Plasma Exchange Therapy for Post- COVID-19 Condition: A Pilot, Randomized Double-Blind Study
Study Details
Study Description
Brief Summary
PAX is a prospective, randomized (1:1), double-blind, placebo-controlled study, that have as a objective to evaluate the safety and tolerability of plasma exchange (PE) in patients with Post Acute Covid-19 Syndrome (PCC) comparing to sham plasma exchange. The participants will be randomized in two arms: (1) 6 sessions of PE (Plasma Exchange) with human serum albumin 5% or (2) 6 sessions with placebo (infusion of of sterile saline solution 0.9%) on days 1, 3, 8, 10, 15 and 17.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 2 |
Detailed Description
Randomized participants will receive plasma exchange (PE) or sham PE (placebo) (6 sessions:
V2, V3, V4, V5, V6 and V7) and will continue their follow-up visits(V8d22, V9d45, V10d90). Plasma volumes will be replaced, which will vary depending on sex, height, weight and hematocrit.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: Plasma Exchange 6 sessions of PE with human serum 5% albumin. Plasma exchange sessions will occur on days 1, 3, 8, 10, 15 and 17 |
Combination Product: Plasma Exchange Procedure
Plasma exchanges will be performed with 5% albumin as the replacement fluid. The typical schedule prescribed will be an exchange of 1 volemia. Blood will be separated into cells and plasma; the cells will be combined with reconstituted 5% human serum albumin and reinfused into the patient with normal saline
Other Names:
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Sham Comparator: Sham Plasma Exchange 6 sessions of sham plasma exchange (one infusion of sterile saline solution 0.9%) on days 1, 3, 8, 10, 15 and 17. |
Other: Sham Plasma Exchange Procedure
For sham plasma exchange procedures, a sound behind the curtain will be performed imitating the sound of the cell processing platform. In these cases, only one infusion of 200 to 250ml of sterile saline solution 0.9% will be performed during the time stablished for all procedures. Albumin will not be necessary for those patients in the Sham plasma exchange arm
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Outcome Measures
Primary Outcome Measures
- Evaluate the safety and tolerability of PE in patients with Post-Acute Covid-19 Syndrome (PCC) comparing to sham plasma exchange (placebo) [Within 90 days from the treatment start]
Proportion of adverse events (AEs) through day 90, considering: All AEs Grade 3 and 4 AEs AEs leading to study discontinuation
- Proportion of subjects with Grade 0, 1 o 2 functional disability assessed by the functional status scale (PCFS) [From baseline to day 90]
Grade 0, 1 o 2 functional disability assessed by the functional status scale (PCFS), being 0 the better outcome and 4 the worse outcome
- Proportion of subjects with Grade 0, 1 o 2 functional disability assessed by the fatigue severity scale (FSS) [From baseline to day 90]
Grade 0, 1 o 2 functional disability assessed by the fatigue severity scale (FSS), being 1 the better outcome and 70 the worse outcome
Secondary Outcome Measures
- Assess the ability of PE to improve PCC symptoms [At days 0, 8, 15, 22, 45 and 90]
Can Ruti PCC symptoms scale questionnare by days 0, 8, 15, 22, 45 and 90
- Assess the impact of PE on quality of life in subjects with PCC [At day 0, 8, 15, 22, 45 and 90.]
Quality of life questionnaires: EuroQol-5D questionnaire being 5 the better outcome and 15 the worse outcome.
- Assess the impact of PE on quality of life in subjects with PCC using MOS-HIV questionnaire [At day 0, 8, 15, 22, 45 and 90.]
Quality of life questionnaires: MOS-HIV questionnaire being 4 the better outcome and 1 the worse outcome.
- Assess the impact of PE on neurocognitive symptoms in subjects with PCC using NeuScreen fluency Test [At days 0, 22 and 90]
The neurocognitive evaluation assessed by the NeuScreen fluency test (Seconds)
- Assess the impact of PE on neurocognitive symptoms in subjects with PCC using MEF-30 questionnaire [At days 0, 22 and 90]
The neurocognitive evaluation assessed by the MEF-30 questionnaire, with being 0 the better outcome and 120 being the worse outcome.
- Assess the impact of PE on neurocognitive symptoms in subjects with PCC using HADs questionnaire [At days 0, 22 and 90]
The neurocognitive evaluation assessed by the HADs questionnaire, with being 0 as the better outcome and 21 being the worse outcome.
- Changes in cellular anti-SARS-CoV-2 immunity associated with PE in subjects with PCC by the determination of SARS-CoV-2 specific igG [At day 0, 8, 15, 22, 45 and 90.]
Changes in cellular anti-SARS-CoV-2 immunity associated with PE in subjects with PCC by the determination of SARS-CoV-2 specific igG in plasma (Arbitrary Units, AU)
- Changes in cellular anti-SARS-CoV-2 immunity associated with PE in subjects with PCC by the neutralization activity evaluation [At day 0, 8, 15, 22, 45 and 90.]
Changes in cellular anti-SARS-CoV-2 immunity associated with PE in subjects with PCC by the analysis of reciprocal titers of neutralizing antibodies against SARS-CoV-2
- Changes in cellular anti-SARS-CoV-2 immunity associated with PE in subjects with PCC by the T-Cell response [At day 0, 8, 15, 22, 45 and 90.]
Changes in cellular anti-SARS-CoV-2 immunity associated with PE in subjects with PCC by the reduction of T-Cell response (%) from plasma samples
- Determination of residual SARS-CoV-2 particles (RNA) in plasma from subjects with PCC [At days 0, 8, 15, 22, 45, and 90]
Virological assessment to determine the residual SARS-CoV-2 RNA (copies/mL)
- Changes in microbiota associated with PE in subjects with PCC [At day 1, 8, 15, 22, 45 and 90]
Stool assessment to determine the residual SARS-CoV-2 RNA (copies/mL)
Eligibility Criteria
Criteria
Inclusion Criteria:
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Male or female individuals 18 years-old or older.
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Evidence of previous SARS-CoV-2 infection at least 90 days prior to study recruitment, defined by either (a) Nasopharyngeal SARS-CoV-2 nucleic acid test (Polymerase chain reaction [PCR] or Transcription-Mediated Amplification [TMA] (b) validated Nasopharyngeal Lateral Flow Assay rapid antigen test [RAT], or (c) SARSCoV-2 serology before SARS-CoV-2 vaccination.
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Symptoms of PCC after 90 days of infection and that last for at least 2 months and cannot explained by an alternative diagnosis.
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Not able to perform all usual duties/ activities due to symptoms, pain, depression or anxiety, defined as grades 3 or 4 in the post-COVID-19 Functional Status (PCFS) scale.
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Availability of an adequate peripheral venous cannulation.
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If women of childbearing potential, use of a highly effective method of contraception (abstinence, hormonal contraception, intra-uterine device [IUD], or anatomical sterility in self).
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Willing to comply with the requirements of the protocol and available for followup for the planned duration of the study.
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Has understood the information provided and capable of giving informed consent. Exclusion criteria
Exclusion Criteria:
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SARS-CoV-2 infection diagnosed during the previous 90 days.
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Last SARS-CoV-2 vaccine dose during the previous 30 days.
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No significant limitations in the subject's ability to perform all usual duties/activities (i.e., grades 0, 1 or 2 in PCFS scale).
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Medical conditions for which 250 mL of intravenous fluid is considered dangerous (i.e., decompensated heart failure or renal failure with fluid overload, among others).
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Pregnant or breastfeeding women.
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Contraindications for therapeutic PE: Non-availability of an adequate peripheral venous catheter, hemodynamic instability, septicemia, known allergy to fresh frozen plasma or replacement colloid/albumin, known allergy to heparin.
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Current or planned hospital admission for any cause during the study follow-up.
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Inability to consent and/or comply with study requirements, in the opinion of the investigator.
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Currently participating or planning to participate in any other clinical trial until day 90 of follow-up.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Germans Trias i Pujol Hospital | Badalona | Barcelona | Spain | 08916 |
Sponsors and Collaborators
- Fundación FLS de Lucha Contra el Sida, las Enfermedades Infecciosas y la Promoción de la Salud y la Ciencia
- IrsiCaixa
- Banc de Sang i Teixits
Investigators
- Principal Investigator: Lourdes Mateu Pruñonosa, PhD, MD, Germans Trias i Pujol Hospital
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- PAX