This is a randomized, double-blind, placebo-controlled, superiority phase IIa trial to assess the safety and efficacy of dupilumab use in hospitalized patients with moderate to severe COVID-19 infection. Subsequently, we conducted a 1 year follow up study to investigate the occurrence of Post COVID conditions (PCC) in our study population through assessment of pulmonary function, symptoms, neurocognition and immune biomarkers to observe for any treatment group differences.
A total of 40 eligible subject were enrolled and randomized in a 1:1 ratio to receive either dupilumab or placebo, stratifying on the disease severity measured by the required oxygen ≤ 15L or \> 15L by nasal cannula. Both arms received standard of care management per current National Institutes of Health (NIH) COVID-19 treatment guideline in addition to their randomized treatments. Patients were then followed prospectively for up to 360 days after enrollment. As an extension to the randomized double-blind placebo-controlled trial assessing dupilumab for treatment of those hospitalized with acute moderate to severe COVID-19, subjects were followed up at 1 year for evaluation of pulmonary function testing (PFT), pulmonary imaging, immune biomarkers, neurocognition and symptoms.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
40
UVA Health
Charlottesville, Virginia, United States
Day 28 Ventilator Free Survival
Proportion of patients alive and free of invasive mechanical ventilation
Time frame: at 28 Days ± 2d
Follow up Study 1 Year Outcome: Pulmonary Function Testing- Oxygen Diffusion and 6 Minute Walk Testing
Proportion of patients with abnormal diffusing capacity for carbon monoxide (DLCO) and/or 6 minute walk testing 1 year after acute COVID-19 infection.
Time frame: 365 ± 90 days
Proportion of Patients With Eosinophilia
defined as an absolute eosinophil count \> 0.6 k/µl at ≥ 1 measurement throughout the study period
Time frame: Day 0 through Day 60
Cumulative Incidence of Grade 3 and 4 Clinical Adverse Events, Serious Adverse Events (SAEs) or Death
defined as number of new events divided by the total number of individuals in the population at risk for the time interval
Time frame: Day 0 through Day 60
SARS-CoV-2 Variants
Prevalence of delta variant in study population.
Time frame: Day 0
Change in Plasma Total Immunoglobulin E (IgE) Levels
Change in levels (difference between day 14- day 0 levels).
Time frame: Day 0 and Day 14
Change in C-reactive Protein (CRP)
Change in levels (difference between day 14- day 0 levels)
Time frame: Day 0 through Day 14
Change in Ferritin
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Change in levels (difference between day 14- day 0 levels).
Time frame: Day 0 through Day 14
Duration of Hospitalization
Measured in days
Time frame: Day 0 through Day 30
Day 60 All Cause Mortality
All cause mortality by day 60
Time frame: Day 60
Day 28 All-cause Mortality Rate
Mortality rate
Time frame: at Day 28
Day 60 Ventilator Free Survival
Proportion of patients alive and free of invasive mechanical ventilation
Time frame: Day 60
Percentage of Patients Needing Extracorporeal Membrane Oxygenation (ECMO)
Percentage
Time frame: Day 0 through Day 60
Percentage of Patients Needing Renal Replacement Therapy
Percentage
Time frame: Day 0 through Day 60
Percentage of Patients Needing Vasopressors
Percentage
Time frame: Day 0 through Day 60
Follow Up Study 1 Year Outcome: All-cause Mortality at 1 Year
Percent of subjects who died by 1 year.
Time frame: 365 days
Follow-up Study 1 Year Outcome: Differences in High Resolution Computed Tomography (HRCT) Chest Scan Appearance Post Recovery
Compare Enrollment HRCT to 1 year HRCT. Percent of abnormal on CT. Reported as percent of subjects with any abnormality on CT.
Time frame: 365 ± 90 days
Follow-up Study 1 Year Outcome: Conduct a 6 Minute Walk Testing
Proportion of patients with greater than 3% oxygen desaturation during 6 minute walk testing
Time frame: 365 ± 90 days
Follow up Study 1 Year Outcome: Pulmonary Function Testing- Abnormal Spirometry
Percentage of subjects with a percent of predicted (compared to Global Lung Function Initiative (GLI) predicted values based on age, sex, height and ethnicity) below normal for forced expiratory volume (FEV1) or forced vital capacity (FVC), which are measures used to determine the volume of air that can be exhaled in one breath.
Time frame: 365 ± 90 days
Follow-up Study 1 Year Outcome: Assess Neurocognitive Function Using the MOCA
Determine the proportion of patients with reduce neurocognitive function. Neurocognitive testing included completion of Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, PROMIS Depression, the Montreal Cognitive Assessment (MOCA), the Insomnia Severity Index (ISI), the Katz Index of Independence In Activities of Daily Living (Katz-ADL), EuroQOL (EQ)-5D-5L and Neuro- Quality of Life (QoL) questionnaires. Reduced neurocognitive function was determined if scoring from at least one of these tests was deemed a variation from population norm per scoring instructions.
Time frame: 365 ± 90 days