after inclusion. The study will be considered either positive or negative, based on the principal objective. This means that the product convalescent plasme will be considered effective if mortality at day 28 is lower is patients treated with convalescent plasma than without it. The follow-up will allow to assess a series of secondary objectives, addressing the evolution of organ failures, viral infection, inflammatory response and long-term physical of psychological impact of COVID-19. Interim analyses will be performed every 100 patients included in order to stop the trial if an exceptionally good or bad result is observed, to prevent using or not using the product appropriately in further patients. These analyses will be supervised by an independent committee. The choice to include only those patients under mechanical ventilation for severe respiratory failure makes this study different from other trials testing convalescent plasma, as most trial include less severe patients.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
2 units of convalescent plasma
Gold Standards
Clinique Saint Pierre Ottignies
Ottignies, Brabant Wallon, Belgium
Centre Hospitalier Wallonie Picarde
Tournai, Hainaut, Belgium
OLVZ Aalst
Aalst, Belgium
Vital status
dead or alive
Time frame: at day 28
day 90 mortality
dead or alive
Time frame: at day 90
number of ventilator-free days at day 28
to assess the ventilator free days
Time frame: at day 28
number of renal replacement therapy free days at day 28
to assess the number of renal replacement therapy free days
Time frame: at day 28
number of vasopressors free-days at day 28
to assess the number of vasopressors free-days
Time frame: at day 28
use of ECMO before day 28
to assess if ECMO was required
Time frame: till day 28
value of the SOFA score at days 7, 14 and 28
to assess the value of SOFA score
Time frame: Day 1, 7, 14, 28
changes in SOFA scores (delta SOFA) over 7, 14 and 28 days
to assess the changes in SOFA scores (delta SOFA)
Time frame: Day 7, 14 and 28 days
assessment of the SARS-CoV-2 viral load
assessment of the SARS-CoV-2 viral load, expressed as cycle threshold, \[2\] in the tracheal aspirates (for intubated patients) or nasopharyngeal swabs (for extubated patients) at days 7, 14 and 28
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NONE
Enrollment
475
UZ Antwerpen
Antwerp, Belgium
Imelda ZH Bonheiden
Bonheiden, Belgium
CHU Saint Pierre
Brussels, Belgium
Erasme
Brussels, Belgium
UZ Brussel
Brussels, Belgium
CHU Charleroi Marie Curie
Charleroi, Belgium
AZ Sint Blasius
Dendermonde, Belgium
...and 7 more locations
Time frame: Days 7, 14 and 28
blood C reactive protein (CRP) concentration
to assess the concentrations of C reactive protein (CRP)
Time frame: Days 7, 14 and 28
ferritin concentration
to assess the concentration of ferritin
Time frame: Days 7, 14 and 28
lymphocyte count
to assess the count of lymphocyte
Time frame: Days 7, 14 and 28
length of stay in the acute care hospital
to assess the lenght of stay in the acute care
Time frame: through study completion, 1 year
location of the patient
to assess the location of the patient : acute care hospital, post acute care hospital, long-term residency, home
Time frame: Day 90
Katz Index of independence in Activity Day Living functional score
to assess the Activity Day Living functional Min value: 0 = Low (patient very dependent) Max value: 6 = High (patient independent)
Time frame: Day 90 and 365
Hospital Anxiety and Depression Scale (HADS)
to evaluate the anxiety-depression For each item 0-7 : Normal 8-10 : Bordeline abnormal (borderline case) 11-21 : Abnormal case
Time frame: Day 90 and 365
Quality of life scale EQ-5D-5L
The EQ-5D-5L is composed of - the EQ-5D-5L descriptive system and the EQ Visual Analogue scale (EQ VAS). The descriptive system comprises 5 dimensions (mobility, self care, usual activities, pain/discomfort, anxiety/depression). Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems, and extreme problems. Each level corresponds to 1-digit number expressing the level selected for that dimension. The EQ VAS corresponds to a 20 cm vertical, visual analogue scale raging from 'the best health you can imagine' to 'the worst health you can imagine'.
Time frame: Day 90 and 365
Transfusion related adverse events
to assess the transfusion related adverse events
Time frame: till 28 days
Determine the type of concommittent inflammatory response
assess clusters based on the profile of cytokines, chemokines and cell adhesion markers
Time frame: till 28 days