COVID-19 is a viral respiratory and systemic disease that has been rapidly spreading globally since the first cases were reported in December 2019 and has now become pandemic. The causative agent of COVID-19 was identified as a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, first designated as 2019-nCoV). The disease manifestations of COVID-19 can range from mild, self-resolving respiratory disease to severe pneumonia, ARDS, multiorgan failure, and ultimately death. In early reports, the mortality rate among patients admitted to hospital and with confirmed SARS-CoV-2 infection was reported to be between 4 and 15%. Although the disease can afflict all age groups, elderly patients and patients with underlying comorbidities such as high body mass index, hypertension, diabetes, cardiovascular disease, or cerebrovascular disease are at risk of developing severe disease and dying. There are currently no etiologic treatments for COVID-19, and efforts are underway to identify therapeutics that could be effective in controlling this disease.
Cyclophilins are cellular (host) peptidyl-prolyl cis/trans isomerases (molecular chaperones) involved in protein folding, maturation, and trafficking. Cyclophilins have been shown to play a key role in the lifecycle of many coronaviruses, including human coronaviruses 229E (HCoV-229E) and NL-63 (HCoV-NL63), feline infectious peritonitis coronavirus (FPIV), SARS-CoV and Middle-East-Respiratory-Syndrome coronavirus (MERS-CoV). Cyclosporin A (CsA), a potent cyclophilin inhibitor, blocks the replication of various coronaviruses in vitro, including HCoV-229E, HCoV-NL63, FPIV, mouse hepatitis virus (MHV), avian infectious bronchitis virus, and SARS-CoV. Alisporivir is a non-immunosuppressive analogue of CsA with potent cyclophilin inhibition properties. In vitro, alisporivir inhibits the replication of HCoV-229E, HCoV-NL63, MHV, SARS-CoV and MERS-CoV at low micromolar concentrations without cytotoxic effect. Although alisporivir has not demonstrated activity against coronaviruses in in vivo models to date, recent experiments showed that alisporivir bears concentration-dependent properties against CoV-2 in vitro. Preclinical pharmacology data indicate that, after oral administration, alisporivir is widely distributed in the whole body, including the lungs. Furthermore, the EC90 of alisporivir against SARS-CoV-2 in VeroE6 cells appears to be clinically achievable in patients. In addition, because alisporivir inhibits all cellular cyclophilins, it also blocks mitochondrial cyclophilin-D, a key regulator of mitochondrial permeability transition pore (mPTP) opening, a mechanism involved in triggering cell death. Therefore, besides its antiviral properties, alisporivir may also be effective in preventing lung tissue damage.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
26
Administration of alisporivir at the dose of 600 mg p.o. BID from D1 to D14 to patients and standard of care (SOC).
Locally accepted regimen protocols for patient care and select agents based on the underlying diagnosis and the severity of COVID 19 (excepting e.g. azithromycin and other antibiotics listed as prohibited medications)
Assistance Publique Hôpitaux de Paris - CHU Henri Mondor
Créteil, France
Change in SARS-CoV-2 viral load in nasopharyngeal swabs
Time frame: at Day 1 and Day 7
Viral Load Response Rate (VLRR)
Time frame: at Day 1 and Day 7
Percentage of patients reporting each severity rating on an 8-point ordinal scale.
Time frame: at Day 1, Day4, Day 7, Day 11, Day 14 and Day 90
Change in National Early Warning Score scale
Time frame: at Day 1, Day 4, Day 7, Day 11, Day 14 and Day 90
Changes in thoracic CT scan
Time frame: screening to Day 1, Day 14 and Day 90
Percentage of patients admitted to Intensive Care Unit (ICU)
Time frame: at Day 1 to Day 28
Time to admission to Intensive Care Unit (ICU)
Time frame: at Day 1 to Day 28
Percentage of patients admitted to Intensive Care Unit (ICU)
Time frame: at Day 90
Time to admission to Intensive Care Unit (ICU)
Time frame: at Day 90
Percentage of patients requiring mechanical ventilation
Time frame: at Day 1 to Day 28
Percentage of patients requiring mechanical ventilation
Time frame: at Day 90
Percentages of patients negative for SARS CoV 2 RNA in nasopharyngeal swabs
Time frame: at Day 14, Day 21 and Day 28
Time to negative viral load
Time frame: at Day 1 to Day 28
Time to resolution of symptoms
Time frame: at Day 1 to Day 28
Time to resolution of symptoms
Time frame: at Day 90
Duration of need for supplemental oxygen
Time frame: at Day 1 to Day 28
Duration of need for supplemental oxygen
Time frame: at Day 90
Duration of hospitalisation
Time frame: at Day 1 to Day 28
Duration of hospitalisation
Time frame: at Day 90
Duration of new non-invasive ventilation or high flow oxygen use
Time frame: at Day 1 to Day 28
Duration of new non-invasive ventilation or high flow oxygen use
Time frame: at Day 90
Duration of new oxygen use
Time frame: at Day 1 to Day 28
Duration of new oxygen use
Time frame: at Day 90
Duration of new ventilator or ECMO use
Time frame: at Day 1 to Day 28
Duration of new ventilator or ECMO use
Time frame: at Day 90
Number of non-invasive ventilation/high flow oxygen free days
Time frame: at Day 1 to Day 28
Number of non-invasive ventilation/high flow oxygen free days
Time frame: at Day 90
Number of oxygenation free days
Time frame: at Day 1 to Day 28
Number of oxygenation free days
Time frame: at Day 90
Patient all-cause mortality
Time frame: at Day 14, Day 28 and Day 90
Cumulative incidence of any AE
Time frame: at Day 1 to Day 90
Cumulative incidence of Grade 3 and 4 AEs
Time frame: at Day 1 to Day 90
Cumulative incidence of SAEs
Time frame: at Day 1 to Day 90
Percentage of re-hospitalization
Time frame: Hospital discharge to D90 ±2d
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.