An Adaptive Study of Favipiravir Compared to Standard of Care in Hospitalized Patients With COVID-19

June 15, 2020 updated by: Chromis LLC

An Adaptive, Multicenter, Randomized, Open-label, Comparative Clinical Study to Assess Efficacy and Safety of Favipiravir in Hospitalized Patients With COVID-19

The study is Phase II/III and consists of pilot and pivotal stages. The objective of the pilot stage is to conduct a preliminary assessment of the efficacy and safety of Favipiravir, and to select the optimal dosing regimen to study during the pivotal stage. The objective of the pivotal stage is to assess the efficacy and safety of Favipiravir compared with the Standard of care (SOC) in hospitalized patients with moderate to severe COVID-19 pneumonia.

Study Overview

Status

Unknown

Conditions

Detailed Description

At the pilot stage: upon signing the informed consent form and screening, 60 eligible patients with polymerase chain reaction (PCR) confirmed COVID-19 pneumonia are randomized at a 1:1:1 ratio to receive either Favipiravir 1600 mg twice a day (BID) on Day 1 followed by 600 mg BID on Days 2-14 (1600/600 mg), or Favipiravir 1800 mg BID on Day 1 followed by 800 mg BID on Days 2-14 (1800/800 mg), or SOC.

At the pivotal stage: additional 270 eligible patients are randomized at a 1:1 ratio to receive either Favipiravir (the dose regimen depends of the subject's weight) or SOC.

Study Type

Interventional

Enrollment (Actual)

330

Phase

  • Phase 2
  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Makhachkala, Russian Federation
        • Republican Clinical Hospital
      • Moscow, Russian Federation
        • First Moscow State Medical University n.a. I.M. Sechenov
      • Moscow, Russian Federation
        • "K+31" Clinic
      • Moscow, Russian Federation
        • "Khaven" Llc
      • Moscow, Russian Federation
        • Central Clinical Hospital with Polyclinic
      • Moscow, Russian Federation
        • Central Research Institute of Epidemiology
      • Moscow, Russian Federation
        • City Clinical Hospital n.a. O.M. Filatov
      • Moscow, Russian Federation
        • City clinical hospital named after S.S. Yudin
      • Moscow, Russian Federation
        • City Clinical Hospital No. 24
      • Moscow, Russian Federation
        • City Clinical Hospital No. 51
      • Moscow, Russian Federation
        • Moscow State University n.a. M. V. Lomonosov
      • Moscow, Russian Federation
        • National Medical and Surgical Center named after N.I. Pirogov
      • Nizhny Novgorod, Russian Federation
        • City Hospital № 33 of the Leninsky region of Nizhny Novgorod
      • Nizhny Novgorod, Russian Federation
        • Infectious clinical hospital No.2 of Nizhny Novgorod
      • Ryazan, Russian Federation
        • Ryazan State Medical University named after I.P. Pavlov
      • Saint Petersburg, Russian Federation
        • Military Medical Academy named after S.M. Kirova
      • Saratov, Russian Federation
        • Saratov State Medical University named after V.I. Razumovsky
      • Smolensk, Russian Federation
        • Clinical hospital No.1
      • Tver, Russian Federation
        • Regional Clinic Hospital
      • Ufa, Russian Federation
        • Bashkir State Medical University
      • Yakutsk, Russian Federation
        • Yakutsk City Clinical Hospital
      • Yaroslavl, Russian Federation
        • Yaroslavl Regional Clinical Hospital for War Veterans

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Signed Patient Information Sheet and Informed Consent form to participate in the study.
  2. Men and women aged 18 years and older.
  3. Patients hospitalized with a diagnosis of COVID-19.
  4. The diagnosis of COVID-19 was confirmed by positive reverse transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2, performed no earlier than 7 days before hospitalization or at screening.
  5. Moderate severity of COVID-19 with pneumonia with at least 1 of the following symptoms:

    • Fever above 38 °C;
    • Cough;
    • Shortness of breath during physical exertion;
    • C reactive protein (CRP) of blood serum > 10 mg/l;
    • SpO2 < 95%
  6. The capability of oral drug administration.
  7. The patients' consent to use adequate contraception methods during the study (condom with spermicide) and for 3 months following completion.

Exclusion Criteria:

  1. Severe type of disease, with at least one of the following criteria:

    • Frequency of breath > 35 per minute, which does not decrease after the body temperature drops to normal or subfebrile values;
    • Blood oxygen saturation (SpO2) < 90% at rest;
    • Partial pressure of oxygen in arterial blood (PaO2) < 60 mm Hg;
    • Oxygenation index (RaO2/FiO2) ≤ 200 mm Hg;
    • Partial pressure of CO2 in arterial blood (PaCO2) < 60 mm Hg;
    • Septic shock.
  2. Patients treated with lopinavir/ritonavir, ribavirin, arbidol, chloroquine, hydroxychloroquine, mefloquine, favipiravir within 7 days prior to screening.
  3. Severe cardiovascular diseases currently or 6 months prior to randomization, including: New York Heart Association (NYHA) Class III or IV chronic heart failure, clinically significant ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation), unstable angina, myocardial infarction, heart and coronary vessel surgery, significant valvular heart disease, uncontrolled arterial hypertension with systolic blood pressure > 180 mm Hg and diastolic blood pressure > 110 mm Hg, pulmonary embolism or deep vein thrombosis.
  4. Severe chronic renal impairment (GFR < 30 ml / min) or continuous renal replacement therapy, hemodialysis or peritoneal dialysis.
  5. A history of cirrhosis or an increase in alanine aminotransferase (ALT) and / or aspartate aminotransferase (AST) > 5 times × upper limit of normal (ULN).
  6. Severe diseases of the central nervous system, including seizures in history or conditions that may lead to their development; stroke or transient ischemic attack within 12 months prior to screening; head injuries or loss of consciousness within 12 months prior to screening; a brain tumor.
  7. Significant uncontrolled concomitant disease, e.g. neurological, renal, hepatic, endocrinological or gastrointestinal disorder which according to the Investigator, could prevent the patient from participating in the study
  8. Malignancies that require chemotherapy within 6 months prior to screening.
  9. Known HIV infection
  10. Hypersensitivity to any component of the study drug.
  11. Participation in other clinical studies or taking other study drugs within 28 days prior to screening.
  12. Pregnant or lactating women or women planning to get pregnant during the clinical study; women of child-bearing potential (including non-sterilized by surgical means and during the post-menopause period less than 2 years) who do not use adequate contraception methods.
  13. Inability to read or write, unwillingness to understand and follow procedures of study protocol, as well as any other concomitant medical or serious mental conditions that make the patient unfit to participate in the study, limit the legality of obtaining informed consent or can affect patient's ability to participate in the study.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Sequential Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Favipiravir, lower dose (pilot stage)
1600mg BID on the 1st day followed by 600mg BID for 13 days
200 mg coated tablets
Other Names:
  • Avifavir
Experimental: Favipiravir, higher dose (pilot stage)
1800mg BID on the 1st day followed by 800mg BID for 13 days
200 mg coated tablets
Other Names:
  • Avifavir
Active Comparator: Standard of care (pilot stage)
Based on approved clinical recommendations for treatment of COVID-19 in the Russian Federation (but not Favipiravir). Might include hydroxychloroquine, chloroquine, lopinavir/ritonavir or other recommended schemes.
Standard of Care will be prescribed in accordance with the recommended treatment regimens presented in the Russian guidelines for the prevention, diagnosis and treatment of COVID-19 according to the decision of the Investigator.
Other Names:
  • Hydroxychloroquine, chloroquine, lopinavir/ritonavir, etc.
Experimental: Favipiravir, selected dose (pivotal stage)
The dose will be selected based on pilot study results.
200 mg coated tablets
Other Names:
  • Avifavir
Active Comparator: Standard of care (pivotal stage)
Based on approved clinical recommendations for treatment of COVID-19 in the Russian Federation (but not Favipiravir). Might include hydroxychloroquine, chloroquine, lopinavir/ritonavir or other recommended schemes.
Standard of Care will be prescribed in accordance with the recommended treatment regimens presented in the Russian guidelines for the prevention, diagnosis and treatment of COVID-19 according to the decision of the Investigator.
Other Names:
  • Hydroxychloroquine, chloroquine, lopinavir/ritonavir, etc.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Rate of viral elimination by Day 10 [pilot stage, dose selection]
Time Frame: 10 Days
Percent of patients with undetectable SARS-CoV-2 RNA level on Day 10
10 Days
Time to viral elimination [pivotal stage]
Time Frame: 28 Days
Median time to reach undetectable SARS-CoV-2 RNA level
28 Days
Time to clinical improvement [pivotal stage]
Time Frame: 28 Days
Median time reach clinical improvement (2 points of the Ordinal Scale for Clinical Improvement) or discharge from the hospital
28 Days

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Rate of viral elimination
Time Frame: Days 3, 5, 7, 9, and 11
Percent of patients with undetectable SARS-CoV-2 RNA level
Days 3, 5, 7, 9, and 11
Time to normalization of clinical symptoms
Time Frame: 28 Days
Median time [days] to reach normal levels of clinical indicators (body temperature, SpO2, breathing rate)
28 Days
Duration of oxygen therapy
Time Frame: 28 Days
Mean duration of oxygen therapy [days]
28 Days
Change in the level of lung damage according to CT
Time Frame: Days 15, 22, and 29
Change of lung damage level according to CT comparing to baseline [% of patients]
Days 15, 22, and 29
Rate of transfer to the intensive care unit
Time Frame: 28 days
Percent of patients transferred to the intensive care unit [% of patients]
28 days
Rate of the use of non-invasive lung ventilation
Time Frame: 28 days
Percent of patients undergoing non-invasive lung ventilation [% of patients]
28 days
Rate of the use of mechanical ventilation
Time Frame: 28 days
Percent of patients undergoing mechanical ventilation [% of patients]
28 days
Mortality
Time Frame: 28 days
Percent of patients died within 28-days period [% of patients]
28 days
Peak plasma concentration (Cmax)
Time Frame: Day 1
Determination of Cmax [ng/ml]
Day 1
Time to peak plasma concentration (Tmax)
Time Frame: Day 1
Determination of Tmax [h]
Day 1
Area under the plasma concentration versus time curve (AUC0-t)
Time Frame: 10 days
Determination of AUC0-t [ng*h/ml]
10 days
Trough plasma concentration (Ctrough)
Time Frame: 10 days
Determination of Ctrough [ng/ml]
10 days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Investigators

  • Principal Investigator: Elena Pavlikova, MD,PhD,Prof, Moscow State University n.a. M.V. Lomonosov
  • Principal Investigator: Nikita Lomakin, MD,PhD, Central Clinical Hospital with Polyclinic

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

April 23, 2020

Primary Completion (Anticipated)

July 1, 2020

Study Completion (Anticipated)

July 1, 2020

Study Registration Dates

First Submitted

June 13, 2020

First Submitted That Met QC Criteria

June 15, 2020

First Posted (Actual)

June 16, 2020

Study Record Updates

Last Update Posted (Actual)

June 16, 2020

Last Update Submitted That Met QC Criteria

June 15, 2020

Last Verified

June 1, 2020

More Information

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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