- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04623255
Randomised Study of Plasma Exchange in Severe COVID-19 (COVIPLEX)
A Randomised Controlled Trial of Plasma Exchange With Standard of Care Compared to Standard of Care Alone in the Treatment of Severe COVID-19 Infection (COVIPLEX)
Study Overview
Detailed Description
COVID19 is a viral pandemic associated with primarily respiratory pathology, in the form of microvascular and macrovascular thrombosis. In patients requiring hospital admission, there is severe disease, requiring respiratory support, from high dose oxygen therapy or ventilatory assistance, which may be invasive or non invasive. The pathology of COVID19 is poorly understood, but it is accepted there is an inflammatory-thrombotic basis. Despite current therapeutic platforms, there is no consensus on a specific therapy within a trial setting that has proven benefit in severe COVID 19.
Thrombotic microangiopathies, such as TTP, are a different disease, but have a comparable prothrombotic phenotype, and similar or higher inflammatory parameters, including D Dimers, ferritin, LDH and IL-6 at acute presentation and resolve with plasma exchange (PEX). The rationale in severe COVID19 infection is to undertake PEX to aid reduction of the hyperinflammation and reduce the morbidity and mortality to the lungs, but also systemically, such as the heart, kidneys and brain. A feasibility study of PEX therapy has been undertaken and confirmed a reduction in the inflammatory markers, no VTE/arterial events and normalisation of the renal function and cardiac function throughout the period of therapy. As plasma exchange is an intensive treatment modality, blocks of 5 daily PEX will be undertaken. Further blocks of PEX treatment can be initiated as dictated by the clinical and laboratory parameters. Unlike many therapeutic schedules, there is no immunosuppression associated with PEX; indeed, the resulting decrease in inflammatory markers were shown to be associated with an increase and sustained lymphocytes count. Therefore, as patients with COVID-19 have elevated procoagulant factors including VWF and factor VIII secondary to direct endothelial activation. This is associated with an exaggerated pro-inflammatory immune response and microvascular thrombosis; resulting in multi-organ dysfunction and eventually death. PEX will improve coagulopathy, as measured by VWF:ADAMTS 13 ratio and D Dimers, with an associated reduction in inflammation, organ-related microthrombosis, and ventilatory support.
Study Type
Enrollment (Anticipated)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
-
London, United Kingdom, NW1 2PG
- Recruiting
- University College London Hospital
-
Contact:
- I Obu
- Phone Number: 0207 679 6428
- Email: uclh.ttp@nhs.net
-
Contact:
- Prof Marie Scully
- Phone Number: 0207 679 6428
- Email: uclh.ttp@nhs.net
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age 18-70
- Proven COVID-19/high clinical suspicion of COVID-19
- Hypoxia/respiratory compromise defined as requiring respiratory support of >2L/min of oxygen by nasal cannulae to maintain SpO2<96%.
Raised inflammatory parameters: at least 2 of the following:
- Raised LDH (> 2 x ULN)
- Raised D Dimers (> 2X ULN)
- Raised CRP (>2X ULN)
- Females of childbearing potential have a negative pregnancy test within 7 days prior to being randomised. Participants are considered not of child bearing potential if they are surgically sterile (i.e. they have undergone a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or they are postmenopausal
Exclusion Criteria:
Significant co-morbid illness with treatment escalation limited to CPAP
- Active bleeding
- PF ratio < 100 on mechanical ventilation OR noradrenaline requirement > 0.5mcg/kg/min to maintain MAP > 65mmHg (suggests futility)
- Known allergies to Octaplas or excipients
- Females who are pregnant
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: STANDARD OF CARE
Standard patient care for severe COVID-19
|
|
Active Comparator: Plasma exchange
Standard patient care for severe COVID-19 with.
plasma exchange daily for 5 days x 3 courses as required
|
plasma exchange
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Inflammatory Marker-CRP
Time Frame: 5 days
|
To compare the change in inflammatory markers with Plasma Exchange and control groups in patients with severe COVID-19
|
5 days
|
Change in Inflammatory Marker-D Dimer
Time Frame: 5 DAYS
|
To compare the change in inflammatory markers with Plasma Exchange and control groups in patients with severe COVID-19
|
5 DAYS
|
Change in Inflammatory Marker-LDH
Time Frame: 5 DAYS
|
To compare the change in inflammatory markers with Plasma Exchange and control groups in patients with severe COVID-19
|
5 DAYS
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rates of mechanical ventilation
Time Frame: 28 days
|
To compare rates of mechanical ventilation between Plasma Exchange (PEX) and control groups in patients with severe COVID requiring CPAP/ NIV at treatment onset
|
28 days
|
Rates of clinical thrombotic events
Time Frame: 28 days
|
To compare rates of clinical thrombotic events either venous (deep vein thrombosis DVT or pulmonary embolism PE) or arterial thrombus (cardiac, neurological and peripheral vascular) between Plasma Exchange (PEX) and control groups in patients with severe Covid-19
|
28 days
|
Change in inflammatory-thrombotic response
Time Frame: 28 days
|
To compare the change in the inflammatory-thrombotic response by monitoring von Willebrand factor VWFA antigen/ADAMTS 13 activity ratio between Plasma Exchange (PEX) and control groups in patients with severe COVID-19
|
28 days
|
To compare the incidence of acute kidney injury
Time Frame: 28 days
|
To compare the incidence of acute kidney injury as defined by KDIGO criteria between Plasma Exchange (PEX) and control groups in patients with severe COVID-19
|
28 days
|
Mortality at day 28
Time Frame: 28 days
|
To compare mortality at day 28 between the PEX and control groups
|
28 days
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Marie Scully, MD, UCLH
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 132796
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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