Randomized Multicenter Study on the Efficacy and Safety of Favipiravir for Parenteral Administration Compared to Standard of Care in Hospitalized Patients With COVID-19

Open-label Randomized Multicenter Comparative Study on the Efficacy and Safety of AREPLIVIR® (Favipiravir) for Parenteral Administration (PROMOMED RUS LLC, Russia) in Hospitalized Patients With COVID-19

This is open-labe randomized multicenter comparative Phase III study conducted in 7 medical facilities. The objective of the study is to assess the efficacy and safety of Favipiravir for parenteral administration compared with the Standard of care (SOC) in hospitalized patients with moderate COVID-19 pneumonia.

Study Overview

• Status: Completed
• Conditions: COVID-19
• Intervention / Treatment: Drug: Favipiravir; Drug: Favipiravir; Drug: Remdesivir

Detailed Description

Upon signing the informed consent form and screening, 217 eligible patients hospitalized with COVID-19 pneumonia were randomized at a 1:1 ratio to receive either Favipiravir intravenously by drip infusion for 2 hours 1600 mg twice a day (BID) on Day 1 followed by 800 mg BID on Days 2-14 (1600/800 mg), or SOC. The course of treatment by Favipiravir is 10 days.

• Study Type: Interventional
• Enrollment (Actual): 217
• Phase: Phase 3

Contacts and Locations

Study Locations

• Russian Federation
  • Ivanovo, Russian Federation, 153025
    • Regional budgetary health care institution "Ivanovo Clinical Hospital named after Kuvaevs"
  • Moscow, Russian Federation
    • State Clinical Hospital №50
  • Moscow, Russian Federation, 127015
    • State Budgetary Institution of Healthcare of the City of Moscow "City Clinical Hospital No. 24 of the Department of Healthcare of the City of Moscow"
  • Ryazan', Russian Federation
    • Regional Clinic Hospital of Ryazan
  • Saransk, Russian Federation
    • Medical institute Ogarev Mordovia State university
  • Smolensk, Russian Federation
    • Smolensk clinical hospital №1

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Availability of the Informed Consent Form of the Patient Information Leaflet (PIL) signed and dated by patient.
2. Men and women aged 18 to 80 years inclusive at the time of signing the Informed Consent Form in PIL.
3. Confirmed case of COVID-19 at the time of screening based on SARS-CoV-2 RNA test using nucleic acid amplification (NAA) method. It is acceptable to include a patient with a presumptive COVID-19 diagnosis prior to receiving the results of SARS-CoV-2 RNA test made at the screening stage.
4. Hospital admission due to COVID-19.

5. Moderate severity infection with SARS-CoV-2:

   • Clinical signs:
   • Mandatory: CT pattern typical of a viral lesion (lesion volume is minimal or moderate; CT 1-2).
   • Additional (at least 1 of the following criteria):
   • body temperature > 38 °C;
   • RR > 22/min;
   • shortness of breath on exertion;
   • SpO2 < 95%;
   • Serum CRP > 10 mg/L.
6. Patient's consent to use reliable contraceptive methods throughout the study and within 1 month for women and 3 months for men after its completion. Reliable means of contraception are: sexual abstinence, use of condom in combination with spermicide.

For men (optional): Consent to avoid sexual contact with pregnant women for the duration of the study and for 3 months after its completion.

Women incapable of childbearing may also participate in the study (with past history of: hysterectomy, tubal ligation, infertility, menopause for more than 2 years), as well as men with infertility or a history of vasectomy.

Exclusion Criteria:

1. Hypersensitivity to favipiravir, remdesivir and/or other components of the study drug.
2. Impossibility of CT procedure (for example, gypsum dressing or metal structures in the field of imaging).
3. History of vaccination against COVID-19.
4. History of presumptive or confirmed COVID-19 case of moderate, severe and extremely severe course of the disease.
5. Use of favipiravir or remdesivir within 10 days prior to screening.
6. The need to use drugs from the list of prohibited therapy.
7. Meeting the criteria for severe and extremely severe course of the disease.
8. Need for treatment in the intensive care unit.
9. Impaired liver function (AST and/or ALT ≥ 2 UNL and/or total bilirubin ≥ 1.5 UNL) at the time of screening.
10. Renal impairment (GFR < 60 ml/min) at the time of screening.
11. History of gout.
12. Positive testing for HIV, syphilis, hepatitis B and/or C.
13. Chronic heart failure FC III-IV according to New York Heart Association (NYHA) functional classification (see Appendix 2).
14. Malignancies in the past medical history.
15. Alcohol, pharmacological and/or drug addiction in the past medical history and/or at the time of screening.
16. Schizophrenia, schizoaffective disorder, bipolar disorder, or other history of mental pathology or suspicion of their presence at the time of screening.
17. Severe, decompensated or unstable somatic diseases (any disease or condition that threaten the patient's life or impair the patient's prognosis, and also make it impossible for him/her to participate in the clinical study).
18. Any history data that the investigating physician believes could lead to complication in the interpretation of the study results or create an additional risk to the patient as a result of his/her participation in the study.
19. Patient's unwillingness or inability to comply with procedures of the Study Protocol (in the opinion of physician investigator).
20. Pregnant or nursing women or women planning pregnancy.
21. Participation in another clinical study for 3 months prior to inclusion in the study.
22. Other conditions that, according to the physician investigator, prevent the patient from being included in the study.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Favipiravir (Areplivir); Arm 1 (n=106) receives the study drug Areplivir for parenteral administration as follows: Day 1 1600 mg 2 times a day, Day 2-10 800 mg 2 times a day. Administration will be done intravenously by drip infusion for 2 hours. The course of treatment is 10 days. The test drug is administered in hospital setting under supervision of a clinical investigator. The test drug is not handed over to the patient.	Drug: Favipiravir; 200 mg coated tablets; Drug: Favipiravir; 400 mg, lyophilizate for preparation of concentrate for solution for infusion; Other Names: Areplivir
Active Comparator: Standard of care; Arm 2 (n=108) patients receive standard therapy prescribed in accordance with the recommended treatment regimens included in the Interim Guidelines for the prevention, diagnosis and treatment of new coronavirus infection (COVID-19) approved by the Russian Ministry of Health by decision of the investigator and taking into account the availability of drugs at the study site. Might include Favipiravir tab, Remdesivir or other recommended schemes. Standard therapy is administered in hospital setting. Discharge of patients from a hospital is carried out in accordance with the local practice of the study site in compliance with the current sanitary and epidemiological regime.	Drug: Favipiravir; 200 mg coated tablets; Drug: Favipiravir; 400 mg, lyophilizate for preparation of concentrate for solution for infusion; Other Names: Areplivir; Drug: Remdesivir; 100 mg, lyophilizate for preparation of concentrate for solution for infusion

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rate of Clinical Status Improvement	Rate of clinical status improvement by WHO categorical ordinal scale of clinical status improvement by 2 or more categories by Day 10. WHO Ordinal Scale for Clinical Improvement (WHO-OSCI), 0 - uninfected (There are no clinical and virological signs of infection), 8 - dead, higher scores mean a worse outcome	By Visit 3, approximately 10 days
Time to Clinical Improvement	Time (in days) to improvement in clinical status by WHO categorical ordinal scale of clinical status improvement	28 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rate of the Use of Mechanical Ventilation	Percentage of cases with mechanical lung ventilation (% of patients)	28 Days
Mortality	Incidence of fatal cases (% of patients)	28 Days
Rate of Clinical Status Improvement	Rate of clinical status improvement by WHO categorical ordinal scale of clinical status improvement by 2 or more categories at Visits 2 (Day 5) and 4 (Day 14)	14 days
Rate of Clinical Status Improvement	Percentage of patients with clinical status of 0 and 1 point according to the WHO categorical ordinal scale of clinical improvement on Days 5, 10 and 14.	14 Days
End of Fever on Days of study	Percentage of patients with fever disappearance (body temperature < 37,2 °C in 3 consecutive measurements without antipyretic medication) an Days 5, 10 and 14.	14 Days
Change in the Level of Lung Damage According to CT	Assessment of lung injury (degree of damage by "empirical" visual scale and % of patients) according to CT data comparing to baseline. The number of patients in whom by the end of therapy there was an improvement in the condition of the lungs (a decrease in the volume of the lesion according to CT)	14 Days
Rate of Viral Elimination	Percentage of patients with SARS-CoV-2 elimination (negative test for SARS-CoV-2 by NAA method) on Days 5, 10, and 14.	14 days
Rate of Transfer to the Intensive Care Unit	Percentage of patients transferred to intensive care unit	28 days
Rate of the Use of Non-invasive Lung Ventilation	Percentage of cases with non-invasive lung ventilation	28 Days

Collaborators and Investigators

• Sponsor: Promomed, LLC
• Collaborators: Solyur Pharmaceuticals Group
• Investigators: Principal Investigator: Dmitriy Pushkar, MD, Academic, Moscow State Clinical Hospital №50

Study record dates

Study Major Dates

• Study Start (Actual): August 11, 2021
• Primary Completion (Actual): December 30, 2021
• Study Completion (Actual): December 30, 2021

Study Registration Dates

• First Submitted: January 7, 2022
• First Submitted That Met QC Criteria: January 7, 2022
• First Posted (Actual): January 11, 2022

Study Record Updates

• Last Update Posted (Actual): January 11, 2022
• Last Update Submitted That Met QC Criteria: January 7, 2022
• Last Verified: January 1, 2022

More Information

Terms related to this study

• Keywords: Coronavirus Infections; SARS-CoV-2; Pneumonia; Favipiravir; 2019-nCoV; Areplivir
• Additional Relevant MeSH Terms: Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Pneumonia, Viral; Pneumonia; Lung Diseases; COVID-19; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Antiviral Agents; Antimetabolites; Favipiravir; Remdesivir
• Other Study ID Numbers: FAV-052021

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Sharing Time Frame: January 2022
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; CSR

Drug and device information, study documents

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