ASKCOV: Antisense Therapy to Block the Kallikrein-kinin Pathway in COVID-19
Study Details
Study Description
Brief Summary
Up to 1/3 of all patients infected with COVID-19 can develop complications that require hospitalization. Severe pneumonia associated with acute respiratory distress syndrome (ARDS) is the most threatening and feared complication of COVID-19 infection, with mortality rates close to 50% in some groups.
Autopsies between these severe cases reveal severe capillary involvement, with signs of intense inflammatory changes, microvascular thrombosis, endothelial injury and abnormal tissue repair. The available evidence suggests that abnormal activation or imbalance in the counter-regulation of the kallikrein-kinin system may play a central role in a positive feedback cycle, leading to consequent diffuse microangiopathy. Blockade of the kallikrein-kinin system can therefore prevent deterioration of lung function by reducing inflammation, edema and microthrombosis.
The objective of this phase IIb study is to assess the preliminary effects on the oxygenation parameters of an antisense oligonucleotide that inhibits pre-kallikrein synthesis in patients with moderate to severe COVID-19.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 2 |
Detailed Description
The objective of this phase IIb study is to assess the preliminary effects on the oxygenation parameters of an antisense oligonucleotide that inhibits pre-kallikrein synthesis in patients with moderate to severe COVID-19.
This is a blind randomized pilot clinical study which aims to include 110 patients (55 per arm).
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Placebo Comparator: Placebo 1.2 mL Normal Saline, single dose subcutaneous, after randomization |
Drug: Normal Saline
1.2 mL subcutaneous
|
Active Comparator: ISIS 721744 1.2 mL ISIS 721744, single dose subcutaneous, after randomization |
Drug: ISIS 721744
1.2 mL of ISIS 721744 subcutaneous once after randomization
|
Outcome Measures
Primary Outcome Measures
- Days alive without respiratory support (any supplemental oxygen) after 15 days (DAFOR15) [15 days]
Number of days the patient is alive and not receiving any supplementary respiratory support (oxygen, non-invasive ventilation, high flow nasal catheter or mechanical ventilation) during 15 days
Secondary Outcome Measures
- SOFA - Sequential Organ Failure Assessment Score up to 15 days after randomization [15 days]
Sequential Organic Failure Assessment [SOFA]. This will be a primary secondary outcome. Analysis will check for trends in SOFA up to 15 days in a single model.
- Need for mechanical ventilation [30 days (or until hospital discharge)]
Intubation and initiation of mechanical ventilation for any given reason
- Duration of mechanical ventilation [30 days (or until hospital discharge)]
Number of days the patient remains in mechanical ventilation
Other Outcome Measures
- Oxygenation index [14 days]
Daily oxygenation levels assessed using the ROX index [(Oxygen Saturation/Inspired Fraction)/Respiratory Rate] from randomization to discharge or day 14, whichever comes first.
- C-reactive protein levels during first 15 days after randomization [15 days]
C-reactive protein levels over time up to 15 days or hospital discharge.
- Lymphocyte/neutrophil ratio during first 15 days after randomization [15 days]
Lymphocyte/neutrophil ratio over time up to 15 or until discharge discharge day.
- D-dimer serum level during first 15 days after randomization [15 days]
D-dimer serum levels over time or until hospital discharge.
- Fibrinogen serum levels during first 15 days after randomization [15 days]
Fibrinogen serum levels over time up to 15 days or until hospital discharge
- Prothrombin Time levels during first 15 days after randomization [15 days]
Prothrombin Time over time up to 15 days or until hospital discharge.
- Activated Partial Thromboplastin Time during first 15 days after randomization [15 days]
Activated Partial Thromboplastin Time over time up to 15 days or until hospital discharge.
- Mortality [1 year after randomization]
One-year all cause mortality
- Euroquol questionnaire for quality of life with 5 dimensions (EQ-5D) [1 year after randomization]
Quality of Life measured by EQ-5D from 11111-33333, lower values being better
Eligibility Criteria
Criteria
Inclusion Criteria:
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Patients with COVID-19 who need supplemental oxygen
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Women must not be pregnant or breastfeeding, and must be surgically sterile or in the postmenopausal stage (without risk of becoming pregnant).
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Men must be surgically sterile or abstinent or, if they are having sex with risk of pregnancy, the subject must use an effective method of contraception from the moment they sign the informed consent form until at least 24 weeks after the dose of the study drug (ISIS 721744 or placebo).
Exclusion Criteria:
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Patients on invasive mechanical ventilation or who may need mechanical ventilation for the next 24 hours. The use of non-invasive ventilation and/or a high-flow nasal catheter is permitted.
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Patients with > 10 days since symptom onset or more than 48h of oxygen use
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Pregnancy, breast-feeding or risk of becoming pregnant
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Hemodynamically unstable (use of vasoconstrictors, such as norepinephrine, at any dose)
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Previous diagnosis of heart failure at functional class III or IV
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Previous uncontrolled hypertension (more than 3 drug classes use at home)
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Severe lung disease (use of home oxygen)
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Age < 18 and > 80 years
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Physician and family not committed to full life support and/or with severe existing illness with a life expectancy of less than 12 months
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Refusal to accept informed consent and/or unwillingness to comply with all requirements of the study procedure and security monitoring
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Hospital Naval Marcílio Dias | Rio De Janeiro | Brazil | ||
2 | BP-A Beneficiência Portuguesa de São Paulo | São Paulo | Brazil | ||
3 | Hospital São Paulo - UNIFESP | São Paulo | Brazil |
Sponsors and Collaborators
- Hospital do Coracao
- Ionis Pharmaceuticals, Inc.
- Hospital Moinhos de Vento
Investigators
- Principal Investigator: Fernando G Zampieri, MD, Research Coordinator
- Study Chair: Alexandre B Cavalcanti, Institute Director
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- ASKCOV_Trial