InterLeukin-7 to Improve Clinical Outcomes in Lymphopenic pAtients With COVID-19 Infection FR BL Cohort (ILIAD-7-FR)

A Multicenter, Randomized, Double-blinded Placebo-controlled Study of Recombinant Interleukin-7 (CYT107) for Immune Restoration of Hospitalized Lymphopenic Patients With Coronavirus COVID-19 Infection in France and Belgium

Comparison of the effects of CYT107 vs Placebo administered IM at 10μg/ kg twice a week for two weeks on immune reconstitution of lymphopenic COVID-19 patients.

Study Overview

• Status: Terminated
• Conditions: COVID-19; Lymphocytopenia
• Intervention / Treatment: Drug: Interleukin-7; Drug: Placebo

Detailed Description

Approximately forty-eight (48) participants will be randomized 1:1 to receive (a) Intramuscular (IM) administration of CYT107 at 3 μg/kg followed, after 48hrs of observation, by 10 μg/kg twice a week for 2 weeks or (b) Intramuscular (IM) placebo (normal saline) at the same frequency. An interim safety review took place after the first 12 patients. Since the CYT107 was well tolerated, the test dose (3 μg/kg) ceased and the initial dose became the same as the rest of the doses (10 μg/kg). So, the remaining patients will be randomized to receive 5 administrations of (a) CYT107 at 10 μg/kg every 3 to 4 days for 2 weeks or (b) Intramuscular (IM) placebo (normal saline) at the same frequency. The aim of the study is to test the ability of CYT107 to produce an immune reconstitution of these patients and observe possible association with a clinical improvement

• Study Type: Interventional
• Enrollment (Actual): 34
• Phase: Phase 2

Contacts and Locations

Study Locations

• France
  • Limoges, France, 87042
    • University Hospital of Limoges
  • Lyon, France, 69003
    • Hôpital Edouard Herriot
  • Lyon, France, 69437
    • Hôpital Edouard Herriot
  • Orléans, France, 45067
    • CHR Orléans La Source
  • Paris, France, 75014
    • Hopital Cochin
  • Tours, France, 37000
    • CHRU Tours

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 25 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• A written, signed informed consent, or emergency oral consent, by the patient or the patient's legally authorized representative, and the anticipated ability for participant to be re-consented in the future for ongoing Study participation
• Men and women aged ≥ 25 - 80 (included) years of age
• Hospitalized patients with one absolute lymphocyte count (ALC) ≤ 1000 cells/mm3, collected at baseline or no more than 72h before baseline
• Hospitalized patients with moderate to severe hypoxemia requiring oxygen therapy at >4L per minute nasal cannula or greater to keep saturations >90%, non-invasive positive pressure ventilation (e.g., BIPAP) for respiratory failure
• Confirmed infection with COVID-19 by any acceptable test available/ utilized at each site
• Patient with medical insurance or government support

Exclusion Criteria:

• Pregnancy or breast feeding;
• Refusal or inability to practice contraception regardless of the gender of the patient;
• ALT and/or AST > 5 x ULN
• Known, active auto-immune disease;
• Ongoing cancer treatment with chemotherapy / immunotherapy or any cancer therapy within last 3 months and/or ongoing;
• Patients with past history of Solid Organ transplant.
• Active tuberculosis, uncontrolled active HBV or HCV infection, HIV with positive viral load.

• Patients whose respiratory condition is showing significant deterioration as indicated by:

  • 8a requirement for an increase in inspired oxygen concentrations of 20% or more over the past 24 hours to maintain SpO2 at greater than or equal to 88%
  • 8b or need for invasive mechanical ventilation
• Patients showing an increase of the NEWS2 score by more than 6 points during the screening / baseline period (48 to 72 hrs prior to first administration)
• Patients with chronic kidney dialysis
• Patients with a SOFA score ≥ 9 at baseline
• Patients with a BMI > 40
• Patients receiving any agent with immune suppressive effects,such as anti-IL6 treatments like Tocilizumab or Sarilumab which should preferably be minimized
• Presence of any of the following abnormal laboratory values at screening: absolute neutrophil count (ANC) < 1.5x109/L, Platelets < 50,000 per mm3
• Patients with uncontrolled pre-existing severe major organ dysfunction (cardiac, liver or renal failure)
• Vaccination with live attenuated vaccines in the month preceding the inclusion
• Use of chronic oral corticosteroids ≥ 10mg prednisone equivalent a day for a non-COVID-19 related condition
• Patients with baseline Rockwood Clinical Frailty Scale ≥ 6.
• Patients with known hypersensitivity to natural or recombinant Interleukin-7 or to any of the excipients
• Patients under guardianship

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: CYT107; Intra-muscular administration of CYT107 twice a week for a total of 5 administrations	Drug: Interleukin-7; Intramuscular (IM) administration of CYT107 at 3 μg/ kg followed, after 48hrs of observation, by 10 μg/kg twice a week for 2 weeks or; Other Names: CYT107
Placebo Comparator: Saline; Intramuscular (IM) administration of saline at the same volume and same time for a total of 5 administrations	Drug: Placebo; Intramuscular (IM) placebo (normal saline) at the same frequency; Other Names: Saline

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Improvement of the absolute lymphocyte count (ALC) of lymphopenic (ALC≤1000/mm3) COVID-19 infected participants out to approximately 30 days following initial Study drug administration or Hospital discharge (HD), whichever occurs first	A statistically significant increase of the absolute lymphocyte count (ALC) from randomization to day 30 or Hospital Discharge	1 month

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
a significant decline of SARS-CoV-2 viral load through day 30 or HD	The decrease of SARS-CoV-2 viral load from measurements at baseline and days of treatment dose 4 and dose 5, Day 21 and Day 30 or HD (whichever occurs first)	1 month or HD (whichever occurs first)
length of hospitalization compared to placebo arm	Number of days of hospitalization during index hospitalization (defined as time from initial Study drug treatment through HD)	45 days
length of stay in ICU compared to placebo arm	Number of days in ICU during index hospitalization	45 days
number of readmissions to ICU compared to placebo arm	Readmissions to ICU through Day 45	45 days
organ support free days compared to placebo arm	Organ support free days (OSFDs) during index hospitalization (This includes ventilator assistance free days)	45 days
Frequency of re-hospitalization through day 45 compared to placebo arm	Number of readmissions to the hospital through Day 45	45 days
All-cause mortality through day 45 compared to placebo arm	All-cause mortality through Day 45	45 days
level of other known biomarkers of inflammation: Ferritin compared to placebo arm	Track and evaluate other known biomarkers of inflammation, Ferritin, from baseline to day 30	30 days
Level of other known biomarkers of inflammation: CRP compared to placebo arm	Track and evaluate other known biomarkers of inflammation, CRP from baseline to day 30	30 days
Level of other known biomarkers of inflammation: D-dimer compared to placebo arm	Track and evaluate other known biomarkers of inflammation, D-dimer from baseline to day 30	30 days
Physiological status through NEWS2 evaluation compared to Placebo arm	Evaluate improvement of the NEWS2 score value. Score form 0 to 4: NO Risk Score of 7 or more: High risk	30 days
To obtain "clinical improvement" as defined by an improvement in a 11-points WHO score for Clinical Assessment, through day 30 or HD.	to determine if CYT107 will improve the clinical status of hospitalized COVID-19 patients as measured by 11 steps WHO clinical improvement score	1 month
frequency of secondary infections through day 45 compared tp placebo arm	Incidence of secondary infections based on pre-specified criteria as adjudicated by the Secondary Infections Committee (SIC) through Day 45	45 days
CD4+ and CD8+ T cell counts compared to placebo arm	Absolute numbers of CD4+ and CD8+ T-cell counts at timepoints indicated on the Schedule of Activities (SoA) through Day 30 or HD	30 days

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Safety assessment through incidence and scoring of grade 3-4 adverse events	Incidence and scoring of all grade 3-4 adverse events through Day 45 (using CTCAE Version 5.0 to assess severity)	45 days

Collaborators and Investigators

• Sponsor: Revimmune
• Collaborators: University Hospital, Limoges; Amarex Clinical Research
• Investigators: Study Chair: Bruno François, MD, University Hospital, Limoges

Publications and helpful links

General Publications

• Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3. Epub 2020 Mar 11. Erratum In: Lancet. 2020 Mar 28;395(10229):1038. Lancet. 2020 Mar 28;395(10229):1038.
• Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020 Mar 17;323(11):1061-1069. doi: 10.1001/jama.2020.1585. Erratum In: JAMA. 2021 Mar 16;325(11):1113.
• Francois B, Jeannet R, Daix T, Walton AH, Shotwell MS, Unsinger J, Monneret G, Rimmele T, Blood T, Morre M, Gregoire A, Mayo GA, Blood J, Durum SK, Sherwood ER, Hotchkiss RS. Interleukin-7 restores lymphocytes in septic shock: the IRIS-7 randomized clinical trial. JCI Insight. 2018 Mar 8;3(5):e98960. doi: 10.1172/jci.insight.98960.
• Venet F, Foray AP, Villars-Mechin A, Malcus C, Poitevin-Later F, Lepape A, Monneret G. IL-7 restores lymphocyte functions in septic patients. J Immunol. 2012 Nov 15;189(10):5073-81. doi: 10.4049/jimmunol.1202062. Epub 2012 Oct 10.

Study record dates

Study Major Dates

• Study Start (Actual): June 8, 2020
• Primary Completion (Actual): March 30, 2022
• Study Completion (Actual): March 30, 2022

Study Registration Dates

• First Submitted: May 27, 2020
• First Submitted That Met QC Criteria: May 28, 2020
• First Posted (Actual): May 29, 2020

Study Record Updates

• Last Update Posted (Actual): April 8, 2022
• Last Update Submitted That Met QC Criteria: March 30, 2022
• Last Verified: March 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Immunologic Deficiency Syndromes; Immune System Diseases; Pneumonia, Viral; Pneumonia; Lung Diseases; Hematologic Diseases; Leukopenia; Leukocyte Disorders; COVID-19; Lymphopenia
• Other Study ID Numbers: CLI107 COVID FR (ILIAD-7-FR)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: publication

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No