Tolerability and Efficacy of RJX in Patients With COVID-19 (RJX)

A Two-part, Two-cohort, Double-blind, Randomized, Placebo-controlled, Multicenter Phase 1/2 Study to Evaluate the Safety, Tolerability and Efficacy of REJUVEINIX (RJX) in Patients With COVID-19

This study is designed as a 2-part, 2-cohort, double-blind, randomized, placebo controlled, multicenter Phase 1/2 study to evaluate the safety, tolerability and efficacy of RJX in patients with COVID-19.

Study Overview

• Status: Active, not recruiting
• Conditions: COVID-19; Acute Respiratory Distress Syndrome; SARS-CoV-2; Hypoxemia
• Intervention / Treatment: Drug: Rejuveinix (RJX) Active Comparator; Drug: Placebo Comparator

Detailed Description

For each cohort, there will be an open label Safety Lead-in (Part 1) and a placebo controlled, randomized, double-blind portion (Part 2). In Part 1, RJX will be administered daily for 7 days. In the active treatment arm of Part 2 for both cohorts, RJX will be administered daily for 7 days per cycle and patients may receive up to 2 cycles. As detailed below, patients will be allowed to receive a second 7 day cycle of therapy based on the medical judgment of the Investigator. The total RJX exposure during Part 2 could therefore be up to 14 days. Both cohorts will start and enroll in parallel and independently. A safety follow-up period will begin at Day 14/Discharge, or when treatment is discontinued, and will continue for approximately 60 days post discharge. Part 1 will be conducted at a single site and Part 2 will be conducted at multiple sites. The 2 cohorts in this study are:

• Cohort 1:

  • Hospitalized COVID-19 patients ≥18 years without hypoxemia who are either not receiving any oxygen therapy OR are receiving supplemental oxygen via mask or nasal prongs (namely, clinical status score 4 or 5 on an 8-point ordinal scale).

  • Patients are required to have the following high-risk characteristics

    1. Age ≥65 years AND type 2 diabetes or hypertension OR

    2. Age ≥18 years with abnormal blood tests AND CRP >50 mg/L PLUS at least 1 of the following biomarkers:

       1. D-dimer >1,000 ng/mL,
       2. Ferritin >500 µg/L,
       3. High sensitivity cardiac troponin >2 × upper limit of normal (ULN),
       4. LDH >245 U/L.

• Cohort 2:

  • Hospitalized COVID-19 patients with hypoxemia without ARDS who are receiving either non-invasive positive pressure ventilation (NIPPV) OR high flow oxygen (namely, clinical status score 3 on an 8-point ordinal scale).

• Study Type: Interventional
• Enrollment (Anticipated): 237
• Phase: Phase 2; Phase 1

Contacts and Locations

Study Locations

• United States
  • Texas
    • Houston, Texas, United States, 77024
      • Memorial Hermann Memorial City Medical Center
    • Houston, Texas, United States, 77089
      • Memorial Hermann Southeast Hospital
    • New Braunfels, Texas, United States, 78130
      • Christus Santa Rosa Hospital

Participation Criteria

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

Cohort 1 (Part 1 and Part 2):

1. Hospitalized COVID-19 patients ≥18 years without hypoxemia who are either not receiving any oxygen therapy OR are receiving supplemental oxygen via mask or nasal prongs (namely, clinical status score 4 or 5 on an 8-point ordinal scale)
2. Hospitalized COVID-19 patients age ≥65 years AND type 2 diabetes or hypertension, OR

3. Hospitalized COVID-19 patients ≥18 years AND abnormal blood tests with CRP >50 mg/L PLUS at least 1 of the following biomarkers:

   1. D-dimer >1,000 ng/mL
   2. Ferritin >500 µg/L
   3. High sensitivity cardiac troponin >2 × ULN
   4. LDH >245 U/L

   Cohort 2 (Part 1 and Part 2):

4. Hospitalized COVID-19 patients with hypoxemia who are either receiving NIPPV OR high-flow oxygen (namely, clinical status score 3 on an 8-point ordinal scale).
5. Bilateral opacities on a chest x-ray OR chest CT scan. Cohort 1 and Cohort 2 (Parts 1 and 2)
6. Male and non-pregnant, non-lactating female patients with SARS-CoV-2 infection that is documented by a Food and Drug Administration (FDA)-authorized diagnostic reverse transcription polymerase chain reaction test at/or within 4 days of Screening
7. ≥18 years of age
8. Body weight ≥40 kg at Screening
9. History of COVID-19 within the last 2 weeks prior to study enrollment
10. The patient OR a legally authorized representative has provided written informed consent
11. Females of childbearing potential must have a negative beta human chorionic gonadotropin pregnancy test at Screening
12. Females of childbearing potential must agree to be abstinent or else use a medically acceptable form of contraception from the Screening period through Day 28. Medically acceptable forms of contraception including implants, injectables, combined oral contraceptives, some intrauterine devices, sexual abstinence or vasectomy, and double-barrier method [condom and occlusive cap (diaphragm or cervical/vault caps)] with spermicidal foam/gel/film/suppository

Exclusion Criteria Cohort 1

1. Receiving high-flow oxygen OR NIPPV. Cohort 1 and Cohort 2
2. ARDS by Berlin definition (Appendix 16.2)
3. On extracorporeal membrane oxygenation
4. Uncontrolled hypertension (systolic blood pressure [BP] >150 mmHg and/or diastolic BP >100 mmHg), unstable angina, congestive heart failure of New York Heart Association Classification Class III or IV (i.e., Class III: marked limitation in activity due to symptoms, even during less-than-ordinary activity, e.g., walking short distances [20 100 m], comfortable only at rest; Class IV: severe limitations, experiences symptoms even while at rest, mostly bedbound patients), serious cardiac arrhythmia requiring treatment (exceptions: atrial fibrillation, paroxysmal supraventricular tachycardia), history of myocardial infarction within 12 months prior to enrollment
5. Subjects with a history of congenital long QT syndrome or of Torsades de pointes; subjects with bradycardia (<60 bpm), heart block (excluding 1st degree block, being PR interval prolongation only); subjects with any of the following findings on electrocardiogram (ECG): QTc interval >470 msec in women OR >450 msec in men; subjects requiring any drugs known to prolong the QTc interval, including antiarrhythmic medications
6. Shock or hypotension requiring vasoactive peptides, such as dopamine, norepinephrine, epinephrine, or dobutamine
7. Renal function impairment with creatinine ≥2 mg/dL
8. Liver function impairment with total bilirubin ≥2 mg/dL
9. Platelet count <50,000/µL
10. Multi-organ failure
11. History of an allergic reaction or hypersensitivity to the study drug or any component of the study drug formulation
12. Use of systemic corticosteroids, nonsteroidal anti-inflammatory drugs, antibiotics, and antiviral drugs that are not part of the standard of care
13. Presence of any uncontrolled concomitant illness (e.g., bacterial sepsis or invasive fungal infection), or other serious illness and medical conditions, or other medical history, including laboratory results, which, in the Investigator's opinion, would be likely to interfere with their participation in the study
14. Pregnancy or breast-feeding (for women)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: DOUBLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
ACTIVE_COMPARATOR: Arm A: RJX; RJX 20 mL (10 mL of Vial A plus 10 mL of Vial B) mixed in normal saline, total volume 120 mL, administered by IV infusion over a period of 40 minutes +/- 10 minutes once daily.; Standard of care (current antiviral and/or supportive care treatment currently in place at the institution for COVID-19 treatment).; Patients in Part 1 are allowed to receive only one 7-day cycle of RJX while patients in Part 2 may be treated daily for up to 14 days.	Drug: Rejuveinix (RJX) Active Comparator; Active drug comprised of: ascorbic acid, magnesium sulfate heptahydrate, cyanocobalamin, thiamine, riboflavin 5' phosphate, niacinamide, pyridoxine, calcium d-pantothenate, and sodium bicarbonate.; Other Names: RJX; Rejuveinix
PLACEBO_COMPARATOR: Arm B: Placebo; Placebo (total of 20 mL normal saline) mixed in normal saline IV, total volume 120 mL of normal saline IV, administered by IV infusion over a period of 40 minutes +/- 10 minutes once daily.; Standard of care (current antiviral and/or supportive care treatment currently in place at the institution for COVID-19 treatment).; Patients in Part 1 will not receive placebo.; Patients in Part 2 may be treated daily for up to 14 days.	Drug: Placebo Comparator; 0.9% Sodium Chloride in Water for Injection a.k.a. Normal Saline for injection; Other Names: 0.9% Sodium Chloride in Water for Injection, USP.; Normal Saline for Injection, USP

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Safety as measured by DLTs and drug related SAE's	• Part 1, Cohorts 1 and 2: Cumulative incidence of DLTs and drug-related SAEs (viz., sum of DLT + SAEs) reported within 14 days of first dose of RJX (Part 1) or reported within 60 days of first dose of study drug (Part 2)	Up to 60 days post-enrollment
Tolerability and Efficacy measured by progression of disease through an ordinal scale.	• Part 2, Cohort 1: Progression to severe disease on an 8-point ordinal scale from a clinical status score of 4 or 5 to a clinical status score of 3, 2, or 1 within 2 weeks of first dose of study drug	Within 2 weeks
Efficacy measured by time to resolution of respiratory failure	• Part 2, Cohort 2: Time to resolution of respiratory failure (TTRRF), with status change on an 8-point ordinal scale from a clinical status score of 3 to a clinical status score of ≥4	60-days post enrollment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Efficacy as measured by day of ICU care.	The key secondary endpoints for Parts 1 and 2, Cohorts 1 and 2 are: • Mean number of days of ICU care	60-days post enrollment
Safety, Tolerability, Efficacy measured by mortality over 28 Days.	The key secondary endpoints for Parts 1 and 2, Cohorts 1 and 2 are: • Proportion of patients that die (any cause) by Day 28 post randomization (patient may be inpatient or outpatient in follow up)	28-days post enrollment
Efficacy measured by mean change in baseline clinical status on Days 7 and 14.	Additional secondary endpoint for Parts 1 and 2, Cohorts 1 and 2 are: • Mean change from baseline of clinical status using an 8-point ordinal scale (with 8 being "Not hospitalized, no limitations on activities", and 1 being "Death") at Days 7 and 14	14-days post enrollment
Efficacy measured by mean change in hospitalization days on Days 7 and 14.	Additional secondary endpoint for Parts 1 and 2, Cohorts 1 and 2 are: • Mean number of hospitalization days	14-days post enrollment
Efficacy measured by time to coming off supplemental oxygen on Days 7 and 14.	Additional secondary endpoint for Parts 1 and 2, Cohorts 1 and 2 are: • Time to coming off supplemental oxygen (defined as a score of ≥5 on an 8-point ordinal scale; Cohort 1 only)	14-days post enrollment
Safety and Efficacy measured by time from first dose to renal therapy.	Additional secondary endpoint for Cohort 2, Part 2 is: • Time to initiation of renal replacement therapy	60-days post enrollment

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Evaluate Change in Serum CRP Concentration	The exploratory endpoint for Parts 1 and 2 is: Kinetic of response of CRP (comparison of baseline to Day 7, Day 14, and Day 28 post-randomization). These laboratory measures will be obtained either as an inpatient or an outpatient follow-up.	Up to 28-days post randomization
Evaluate Change in Serum Ferritin Concentration	The exploratory endpoint for Parts 1 and 2 is: Kinetic of response of ferritin (comparison of baseline to Day 7, Day 14, and Day 28 post-randomization). These laboratory measures will be obtained either as an inpatient or an outpatient follow-up.	Up to 28-days post randomization
Evaluate Change in Serum D-dimer Concentration	The exploratory endpoint for Parts 1 and 2 is: Kinetic of response of D-dimer (comparison of baseline to Day 7, Day 14, and Day 28 post-randomization). These laboratory measures will be obtained either as an inpatient or an outpatient follow-up.	Up to 28-days post randomization
Evaluate Change in Serum LDH Concentration	The exploratory endpoint for Parts 1 and 2 is: Kinetic of response of LDH (comparison of baseline to Day 7, Day 14, and Day 28 post-randomization). These laboratory measures will be obtained either as an inpatient or an outpatient follow-up.	Up to 28-days post randomization
Evaluate Change in Serum IL-6 Concentration	The exploratory endpoint for Parts 1 and 2 is: Kinetic of response of IL-6 (comparison of baseline to Day 7, Day 14, and Day 28 post-randomization). These laboratory measures will be obtained either as an inpatient or an outpatient follow-up.	Up to 28-days post randomization
Evaluate Change in Serum IL-10 Concentration	The exploratory endpoint for Parts 1 and 2 is: Kinetic of response of IL-10 (comparison of baseline to Day 7, Day 14, and Day 28 post-randomization). These laboratory measures will be obtained either as an inpatient or an outpatient follow-up.	Up to 28-days post randomization
Evaluate Change in Serum TNF-α Concentration	The exploratory endpoint for Parts 1 and 2 is: Kinetic of response of TNF-α (comparison of baseline to Day 7, Day 14, and Day 28 post-randomization). These laboratory measures will be obtained either as an inpatient or an outpatient follow-up.	Up to 28-days post randomization
Evaluate Change in Serum TGF-β Concentration	The exploratory endpoint for Parts 1 and 2 is: Kinetic of response of TGF-β (comparison of baseline to Day 7, Day 14, and Day 28 post-randomization). These laboratory measures will be obtained either as an inpatient or an outpatient follow-up.	Up to 28-days post randomization
Evaluate Change in Serum C3 Concentration	The exploratory endpoint for Parts 1 and 2 is: Kinetic of response of C3 (comparison of baseline to Day 7, Day 14, and Day 28 post-randomization). These laboratory measures will be obtained either as an inpatient or an outpatient follow-up.	Up to 28-days post randomization
Evaluate Change in Serum C5 Concentration	The exploratory endpoint for Parts 1 and 2 is: Kinetic of response of C5 (comparison of baseline to Day 7, Day 14, and Day 28 post-randomization). These laboratory measures will be obtained either as an inpatient or an outpatient follow-up.	Up to 28-days post randomization
Evaluate Change in Plasma ascorbic acid Concentration	The exploratory endpoint for Parts 1 and 2 is: Kinetic of response of ascorbic acid (comparison of baseline to Day 7, Day 14, and Day 28 post-randomization). These laboratory measures will be obtained either as an inpatient or an outpatient follow-up.	Up to 28-days post randomization
Evaluate Change in plasma niacinamide Concentration	The exploratory endpoint for Parts 1 and 2 is: Kinetic of response of niacinamide (comparison of baseline to Day 7, Day 14, and Day 28 post-randomization). These laboratory measures will be obtained either as an inpatient or an outpatient follow-up.	Up to 28-days post randomization
Evaluate Change in plasma thiamine Concentration	The exploratory endpoint for Parts 1 and 2 is: Kinetic of response of thiamine (comparison of baseline to Day 7, Day 14, and Day 28 post-randomization). These laboratory measures will be obtained either as an inpatient or an outpatient follow-up.	Up to 28-days post randomization
Evaluate Change in plasma cyanocobalamin Concentration	The exploratory endpoint for Parts 1 and 2 is: Kinetic of response of cyanocobalamin (comparison of baseline to Day 7, Day 14, and Day 28 post-randomization). These laboratory measures will be obtained either as an inpatient or an outpatient follow-up.	Up to 28-days post randomization

Collaborators and Investigators

• Sponsor: Reven Pharmaceuticals, Inc.

Study record dates

Study Major Dates

• Study Start (ACTUAL): March 25, 2021
• Primary Completion (ANTICIPATED): October 1, 2022
• Study Completion (ANTICIPATED): February 1, 2023

Study Registration Dates

• First Submitted: January 4, 2021
• First Submitted That Met QC Criteria: January 12, 2021
• First Posted (ACTUAL): January 13, 2021

Study Record Updates

• Last Update Posted (ACTUAL): March 15, 2022
• Last Update Submitted That Met QC Criteria: March 14, 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; Respiration Disorders; Pneumonia, Viral; Pneumonia; Lung Diseases; Infant, Newborn, Diseases; Signs and Symptoms, Respiratory; Lung Injury; Infant, Premature, Diseases; COVID-19; Hypoxia; Respiratory Distress Syndrome; Respiratory Distress Syndrome, Newborn; Acute Lung Injury; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Anti-Inflammatory Agents; Protective Agents; Antioxidants; Ascorbic acid, magnesium sulfate heptahydrate, cyanocobalamin, thiamine hydrochloride, riboflavin 5' phosphate, niacinamide, pyridoxine hydrochloride, and calcium D-pantothenate drug combination
• Other Study ID Numbers: RPI015

Plan for Individual participant data (IPD)

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

Drug and device information, study documents

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