Study of Varespladib in Patients Hospitalized With Severe COVID-19 (STAIRS)

August 3, 2023 updated by: Ophirex, Inc.

A Phase 2, Randomized, Double-blind, Placebo-controlled Study to Evaluate the Safety, Tolerability, and Efficacy of Varespladib in Patients Hospitalized With Severe COVID 19 Caused by SARS-CoV-2

This is a 2-part, multi-center, randomized, double-blind, placebo-controlled, phase 2 study designed to evaluate the safety, tolerability, and efficacy of oral varespladib, in addition to standard of care, in patients hospitalized with severe COVID-19 caused by SARS-CoV-2.

Study Overview

Detailed Description

The goals of this 2-part, multi-center, randomized, double-blind, placebo-controlled, phase 2 study are to define a safe dose for the population and to assess the safety, tolerability, and efficacy of orally dosed varespladib to improve survival without respiratory failure in patients hospitalized with severe coronavirus disease 2019 (COVID-19), when given in addition to the institutional standard of care therapy.

Mortality rates of COVID-19 are strongly linked to acute respiratory distress syndrome (ARDS) which may be, additionally, correlated with elevations of secretory phospholipase 2 (sPLA2) and widespread loss of functioning lung tissue. Upregulation of sPLA2 is thought to be involved in the dysregulated inflammatory cascade pathways (increased markers of immune activation, also known as cytokine release syndrome) and enzymatic degradation of lung surfactant linked to the development of ARDS. It is believed that treatment with varespladib, a potent inhibitor of sPLA2, might prevent or mitigate progression of pulmonary dysfunction in COVID-19 patients by two mechanisms: suppression of sPLA2-induced inflammation and, uniquely, preservation of pulmonary surfactant by direct inhibition of the enzyme responsible for surfactant phospholipid degradation: sPLA2.

Data from previous phase 2 clinical trials of varespladib suggested it had potential to reduce mortality in severely septic patients with ARDS, particularly when treatment was initiated within 18 hours of identification of organ failure.

The study will be conducted in two parts. Both parts will be randomized and double-blind. Part 1 will be dose-finding in four parallel treatment groups randomized to treatment with varespladib (at 250 mg once daily [QD], twice daily [BID], or three times daily [TID] [250, 500, or 750 mg/day]) or placebo in a 5:5:5:3 ratio. After all participants in Part 1 have completed Day 28, a data safety monitoring board (DSMB) will review the safety results from Part 1, including all available safety data through Day 60, and will recommend the dose regimen to be used in Part 2. Part 2 will randomize an additional 72 participants to the dose regimen selected from Part 1 or placebo in a 1:1 ratio.

In both parts of the study, eligible participants will be enrolled and randomized to receive active varespladib or placebo in addition to institutional standard of care for 7 days.

Participants will be assessed daily per standard of care while hospitalized and on a regular basis after discharge. The Day 1, 4, 7, 14, and 28 visits will be performed in person (either at the hospital/site or via a home health provider) to assess safety, obtain blood and urine samples for laboratory tests, and obtain clinical outcome data. The Day 2, 3, 5, 6, 8, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 20, 21, 45, and 60 visits for discharged participants may be conducted by phone or via electronic patient-reported outcome (ePRO) devices.

Efficacy will be assessed by respiratory failure-free survival at Day 28. Safety will be assessed by evaluating adverse events (AEs), vital sign measurements, use of oxygen therapies, changes in levels of biomarkers, clinical laboratory test results, electrocardiograms (ECGs), physical examination findings, and concomitant medications and therapies. A DSMB will evaluate safety data at specified intervals during both parts of the trial.

Pharmacokinetic (PK) samples will be drawn from all participants in Part 1 and in a subset of approximately 14 participants in Part 2 in order to enable estimation of PK parameters in approximately 22 participants receiving active treatment with varespladib.

Study Type

Interventional

Enrollment (Actual)

18

Phase

  • Phase 2

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

    • California
      • Ventura, California, United States, 93003
        • Ventura Clinical Trials
    • Florida
      • Miami, Florida, United States, 33136
        • University of Miami Miller School of Medicine
      • Miami, Florida, United States, 33155
        • Westchester Research Center at Westchester General Hospital
    • Indiana
      • Munster, Indiana, United States, 46321
        • Franciscan Alliance
    • Massachusetts
      • Boston, Massachusetts, United States, 02115
        • The Brigham and Women's Hospital Emergency Medicine
    • New Jersey
      • Camden, New Jersey, United States, 08103
        • Cooper University Hospital
    • Oklahoma
      • Tulsa, Oklahoma, United States, 74104
        • Ascension St. John Clinical Research Institute

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 to 80 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  1. Participant is hospitalized with severe COVID-19 illness, defined in accordance with the Food and Drug Administration (FDA) Guidance for Industry - COVID-19: Developing Drugs and Biological Products for Treatment or Prevention (May 2020):

    a. Severe illness:

    i. Symptoms suggestive of severe systemic illness with COVID-19, which could include any symptom of moderate illness or shortness of breath at rest, or respiratory distress

    ii. Clinical signs indicative of severe systemic illness with COVID-19, such as respiratory rate ≥30 per minute, heart rate ≥125 per minute, SpO₂ ≤93% on room air at sea level or partial pressure of oxygen PaO₂/fraction of inspired oxygen FiO₂ <300.

  2. Participant has a positive virologic nucleic acid amplification test (NAAT) indicating SARS-CoV-2 infection in a sample collected <72 hours prior to randomization.
  3. Participant is between the ages of 18 and 80 years at the time of enrollment.
  4. Participant provides informed consent prior to initiation of any study procedures.
  5. Participant agrees to not participate in another clinical trial for the treatment of COVID 19 or SARS-CoV-2 through Day 28.
  6. Participant has adequate hematologic status (in the absence of transfusion and growth factor support for at least 28 days), defined as follows:

    1. Absolute neutrophil count (ANC) ≥1.5 × 10⁹/L
    2. Platelet count ≥75 × 10⁹/L
    3. Hemoglobin ≥9 g/dL.
  7. Participant has an Eastern Cooperative Oncology Group (ECOG) performance score of 0-2.

Exclusion Criteria:

  1. Participant has mild, moderate, or critical COVID-19 defined in accordance with the FDA Guidance for Industry:

    a. Mild COVID-19:

    i. Symptoms of mild illness with COVID-19 that could include fever, cough, sore throat, malaise, headache, muscle pain, gastrointestinal symptoms, without shortness of breath or dyspnea

    ii. No clinical signs indicative of moderate, severe, or critical severity

    b. Moderate COVID-19:

    i. Symptoms of moderate illness with COVID-19, which could include any symptom of mild illness (fever, cough, sore throat, malaise, headache, muscle pain, gastrointestinal symptoms) or shortness of breath with exertion

    ii. Clinical signs suggestive of moderate illness with COVID-19, such as respiratory rate ≥20 breaths per minute, peripheral oxygen saturation (SpO₂) >93% on room air at sea level, heart rate ≥90 beats per minute

    iii. No clinical signs indicative of severe or critical illness

    c. Critical COVID-19:

    i. Respiratory failure defined based on resource utilization requiring at least one of the following:

    • Endotracheal intubation and mechanical ventilation
    • Oxygen delivered by high-flow nasal cannula ([HFNC] heated, humidified, oxygen delivered via reinforced nasal cannula at flow rates >20 L/min with fraction of delivered oxygen ≥0.5)
    • Noninvasive positive pressure ventilation
    • ECMO, or
    • Clinical diagnosis of respiratory failure (i.e., clinical need for one of the preceding therapies, but preceding therapies not able to be administered in setting of resource limitation)

    ii. Shock (defined by systolic blood pressure <90 mmHg, or diastolic blood pressure <60 mmHg or requiring vasopressors)

    iii. Multi-organ dysfunction/failure.

  2. Participant has taken investigational medications within 7 days or 5 half-lives prior to enrollment, whichever is shorter.
  3. Participant has required any new form of sedation, anxiolysis or central nervous system (CNS) depressant within the 48 hours prior to enrollment that would interfere with neurologic assessments at enrollment.
  4. Has history of cerebrovascular accident or intracranial bleeding of any kind, acute coronary syndrome, myocardial infarction, or severe pulmonary hypertension.
  5. Participant has chronic respiratory failure not associated with COVID-19, defined as prior need for home oxygen, need for home noninvasive positive-pressure ventilation (NIPPV) for reasons other than isolated sleep apnea, or other signs of chronic respiratory failure, in the investigator's judgment.
  6. Upper gastrointestinal (GI) bleed evidenced by hematemesis, "coffee-ground" emesis or nasogastric aspirate, or hematochezia thought to originate from upper GI tract.
  7. Participant has abnormal liver function defined as any 2 of the following at screening:

    1. Total bilirubin ≥2 × ULN
    2. Alanine aminotransferase (ALT) ≥3 × ULN
    3. Aspartate aminotransferase (AST) ≥3 × ULN
    4. Alkaline phosphatase (ALP) >3 × ULN
    5. Gamma-glutamyl transferase (GGT) >3 × ULN
  8. Participant has an estimated glomerular filtration rate (eGFR) <60 mL/min.
  9. Participant has a known allergy or significant adverse reaction to varespladib-methyl or related compounds.
  10. Participant is considered by the investigator to be unable to comply with protocol requirements due to geographic considerations, psychiatric disorders, or other compliance concerns; or has any serious medical condition or clinically significant laboratory, ECG, vital sign, or physical examination abnormality that would prevent study participation or place the participant at significant risk, as judged by the Investigator.
  11. Participant is breast-feeding, pregnant, has a positive serum hCG pregnancy test, or is not willing to use a highly effective method of contraception for 14 days after treatment. Highly effective methods of contraception are as follows:

    1. Combined (estrogen- and progestogen-containing) hormonal contraception associated with inhibition of ovulation (oral, intravaginal, or transdermal)
    2. Progestogen-only hormonal contraception associated with inhibition of ovulation (oral, injectable, or implantable)
    3. Intrauterine device, intrauterine hormone-releasing system
    4. Bilateral tubal occlusion
    5. Vasectomized partner
    6. Sexual abstinence
    7. Double-barrier method (condoms, sponge, diaphragm, with spermicidal jellies, or cream).

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: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Varespladib: 250 mg TID
For 7 days, and in addition to institutional standard of care, participants will take 250 mg varespladib in the morning, in the afternoon, and in the evening.
250 mg immediate-release oblong, white, film-coated tablet for oral administration
Other Names:
  • LY333013
Placebo Comparator: Placebo
For 7 days, and in addition to institutional standard of care, participants will take 1 placebo tablet in the morning, in the afternoon, and in the evening.
Oral formulation matched to the oral varespladib tablet
Experimental: Varespladib: 250 mg QD + Placebo + placebo
For 7 days, and in addition to institutional standard of care, participants will take 250 mg varespladib in the morning. In order to maintain the blind, they will also take 1 placebo tablet in the afternoon and 1 placebo tablet in the evening.
250 mg immediate-release oblong, white, film-coated tablet for oral administration
Other Names:
  • LY333013
Oral formulation matched to the oral varespladib tablet
Experimental: Varespladib: 250 mg BID + placebo
For 7 days, and in addition to institutional standard of care, participants will take 250 mg varespladib in the morning and in the evening. In order to maintain the blind, they will also take 1 placebo tablet in the afternoon.
250 mg immediate-release oblong, white, film-coated tablet for oral administration
Other Names:
  • LY333013
Oral formulation matched to the oral varespladib tablet
Experimental: Varespladib: 250mg BID (Part 2 of trial)
Dose chosen for Part 2 was twice a day dosing. For 7 days, and in addition to institutional standard of care, participants will take 250 mg varespladib in the morning, and in the evening.
250 mg immediate-release oblong, white, film-coated tablet for oral administration
Other Names:
  • LY333013
Placebo Comparator: Placebo (Part 2 of trial)
For 7 days, and in addition to institutional standard of care, participants will take 1 placebo tablet in the morning, and in the afternoon.
Oral formulation matched to the oral varespladib tablet

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Proportion of participants alive and free of respiratory failure at Day 28
Time Frame: Baseline to Day 28

The proportion of respiratory failure-free surviving participants in each Part 2 treatment group at Day 28 will be analyzed using the Mantel-Haenszel stratum-weighted estimator with treatment as a factor. Respiratory failure is defined based on resource utilization requiring at least one of the following:

  • Endotracheal intubation and mechanical ventilation
  • Oxygen delivered by high-flow nasal cannula ([HFNC] heated, humidified, oxygen delivered via reinforced nasal cannula at flow rates >20 L/min with fraction of delivered oxygen ≥0.5)
  • Noninvasive positive pressure ventilation
  • ECMO, or
  • Clinical diagnosis of respiratory failure (i.e., clinical need for one of the preceding therapies, but preceding therapies not able to be administered in setting because of resource limitation)
Baseline to Day 28

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Proportion of subjects using HFNC within the first 28 days after randomization
Time Frame: From randomization through Day 28
The proportion of subjects using HFNC within the first 28 days after randomization.
From randomization through Day 28
Time to initiation of use of HFNC within the first 28 days after randomization
Time Frame: From randomization through Day 28
Number of days to initiation of use of HFNC within the first 28 days after randomization.
From randomization through Day 28
Duration of use of HFNC within the first 28 days after randomization
Time Frame: From randomization through Day 28
Number of days of use of HFNC within the first 28 days after randomization.
From randomization through Day 28
Proportion of subjects using noninvasive respiratory support within the first 28 days after randomization
Time Frame: From randomization through Day 28
Proportion of subjects using noninvasive respiratory support within the first 28 days after randomization.
From randomization through Day 28
Time to initiation of noninvasive respiratory support within the first 28 days after randomization
Time Frame: From randomization through Day 28
Number of days to initiation of noninvasive respiratory support within the first 28 days after randomization.
From randomization through Day 28
Duration of noninvasive respiratory support within the first 28 days after randomization
Time Frame: From randomization through Day 28
Number of days of noninvasive respiratory support within the first 28 days after randomization.
From randomization through Day 28
Proportion of subjects using mechanical ventilation within the first 28 days after randomization
Time Frame: From randomization through Day 28
Proportion of subjects using mechanical ventilation within the first 28 days after randomization.
From randomization through Day 28
Time to initiation of subjects using mechanical ventilation within the first 28 days after randomization
Time Frame: From randomization through Day 28
Number of days to initiation of subjects using mechanical ventilation within the first 28 days after randomization.
From randomization through Day 28
Duration of use by subjects of mechanical ventilation within the first 28 days after randomization
Time Frame: From randomization through Day 28
Number of days of use by subjects of mechanical ventilation within the first 28 days after randomization.
From randomization through Day 28
Number of days of oxygen support through Day 28 after randomization
Time Frame: From randomization through Day 28
Number of days of oxygen support through Day 28 after randomization.
From randomization through Day 28
SpO₂ through Day 28 after randomization
Time Frame: From randomization through Day 28
Changes in SpO₂ (percentage) from randomization through Day 28.
From randomization through Day 28
Proportion of participants remaining free of mechanical ventilation or ECMO throughout the 28 days after randomization
Time Frame: From randomization through Day 28
Proportion of participants remaining free of mechanical ventilation or ECMO throughout the 28 days after randomization.
From randomization through Day 28
Number of ventilator-free days through Day 28 after randomization
Time Frame: From randomization through Day 28
Number of ventilator-free days through Day 28 after randomization.
From randomization through Day 28
Number of hospitalization days through Day 28 after randomization
Time Frame: From randomization through Day 28
Number of hospitalization days through Day 28 after randomization.
From randomization through Day 28
Clinical status as measured by the World Health Organization (WHO) 9-point ordinal scale from baseline through Day 60
Time Frame: From baseline through Day 60
Changes from baseline in clinical status as measured by the WHO 9-point ordinal scale, where 0 = no clinical or virological evidence of infection and 8 = death
From baseline through Day 60
Number of vasopressor-free days through Day 28 after randomization
Time Frame: From randomization through Day 28
Number of vasopressor-free days through Day 28 after randomization.
From randomization through Day 28
Number of days without renal stabilization and/or replacement through Day 28 after randomization
Time Frame: From randomization through Day 28
Number of days without renal stabilization and/or replacement through Day 28 after randomization.
From randomization through Day 28
Number of days at elevated level of care (ICU) through Day 28 after randomization
Time Frame: From randomization through Day 28
Number of days at elevated level of care (ICU) through Day 28 after randomization.
From randomization through Day 28
Number of healthcare encounters through Day 28 after randomization
Time Frame: From randomization through Day 28
Number of healthcare encounters through Day 28 after randomization.
From randomization through Day 28
Proportion of subjects with all-cause mortality through Day 60
Time Frame: From randomization through Day 60
Proportion of subjects who experience all-cause mortality from randomization through Day 60.
From randomization through Day 60
Time to all-cause mortality through Day 60
Time Frame: From randomization through Day 60
Time to all-cause mortality for all subjects who experience the event from randomization through Day 60.
From randomization through Day 60
Number of organ failure-free days through Day 28 after randomization
Time Frame: From randomization through Day 28
Number of organ failure-free days through Day 28 after randomization.
From randomization through Day 28
Incidence and severity of AEs, SAEs, and AEs leading to discontinuation of IP
Time Frame: From providing informed consent through Day 60
From providing informed consent through Day 60
Changes in vital signs: SpO₂
Time Frame: From providing informed consent through Day 60
Changes in SpO₂ (percentage) from providing informed consent through Day 60.
From providing informed consent through Day 60
Changes in vital signs: respiratory rate
Time Frame: From providing informed consent through Day 60
Changes in respiratory rate (breaths per minute) from providing informed consent through Day 60.
From providing informed consent through Day 60
Changes in vital signs: body temperature
Time Frame: From providing informed consent through Day 60
Changes in body temperature (degrees Celsius) from providing informed consent through Day 60.
From providing informed consent through Day 60
Changes in vital signs: heart rate
Time Frame: From providing informed consent through Day 60
Changes in heartrate (beats per minute) from providing informed consent through Day 60.
From providing informed consent through Day 60
Changes in vital signs: blood pressure
Time Frame: From providing informed consent through Day 60
Changes in blood pressure (systolic and diastolic blood pressure; mmHg) from providing informed consent through Day 60.
From providing informed consent through Day 60
Changes in levels of biomarkers: cardiac troponin
Time Frame: From providing informed consent through Day 28
Changes in levels of cardiac troponin
From providing informed consent through Day 28
Changes in levels of biomarkers: C-reactive protein (CRP)
Time Frame: From providing informed consent through Day 28
Changes in levels of CRP
From providing informed consent through Day 28
Changes in levels of biomarkers: D-dimer
Time Frame: From providing informed consent through Day 28
Changes in levels of D-dimer
From providing informed consent through Day 28
Changes in levels of biomarkers: ferritin
Time Frame: From providing informed consent through Day 28
Changes in levels of ferritin
From providing informed consent through Day 28
Changes in clinical laboratory evaluations: chemistry
Time Frame: From providing informed consent through Day 28
The percentage of subjects with at least 1 post-baseline potentially clinically significant abnormality.
From providing informed consent through Day 28
Changes in clinical laboratory evaluations: coagulation
Time Frame: From providing informed consent through Day 28
The percentage of subjects with at least 1 post-baseline potentially clinically significant abnormality.
From providing informed consent through Day 28
Changes in clinical laboratory evaluations: hematology
Time Frame: From providing informed consent through Day 28
The percentage of subjects with at least 1 post-baseline potentially clinically significant abnormality.
From providing informed consent through Day 28
Changes in clinical laboratory evaluations: urinalysis
Time Frame: From providing informed consent through Day 28
The percentage of subjects with at least 1 post-baseline potentially clinically significant abnormality.
From providing informed consent through Day 28
Changes in 12-lead ECGs
Time Frame: From providing informed consent through Day 28
The percentage of subjects with an investigator interpretation of ECG results as abnormal clinically significant.
From providing informed consent through Day 28

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Participant-reported quality-of-life assessment using the 12-item Short Form Survey (SF-12) at Day 28 after randomization
Time Frame: Day 28
Changes from baseline to Day 28 in SF-12 scores, which range from 0 to 100, with higher scores indicating better physical and mental health functioning.
Day 28
Activity of sPLA2 within blood samples collected as clinically required from treatment initiation to Day 28 after randomization
Time Frame: From treatment initiation through Day 28
Changes in observed sPLA2 values
From treatment initiation through Day 28
Changes in PK parameters: area-under-the-curve (AUC)
Time Frame: Day 1 through Day 3
Change in AUC from Day 1 through Day 3
Day 1 through Day 3
Changes in PK parameters: maximum concentration (Cmax)
Time Frame: Day 1 through Day 3
Change in Cmax from Day 1 through Day 3
Day 1 through Day 3
Changes in PK parameters: time of Cmax (Tmax)
Time Frame: Day 1 through Day 3
Change in Tmax from Day 1 through Day 3
Day 1 through Day 3

Collaborators and Investigators

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

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.

General Publications

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)

June 30, 2021

Primary Completion (Actual)

February 11, 2022

Study Completion (Actual)

November 22, 2022

Study Registration Dates

First Submitted

July 8, 2021

First Submitted That Met QC Criteria

July 19, 2021

First Posted (Actual)

July 21, 2021

Study Record Updates

Last Update Posted (Actual)

August 7, 2023

Last Update Submitted That Met QC Criteria

August 3, 2023

Last Verified

August 1, 2023

More Information

Terms related to this study

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

product manufactured in and exported from the U.S.

No

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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