The study aims at assessing the non-inferiority of tixagevimab plus cilgavimab and nirmatrelvir plus ritornavir vs. sotrovimab (reference standard due to the wider evidence gathered on its efficacy) on COVID-19 progression in a real-life setting of outpatients aged at least 50 years at an early stage of the disease. The progression of COVID-19 disease (hospitalization, need for supplementary oxygen therapy at home, death) within 14 days of randomisation is the composite outcome variable on which the calculation of the sample size is based. Based on available data regarding the reduction in the number of hospitalisations and medical visits with the use of sotrovimab at an early-stage of COVID-19, a disease progression of 1% has been estimated in the reference arm. 3% delta margin was considered clinically relevant, taking into account both the estimates of disease progression in the study population in absence of early treatment (7%, based on national data) and the efficacy of the reference standard. Therefore, 1095 participants will be randomly assigned in an equal ratio between the reference standard and each of the other two experimental arms (1:1:1). Randomization will be computer-generated in permuted blocks with a stratification based on site.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
536
Single intravenous infusion of sotrovimab 500 mg (500 mg/8 mL), administered in 100 mL prefilled 0.9% sodium chloride injection infusion solution over 1/2 hour.
2 subsequent injections: 1. tixagevimab 300mg/3mL (100mg/mL) 2. cilgavimab 300mg/3mL (100mg/mL)
300 mg nirmatrelvir (two 150 mg tablets) with 100 mg ritonavir (one 100 mg tablet) with all three tablets taken together twice daily for 5 days
RCCS Policlinico di S. Orsola
Bologna, Italy
PO SS Trinità di Cagliari
Cagliari, Italy
Azienda Ospedaliera Cannizzaro
Catania, Italy
Azienda Ospedaliera Universitaria Policlinico Vittorio Emanuele
Catania, Italy
PO Garibaldi Nesima
Catania, Italy
Azienda Socio-Sanitaria Territoriale di Cremona
Cremona, Italy
Ospedale S. Maria Annunziata
Florence, Italy
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Milan, Italy
Azienda Ospedaliera dei Colli, presidio ospedaliero Cotugno
Napoli, Italy
Azienda Ospedaliera di Padova
Padua, Italy
...and 9 more locations
COVID-19 progression
(1) hospitalization or (2) need of supplemental oxygen therapy at home or (3) death within 14 days of randomisation
Time frame: 14 days
Visits to the Emergency Room
Number of visits to the Emergency Room without subsequent hospitalization within 28 days of randomization
Time frame: 28 days
Duration of supplemental oxygen therapy
Days of supplemental oxygen therapy within 90 days of randomization
Time frame: 90 days
Duration of hospitalization
Days of any hospitalization within 90 days of randomization
Time frame: 90 days
Non-invasive ventilation
Rate of patients undergoing non-invasive ventilation within 28 days of randomization
Time frame: 28 days
Duration of non-invasive ventilation
Days of non-invasive ventilation within 90 days of randomization
Time frame: 90 days
Mechanical ventilation
Rate of patients undergoing mechanical ventilation within 28 of randomization
Time frame: 28 days
Duration of mechanical ventilation
Days of mechanical ventilation within 90 days of randomization
Time frame: 90 days
28-day mortality
Death rate at 28 days of randomization
Time frame: 28 days
90-day mortality
Death rate at 90 days of randomization
Time frame: 90 days
Duration of symptoms
Days of symptoms within 90 days of randomization
Time frame: 90 days
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