This study is designed as a 2-part, 2-cohort, double-blind, randomized, placebo controlled, multicenter Phase 1/2 study to evaluate the safety, tolerability and efficacy of RJX in patients with COVID-19.
For each cohort, there will be an open label Safety Lead-in (Part 1) and a placebo controlled, randomized, double-blind portion (Part 2). In Part 1, RJX will be administered daily for 7 days. In the active treatment arm of Part 2 for both cohorts, RJX will be administered daily for 7 days per cycle and patients may receive up to 2 cycles. As detailed below, patients will be allowed to receive a second 7 day cycle of therapy based on the medical judgment of the Investigator. The total RJX exposure during Part 2 could therefore be up to 14 days. Both cohorts will start and enroll in parallel and independently. A safety follow-up period will begin at Day 14/Discharge, or when treatment is discontinued, and will continue for approximately 60 days post discharge. Part 1 will be conducted at a single site and Part 2 will be conducted at multiple sites. The 2 cohorts in this study are: * Cohort 1: * Hospitalized COVID-19 patients ≥18 years without hypoxemia who are either not receiving any oxygen therapy OR are receiving supplemental oxygen via mask or nasal prongs (namely, clinical status score 4 or 5 on an 8-point ordinal scale). * Patients are required to have the following high-risk characteristics 1. Age ≥65 years AND type 2 diabetes or hypertension OR 2. Age ≥18 years with abnormal blood tests AND CRP \>50 mg/L PLUS at least 1 of the following biomarkers: 1. D-dimer \>1,000 ng/mL, 2. Ferritin \>500 µg/L, 3. High sensitivity cardiac troponin \>2 × upper limit of normal (ULN), 4. LDH \>245 U/L. * Cohort 2: * Hospitalized COVID-19 patients with hypoxemia without ARDS who are receiving either non-invasive positive pressure ventilation (NIPPV) OR high flow oxygen (namely, clinical status score 3 on an 8-point ordinal scale).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
237
Active drug comprised of: ascorbic acid, magnesium sulfate heptahydrate, cyanocobalamin, thiamine, riboflavin 5' phosphate, niacinamide, pyridoxine, calcium d-pantothenate, and sodium bicarbonate.
0.9% Sodium Chloride in Water for Injection a.k.a. Normal Saline for injection
Memorial Hermann Memorial City Medical Center
Houston, Texas, United States
Memorial Hermann Southeast Hospital
Houston, Texas, United States
Christus Santa Rosa Hospital
New Braunfels, Texas, United States
Safety as measured by DLTs and drug related SAE's
• Part 1, Cohorts 1 and 2: Cumulative incidence of DLTs and drug-related SAEs (viz., sum of DLT + SAEs) reported within 14 days of first dose of RJX (Part 1) or reported within 60 days of first dose of study drug (Part 2)
Time frame: Up to 60 days post-enrollment
Tolerability and Efficacy measured by progression of disease through an ordinal scale.
• Part 2, Cohort 1: Progression to severe disease on an 8-point ordinal scale from a clinical status score of 4 or 5 to a clinical status score of 3, 2, or 1 within 2 weeks of first dose of study drug
Time frame: Within 2 weeks
Efficacy measured by time to resolution of respiratory failure
• Part 2, Cohort 2: Time to resolution of respiratory failure (TTRRF), with status change on an 8-point ordinal scale from a clinical status score of 3 to a clinical status score of ≥4
Time frame: 60-days post enrollment
Efficacy as measured by day of ICU care.
The key secondary endpoints for Parts 1 and 2, Cohorts 1 and 2 are: • Mean number of days of ICU care
Time frame: 60-days post enrollment
Safety, Tolerability, Efficacy measured by mortality over 28 Days.
The key secondary endpoints for Parts 1 and 2, Cohorts 1 and 2 are: • Proportion of patients that die (any cause) by Day 28 post randomization (patient may be inpatient or outpatient in follow up)
Time frame: 28-days post enrollment
Efficacy measured by mean change in baseline clinical status on Days 7 and 14.
Additional secondary endpoint for Parts 1 and 2, Cohorts 1 and 2 are: • Mean change from baseline of clinical status using an 8-point ordinal scale (with 8 being "Not hospitalized, no limitations on activities", and 1 being "Death") at Days 7 and 14
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Time frame: 14-days post enrollment
Efficacy measured by mean change in hospitalization days on Days 7 and 14.
Additional secondary endpoint for Parts 1 and 2, Cohorts 1 and 2 are: • Mean number of hospitalization days
Time frame: 14-days post enrollment
Efficacy measured by time to coming off supplemental oxygen on Days 7 and 14.
Additional secondary endpoint for Parts 1 and 2, Cohorts 1 and 2 are: • Time to coming off supplemental oxygen (defined as a score of ≥5 on an 8-point ordinal scale; Cohort 1 only)
Time frame: 14-days post enrollment
Safety and Efficacy measured by time from first dose to renal therapy.
Additional secondary endpoint for Cohort 2, Part 2 is: • Time to initiation of renal replacement therapy
Time frame: 60-days post enrollment