Outpatient Treatment With Anti-Coronavirus Immunoglobulin (OTAC)

An International Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial of the Safety and Efficacy of Anti-Coronavirus Hyperimmune Intravenous Immunoglobulin for the Treatment of Adult Outpatients in Early Stages of COVID-19

The primary objective of the Outpatient Treatment with Anti-Coronavirus Immunoglobulin (OTAC) (INSIGHT 012) trial is to compare the safety and efficacy of a single infusion of anti-COVID-19 hyperimmune intravenous immunoglobulin (hIVIG) versus placebo among adults with recently diagnosed severe acute respiratory syndrome - coronavirus 2 (SARS-CoV2) infection who do not require hospitalization. The primary endpoint of this double-blind randomized trial is a five-category ordinal outcome that assesses the participant's clinical status seven days after the infusion of hIVIG or placebo.

1. Asymptomatic and no limitations in usual activity due to COVID-19
2. Mild COVID-19 illness or minor limitations to usual activity
3. Moderate COVID-19 illness and with major limitations to usual activity
4. Severe COVID-19 or serious disease manifestation from COVID-19
5. Critical illness from COVID-19 or Death

Two strata of participants will be identified for analysis purposes. Stratum 2 will be participants who receive direct-acting antivirals (DAAs) or other anti-SARS-CoV2 agents that are approved/available and recommended for use as part of standard of care (SOC), estimated to be about 20% of participants. Stratum 1 will be participants who do not receive this agents, estimated to be about 80% of participants.

Study Overview

• Status: Suspended
• Conditions: Covid19; COVID; SARS-CoV2 Infection
• Intervention / Treatment: Biological: Hyperimmune immunoglobulin to SARS-CoV-2 (hIVIG); Other: Placebo

Detailed Description

The primary objective will be addressed by testing two hypotheses aimed at assessing whether hIVIG + standard of care (SOC) is superior to placebo + SOC for the primary ordinal endpoint at Day 7. These hypotheses will be tested for the following two groups: a) among all randomized participants (stratum 1 and 2), and b) among only participants enrolled in stratum 1. For the primary analysis, overall type 1 error will be controlled at 5% by using a 2-sided significance level of 0.035 for each hypothesis. This significance level was obtained using the correlation between the test statistics for the proportional log odds ratio for all randomized participants and for this log odds ratio for those in stratum 1. This correlation was determined to be 0.895. With this approach hIVIG will be considered superior to placebo if either of the two hypotheses is rejected.

Participants will be randomized to a single infusion of an hIVIG product or placebo in a 1:1 allocation. Randomization will be stratified by study site pharmacy and the two SOC strata.

• Study Type: Interventional
• Enrollment (Estimated): 820
• Phase: Phase 3

Contacts and Locations

Study Locations

• Argentina
  • Buenos Aires, Argentina, C1221ADC
    • Hospital General de Agudos JM Ramos Mejia
  • Buenos Aires
    • La Plata, Buenos Aires, Argentina, B1900AVG
      • Instituto Medico Platense
    • Mar del Plata, Buenos Aires, Argentina, B7600FYK
      • Centro de Investigaciones Medicas de Mar del Plata (Site 611-031)
  • Río Negro Province
    • Villa Regina, Río Negro Province, Argentina, R8336
      • Clínica Central S.A. (611-028)
• Australia
  • New South Wales
    • Sydney, New South Wales, Australia, 2010
      • St. Vincent's Hospital
• Denmark
  • Aalborg, Denmark, 9000
    • Department of Infectious Diseases
  • Copenhagen, Denmark, 2400
    • Bispebjerg Hospital
  • Copenhagen, Denmark, 2100
    • Rigshospitalet, CHIP
  • Hellerup, Denmark, 2900
    • Herlev/Gentofte Hospital
  • Hvidovre, Denmark, 2650
    • Hvidovre University Hospital, Department of Infectious Diseases
  • Kolding, Denmark, 6000
    • Kolding Sygehus
  • C
    • Odense, C, Denmark, 5000
      • Odense University Hospital
  • N
    • Aarhus, N, Denmark, 8200
      • Aarhus Universitetshospital, Skejby
• Greece
  • Attica
    • Athens, Attica, Greece, 10676
      • Dept of Critical Care and Pulmonary Medicine, Evangelismos General Hospital
    • Athens, Attica, Greece, 11527
      • 3rd Dept of Medicine, Medical School
    • Athens, Attica, Greece, 11527
      • Laiko Athens General Hospital
    • Athens, Attica, Greece, 11528
      • Department of Clinical Therapeutics of Alexandra Hospital
    • Athens, Attica, Greece, 12462
      • 4th Department of Internal Medicine
• Malaysia
  • Kuala Lumpur
    • Kuala Lumpur, Kuala Lumpur, Malaysia, 59100
      • University Malaya Medical Centre (Site 612-501)
• Mexico
  • Mexico City
    • Mexico City, Mexico City, Mexico, 14080
      • Instituto Nacional de Enfermedades Respiratorias Ismael Cosió Villegas
    • Mexico City, Mexico City, Mexico, 14080
      • Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran
    • Mexico City, Mexico City, Mexico, 14080
      • Hospital General Dr. Manuel Gea Gonzáles
  • OA
    • Oaxaca City, OA, Mexico, 68050
      • Hospital General Dr. Aurelio Valdivieso
• Peru
  • Lima, Peru, 15012
    • Unidad de Ensayos Clinicos Socios En Salud Sucursal Perú (651-009)
• Spain
  • Barcelona, Spain, 08757
    • CAP Corbera
  • Barcelona
    • Badalona, Barcelona, Spain, 08916
      • Hospital Universitari Germans Trias i Pujol
    • Castelldefels, Barcelona, Spain, 08860
      • CAP Can Bou
    • Mataró, Barcelona, Spain, 08303
      • CAP El Maresme
• Thailand
  • Khon Kaen, Thailand, 40002
    • Khon Kaen University, Srinagarind Hospital (Site 613-003)
  • Nonthaburi, Thailand, 11000
    • Bamrasnaradura Infections Diseases Institute (613-007)
  • Bangkok
    • Bangkok Noi, Bangkok, Thailand, 10700
      • Siriraj Hospital (Site 613-002)
    • Pathum Wan, Bangkok, Thailand, 10330
      • Chulalongkorn University and The HIV-NAT
• Uganda
  • Entebbe, Uganda
    • MRC/UVRI & LSHTM Uganda Research Unit
  • Kampala, Uganda
    • Joint Clinical Research Center (JCRC)
  • Kampala, Uganda
    • Makerere University Lung Institute (Site 634-604)
  • Kampala, Uganda
    • St. Francis Hospital, Nsambya
  • Lira, Uganda
    • Lira Regional Referral Hospital
  • Masaka, Uganda
    • Masaka Regional Referral Hospital
• Ukraine
  • Ivano-Frankivsk, Ukraine, 76018
    • Central City Clinical Hospital of Ivano-Frankivsk City Council
• United Kingdom
  • London, United Kingdom, WC1E 6JB
    • University College London Hospitals
  • Newcastle upon Tyne, United Kingdom, NE1 4LP
    • Royal Victoria Infirmary
• United States
  • Arizona
    • Tucson, Arizona, United States, 85723
      • Southern Arizona VA Healthcare System (074-009)
  • California
    • Mather, California, United States, 95655
      • VA Northern California Health Care System (074-023)
    • Palo Alto, California, United States, 94305
      • Stanford University Hospital & Clinics (Site 203-003)
    • San Francisco, California, United States, 94121
      • San Francisco VAMC (Site 074-002)
  • Colorado
    • Aurora, Colorado, United States, 80045
      • Rocky Mountain Regional VA Medical Center (074-010)
  • Michigan
    • Detroit, Michigan, United States, 48202
      • Henry Ford Health System Site (014-001)
  • New York
    • New York, New York, United States, 10029
      • Icahn School of Medicine at Mount Sinai
  • Ohio
    • Cleveland, Ohio, United States, 44195
      • Cleveland Clinic Foundation (Site 207-001)
  • Pennsylvania
    • Hershey, Pennsylvania, United States, 17033
      • Penn State Health Milton S. Hershey Medical Center (209-002)
  • Texas
    • Corpus Christi, Texas, United States, 78404
      • CHRISTUS Spohn Shoreline Hospital
    • Dallas, Texas, United States, 75390
      • UT Southwestern Medical Center
  • Utah
    • Murray, Utah, United States, 84107
      • Intermountain Medical Center (211-001)
  • Virginia
    • Charlottesville, Virginia, United States, 22908
      • UVA Health System, University Hospital (Site 210-003)
    • Roanoke, Virginia, United States, 24015
      • Carilion Medical Center (Site 080-018)
    • Salem, Virginia, United States, 24153
      • Salem VA Medical Center (074-014)
  • Washington
    • Seattle, Washington, United States, 98122
      • Swedish Hospital First Hill

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Clinical risk based on age ≥ 55 years or an adult (age ≥ 18 years) with an immunosuppressed condition.
• Positive test for SARS-CoV-2 within ≤5 days (if >1 test, the first positive is within ≤5 days). Tests may include an institutional-based nucleic acid amplification test (NAAT), or any protocol-approved rapid test.
• Within ≤5 days from symptom onset, if symptomatic from current SARS-CoV-2 infection.
• Agrees to not participate in another clinical trial for the treatment or management of SARS-CoV-2 infection through Day 7, or until hospitalized or significant disease progression if prior to Day 7 (defined by ordinal category 4 or 5).
• Participant provides written informed consent prior to study procedures, and understands and agrees to adhere to planned study procedures through Day 28.

Ongoing immunosuppressive condition or immunosuppressive treatment, includes:

1. Steroids equivalent to prednisone > 10 mg/day for at least the last 28 days
2. Rheumatologic or autoimmune disorder treated with a biologic or non-biologic immunosuppressive therapy
3. Antirejection medicine after solid organ or stem cell transplantation
4. Cancer treatment with systemic chemotherapy, biologic and/or cell-based therapy in the last 12 months
5. Primary or acquired severe B- or T-lymphocyte immune dysfunction
6. HIV infection
7. Splenectomy or functional asplenia

Exclusion Criteria:

• Asymptomatic and had prior symptoms from the current infection that have now resolved (for >24 hours).
• Asymptomatic and has received a vaccination for COVID-19 (≥1 dose).
• Undergoing evaluation for possible admission to hospital for medical management (this does not include evaluation of possible hospitalization for public health purposes).
• Evidence of pneumonia and/or hypoxia due to COVID-19 (NOTE: chest imaging is not required, but if available it should not show new infiltrates suggestive of pneumonia; hypoxia is defined by new oxygen supplementation or increase above pre-illness level).
• Prior receipt of immunoglobulin product or passive immune therapy for SARS-CoV-2 in the past 90 days (i.e., convalescent plasma, SARS-CoV-2 monoclonal antibodies, or any IVIG).

• Any of the following thrombotic or procoagulant conditions or disorders:

  1. acute coronary syndrome, cerebrovascular syndrome, pulmonary embolism, or deep venous thrombosis within 28 days of randomization.
  2. prothrombin gene mutation 20210, homozygous Factor V Leiden mutations, antiphospholipid syndrome, or a deficiency in antithrombin III, protein C, or protein S.
• History of hypersensitivity to blood, plasma or IVIG excipients.
• Known immunoglobulin A (IgA) deficiency or anti-IgA antibodies.
• In the opinion of the investigator, any condition for which participation would not be in the best interest of the participant or that could prevent or confound protocol assessments.

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: Treatment Group; Participants in this group will receive the investigational treatment in addition to standard of care.	Biological: Hyperimmune immunoglobulin to SARS-CoV-2 (hIVIG); The hIVIG product is administered as a single dose of 3.5 grams, or 35 milliliter at a concentration of 0.1 grams/milliliter.
Placebo Comparator: Placebo Group; Participants in this group will receive a placebo in addition to standard of care.	Other: Placebo; Infusion of 35 milliliters standard isotonic saline

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clinical Status	The primary outcome is to compare the safety and efficacy of a single infusion of hIVIG versus placebo on clinical status after seven days. Outcome will be reported as the percent of participants who fall into each of 5 clinical status categories as defined below.; Asymptomatic and no limitations in usual activity due to COVID-19; Mild COVID-19 illness or minor limitations to usual activity; Moderate COVID-19 illness and with major limitations to usual activity; Severe COVID-19 or serious disease manifestation from COVID-19; Critical illness from COVID-19 or Death	7 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
All-cause hospitalization or death through 28 days.	Outcome reported as the percent of participants who are hospitalized or who expire for any reason by day 28 post treatment.	28 days
All-cause mortality through 28 days.	Outcome reported as the percent of participants who expire for any reason by day 28 post treatment.	28 days
Significant Disease Progression	Outcome is reported as the number of participants with significant disease progression through 28 days, which is defined by fulfilling criteria for category 4 or 5 on the ordinal scale using a time to event analysis.	28 days
Ordinal Scale Distribution	Outcome will be reported as the percent of participants who fall into each of 5 clinical status categories as defined below at days 4, 14, and 28 following treatment.; Asymptomatic and no limitations in usual activity due to COVID-19; Mild COVID-19 illness or minor limitations to usual activity; Moderate COVID-19 illness and with major limitations to usual activity; Severe COVID-19 or serious disease manifestation from COVID-19; Critical illness from COVID-19 or Death	4, 14, 28 days
Disease Progression Through 7 Days	Outcome is reported as the proportion of participants with any disease progression at Day 7, using a sliding dichotomous scale progression defined by a categorization on the ordinal scale that is worse than the status at entry.	7 days
Significant Disease Progression Through 7 Days	Outcome is reported as the proportion of participants who progress to categories 3-5 on the clinical ordinal scale at Day 7 among participants in categories 1 or 2 of the ordinal scale at entry.	7 days
Disease Progression at Follow-up	Outcome is reported as the percent of participants who experience severe disease progression during follow-up, defined by the worst health status achieved on the clinical ordinal scale at any point by Day 7, 14, and 28.	7, 14, 28 days
Activity Limitations at Follow-up	Outcome is reported as the percent of participants who attain their pre-COVID health status without limitations in usual activity (defined as category 1 on the ordinal scale) at Day 7, 14, and 28.	7, 14, 28 days
Change in Viral Burden from Serum Antigen	Outcome is reported as the change between Day 0 and Day 7 in viral burden as determined by serum antigen levels from nasal and saliva specimens.	7 days
Change in Viral Burden from PCR	Outcome is reported as the change between Day 0 and Day 7 in viral burden as determined by polymerase chain reaction (PCR) from nasal and saliva specimens.	7 days
Change in SARS-CoV-2 Antibody Concentration	Outcome is reported as the change in SARS-CoV-2 antibody levels between Day 0 and Day 7, including subclasses and neutralizing titers.	7 days
Healthcare Utilization at Follow-up	Outcome is reported as the percent of participants who had health care engagement for the purposes of medical evaluation and/or management of COVID-19 illness (e.g., via telehealth, clinic, urgent care, emergency room, or hospitalization) at 28 days follow-up.	28 days
Worst Status Through 28 Days	Outcome is reported as the number of participants who experience each of the following categories as their worst respiratory status through 28 days, including: a) no respiratory symptoms, b) upper respiratory symptoms, c) lower respiratory symptoms without hypoxia, c) hypoxia requiring conventional oxygen supplementation by nasal canula, d) respiratory failure requiring high-flow oxygen delivery device or non-invasive ventilation, or e) respiratory failure requiring mechanical ventilation or extra-corporeal membrane oxygenation (ECMO).	28 days
Hypoxemia Through Day 7	Outcome is reported as the mean oxygen saturation (percentage) level in each group at 7 days.	7 days
Additional COVID-19 Treatment	Outcome is reported as the number of patients starting other treatments targeting COVID-19 through 28 days post treatment.	28 days

Collaborators and Investigators

• Sponsor: University of Minnesota
• Collaborators: National Institute of Allergy and Infectious Diseases (NIAID); National Institutes of Health (NIH); International Network for Strategic Initiatives in Global HIV Trials (INSIGHT)
• Investigators: Principal Investigator: Cavan Reilly, PhD, University of Minnesota

Publications and helpful links

General Publications

• Jha A, Barker D, Lew J, Manoharan V, van Kessel J, Haupt R, Toth D, Frieman M, Falzarano D, Kodihalli S. Efficacy of COVID-HIGIV in animal models of SARS-CoV-2 infection. Sci Rep. 2022 Oct 10;12(1):16956. doi: 10.1038/s41598-022-21223-2.

Study record dates

Study Major Dates

• Study Start (Actual): August 6, 2021
• Primary Completion (Actual): May 24, 2026
• Study Completion (Estimated): June 16, 2026

Study Registration Dates

• First Submitted: June 1, 2021
• First Submitted That Met QC Criteria: June 1, 2021
• First Posted (Actual): June 2, 2021

Study Record Updates

• Last Update Posted (Actual): June 11, 2026
• Last Update Submitted That Met QC Criteria: June 9, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: immunotherapy; early treatment; hIVIG
• Additional Relevant MeSH Terms: Respiratory Tract Infections; Infections; RNA Virus Infections; Virus Diseases; Respiratory Tract Diseases; Lung Diseases; Pneumonia, Viral; Pneumonia; Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; COVID-19; Substandard Drugs; Pharmaceutical Preparations; HIV hyperimmune globulin
• Other Study ID Numbers: INSIGHT12; 2021-001663-24 (EudraCT Number)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: A public data set will be made available at the end of the trial.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; CSR

Drug and device information, study documents

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