Early High-Titre Convalescent Plasma in Clinically Vulnerable Individuals With Mild COVID-19 (COVIC-19)

A Randomised Open-Label Trial of Early, Very High-Titre Convalescent Plasma Therapy in Clinically Vulnerable Individuals With Mild COVID-19

• Research Question: Does convalescent plasma (CCP) collected from donors who have recovered from COVID-19 and who have a very high titre of anti-SARS-CoV-2 antibodies reduce the risk of hospitalisation (for COVID-19) or death in patients with early symptoms of acute COVID-19 who are vulnerable to this disease compared to standard of care?
• Study product: Very high antibody titre COVID-19 convalescent plasma collected more than 15 days after end of symptoms in COVID-19 patients who also had received at least one dose of a SARS-CoV-2 vaccine.
• Methodology: Multicentre, randomised, open-label, adaptive superiority trial: COVID-19 very high neutralizing Ab titre convalescent plasma vs standard care in 2 cohorts of vulnerable patients (cohort 1: elderly (≥ 70 years) and younger with comorbidities, cohort 2: immunosuppressed patients).
• Study phase: Phase 3
• Intervention: Two units of high antibody titre COVID-19 convalescent plasma to individuals randomised to the intervention group, 2 units from 2 different donors, preferably transfused on the same day. Plasma provided by convalescent vaccinated donors with a minimum antibody titre of 1:640 against delta variant (B1.617.2) or antibody concentration >=4.000 BAU/ml in the QuantiVac anti-SARS-CoV-2 IgG ELISA or >=20.000 U/ml in the Elecsys anti-SARS-CoV-2 CLIA
• Randomisation: 1:1 (standard of care + convalescent plasma vs. standard of care) stratified by centre (cohorts 1 and 2)

Study Overview

• Status: Terminated
• Conditions: COVID-19
• Intervention / Treatment: Other: Current standard of care; Biological: Current standard of care and COVID-19 convalescent and vaccinated plasma

Detailed Description

COVIC-19 is a multicentre international, randomised, open-label adaptive superiority phase III trial to evaluate the efficacy and safety of COVID-19 convalescent plasma in the treatment of COVID-19. It is conducted in a harmonized approach in different countries in Europe.

The study is randomizing adult COVID-19 patients to one of two arms (1:1 ratio): standard of care or standard of care and very high neutralizing Ab titre convalescent plasma. Randomization will be stratified by centre and by patient cohort. The control group will receive 'standard care' therapy. Neither blinding nor placebo will be used to avoid unnecessary intravenous access.

Standard of care therapy may include anti-SARS-CoV-2 specific medication listed as authorized in the protocol. Centres should ensure that medications used as standard of care are used similarly for patients in both treatment arms.

Participating patients will be included in 2 cohorts of vulnerable patients (cohort 1: elderly (≥ 70 years) and younger with comorbidities (cohort 1: < 70 with comorbidities), cohort 2: immunosuppressed patients).

All subjects will undergo a series of efficacy and safety assessments, including laboratory assays. Subjects will be assessed at baseline, and at Days 3, 14, 28, 90 and 180.

Nasopharyngeal swabs (NP) or lower respiratory tract samples will be obtained at D1 (pre-treatment), and at D3, D14 and D28 (and monthly in case of positivity until of clearance) for cohort 2.

Blood samples will be obtained at D1, D14 and D28 and on the day of hospitalization (if applicable).

The trial is sponsored by the University Hospital of Besançon in France, the German Red Cross in Germany and the NHSBT in the United Kingdom.

• Study Type: Interventional
• Enrollment (Actual): 120
• Phase: Phase 3

Contacts and Locations

Study Locations

• France
  • Besançon, France, 25000
    • CHU Besancon
• Germany
  • Berlin, Germany, 10117
    • Charité Medizinische Klinik IV
  • Chemnitz, Germany, 09116
    • Klinikum Chemnitz gGmbH
  • Baden-Wuerttemberg
    • Mutlangen, Baden-Wuerttemberg, Germany, 73527
      • Stauferklinikum Schwäbisch Gmünd
    • Stuttgart, Baden-Wuerttemberg, Germany, 70174
      • Klinikum Stuttgart
    • Stuttgart, Baden-Wuerttemberg, Germany, 70176
      • Diakonie-Klinikum Stuttgart
    • Tübingen, Baden-Wuerttemberg, Germany, 72076
      • Uniklinikum Tübingen
    • Ulm, Baden-Wuerttemberg, Germany, 89081
      • Institut für Klinische Transfusionsmedizin (IKT)
    • Ulm, Baden-Wuerttemberg, Germany, 89081
      • Uniklinikum Ulm
  • Brandenburg
    • Brandenburg an der Havel, Brandenburg, Germany, 14770
      • Universitätsklinikum Brandenburg
  • Hessen
    • Frankfurt, Hessen, Germany, 60590
      • Universitätsklinikum Frankfurt
  • Sachsen
    • Riesa, Sachsen, Germany, 01589
      • Elblandkliniken Riesa
• Netherlands
  • Rotterdam, Netherlands, 3000CA
    • Erasmus Medical Center
• United Kingdom
  • Oxford, United Kingdom
    • NHS Blood and Transplant

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Cohort 1: Elderly and high COVID-age population:

Inclusion criteria:

• SARS-CoV-2 RNA detected in a specimen, ≤ 7 days after onset of symptoms
• Symptoms of COVID-19 (so including but not limited to: fever; cough; breathlessness; chest pain; wheeze; sore throat; haemoptysis; runny nose; fatigue; muscle or joint pain; confusion; headache; seizures; nausea; vomiting; diarrhoea; abdominal pain; poor appetite; skin ulcers or rash; ear pain; conjunctivitis; anosmia; bleeding; lymphadenopathy. The attending clinician will determine if symptoms are consistent with COVID-19.
• Clinical status not requiring admission to hospital for COVID-19 disease and oxygen support
• Ability to transfuse (per randomisation) within 7 days after onset of symptoms
• Men or women, 70 years or older OR
• under 70 years with significant comorbidities (arterial hypertension, diabetes, obesity, asthma or other chronic pulmonary disease, cardiovascular disease, cerebrovascular disease, chronic kidney disease / dialysis, hemoglobinopathies, liver disease, chronic neurological disease, rheumatoid arthritis, lupus or psoriasis) resulting in a 'COVID-age' of 70 years or more according to the ALAMA risk calculator https://alama.org.uk/covid-19-medical-risk-assessment/

Exclusion Criteria:

• Age < 18 years (France and Germany only)
• Prior or concurrent treatment for COVID-19 (unless listed as authorized)
• History of COVID-19 disease in the last 90 days prior to enrollment
• Prior anti-SARS-CoV-2 immunization
• Contraindication to receiving CCP including previous history of transfusion-related acute lung injury (TRALI) or moderate or severe allergic reaction to blood components
• Known participant objection to receiving plasma products
• Primary or acquired immune deficiency listed below (see cohort 2)
• Refusal to participate expressed by patient or legally authorised representative
• Pregnancy

Cohort 2: High-risk immunocompromised population

Inclusion criteria:

• SARS-CoV-2 RNA, or positive antigenic test, detected in a specimen, ≤ 7 days after onset of symptoms
• Symptoms of COVID-19 (so including but not limited to: fever; cough; breathlessness; chest pain; wheeze; sore throat; haemoptysis; runny nose; fatigue; muscle or joint pain; confusion; headache; seizures; nausea; vomiting; diarrhoea; abdominal pain; poor appetite; skin ulcers or rash; ear pain; conjunctivitis; anosmia; bleeding; lymphadenopathy. The attending clinician will determine if symptoms are consistent with COVID-19.
• Clinical status not requiring admission to hospital for COVID-19 disease and oxygen support
• Ability to transfuse (per randomisation) within 7 days after onset of symptoms

• Male or female with extremely high risk including:

  a. Patients with at least one of the following acquired immune deficiencies

  i. Lymphoid malignancies treated within the last 12 months ii. Lymphoid malignancies with persistent hypogammaglobulinaemia (IgG < 5g/L) iii. Myeloid malignancies treated by chemotherapy within the last 12 months iv. Myeloid malignancies treated by anti-BCL-2 drugs within the last 12 months v. Myeloid malignancies associated with prolonged neutropenia (≥ 6 weeks) vi. Solid tumour undergoing treatment with chemotherapy (until 3 months after completion of the last chemotherapy cycle) vii. Allogenic hematopoietic stem cell transplantation within the last 12 months or anytime if on-going treatment for chronic GVHD viii. Organ transplantation ix. Anti-B (CD20/CD19) MoAb and/or mycophenolate mofetil treatment within the last 12 months x. Anti-CD19/CD20 CAR-T cell treatment xi. ATG or alemtuzumab treatment within the last 6 months xii. AIDS

OR b. Patients with primary lymphoid immune deficiencies. i. B cell deficiencies (such as Bruton agammaglobulinemia) ii. T cell deficiencies (such as Wiskott Aldrich disease) iii. Combined deficiencies (such as Common variable immunodeficiency).

OR c. Patients without detectable seroconversion ≥ 3 weeks after complete vaccination schedule with an approved vaccine.

Exclusion Criteria:

• Age < 18 years (France and Germany only)
• Prior or concurrent treatment for COVID-19 (dexamethasone, anti-IL-6/IL6R, remdesivir) except for prophylactic administration of anti-SARS-CoV-2 monoclonal antibodies (pre or post exposure) and authorized specific treatment
• History of COVID-19 disease in the last 90 days prior to enrollment
• Contraindication to receiving CCP including previous history of transfusion-related acute lung injury (TRALI) or moderate or severe allergic reaction to blood components
• Known participant objection to receiving plasma products
• Refusal to participate expressed by patient or legally authorised representative
• Pregnancy

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
Active Comparator: Current standard of care; Standard of care therapy may include anti-SARS-CoV-2 specific medication such as, but not limited to: Casirivimab; Casirivimab / Imdevimab (REGN-COV2 or Ronapreve); Imdevimab; Sotrovimab (Xevudy); Tixagevimab / Cilgavimab (Evusheld); Molnupiravir (MK-4482); Nirmatrevlir / Ritonavir (Paxlovid); Remdesivir Centres should ensure that medications used as standard of care are used similarly for patients in both treatment arms.	Other: Current standard of care; Standard of care therapy may include anti-SARS-CoV-2 specific medication such as, but not limited to: Casirivimab; Casirivimab / Imdevimab (REGN-COV2 or Ronapreve); Imdevimab; Sotrovimab (Xevudy); Tixagevimab / Cilgavimab (Evusheld); Molnupiravir (MK-4482); Nirmatrevlir / Ritonavir (Paxlovid); Remdesivir Centres should ensure that medications used as standard of care are used similarly for patients in both treatment arms.
Experimental: Current standard of care and convalescent plasma; Current standard of care and the infusion of two plasma units collected from two different COVID-19 convalescent patients.	Biological: Current standard of care and COVID-19 convalescent and vaccinated plasma; ABO compatible convalescent plasma infused intravenously on study day 1 (as soon as possible after randomisation) and the second on day 1 or day 2. Plasma obtained by apheresis from donors who have recovered from COVID-19 infection (at least 14 days after recovery) and have been vaccinated (at least 3 weeks after first dose of vaccine). A combination of both a SARS-CoV-infection and a SARS-CoV-2 vaccination of the donor is required - irrespective of the sequence of infection and vaccination. As far as the availability of CCP units allows, the two plasma units should have been donated by two different convalescents.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of participants with hospitalisation with progressive COVID-19 symptoms or death	Proportion of participants with (1) at least one overnight stay in hospital for progressive COVID-19 symptoms or (2) who died	Day 28

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of participants with hospitalisation for progressive COVID-19 symptoms or death		Day 14
Proportion of patients with hospitalisation for progressive COVID-19 symptoms requiring O2 support*, or death *O2 support: requirement based on O2 saturation level on room air <=93% or respiration rate >30		Day 14 and Day 28
All-cause mortality		Day 28, 90, 180
Proportion of patients with supplemental oxygen		Day 14, 28
Proportion of patients with non-invasive ventilation		Day 14, 28
Proportion of patients with intubation and mechanical ventilation		Day 14, 28
Change in 10-point WHO Clinical Progression Scale score	The 10-point WHO clinical progression scale ranges from 0 to 10 (0: uninfected; 10: death)	Day 14, 28
Duration of hospital admission censored at 28 days		Day 28
Proportion of patients with admission to ITU		Day 14, 28
Duration of ITU admission censored at 28 days		Day 28
Proportion of patients with long COVID-19 symptoms and time to recovery		Day 28, 180
Health-related quality of life assessed by EQ-5D quality of life index	EQ-5D is one of the most widely used Health-related quality of life measure. EQ-5D questionnaires have 5 dimensions: Mobility, Human Autonomy, Current Activities, Pain & Discomfort, "Anxiety & Depression, and all dimensions are described by 5 levels corresponding to patient response choices. A quality of life index ranging from less than 0 (worse than death) to 1 (full health) is derived from the answers to the questionnaires.	Day 28, 180
Number of Serious Adverse Events	Grade 3/4 adverse events and AE unexpected for their nature, onset, evolution, severity or frequency	72 hours
Number of Participants with arterial and venous thromboembolic events		Day 28, 90, 180

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in SARS-CoV-2 RNA level	Polymerase chain reaction, Cycle Threshold value in oral or nose/throat swab samples at days 3, 14, 28 and 180 after randomisation	Day 3, 14, 28, 180
Change in anti-SARS-CoV-2 spike antibody levels in blood		Day 14, 28
SARS-CoV-2 whole-genome sequence analysis		Day 1, 28
Proportion and clinical characteristics of patients with cultivable virus		Day 28, 180
Virus sequence variation and cultivability over time, overall and in individuals receiving vs not receiving CCP		Day 1, 28

Collaborators and Investigators

• Sponsor: Deutsches Rotes Kreuz DRK-Blutspendedienst Baden-Wurttemberg-Hessen
• Collaborators: Erasmus Medical Center; NHS Blood and Transplant
• Investigators: Principal Investigator: Bart Rijnders, MD, PhD, Erasmus Medical Center; Study Director: Pierre Tiberghien, MD, PhD, Etablissement Français du Sang, La Plaine Saint-Denis, France; Principal Investigator: Eric Toussirot, MD, PhD, Rheumatology department, CHU Besançon, France; Principal Investigator: Hubert Schrezenmeier, MD, PhD, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen; Principal Investigator: Lise Estcourt, MD, PhD, NHS Blood and Transplant, Oxford, United Kingdom; Principal Investigator: David Roberts, MD, PhD, NHS Blood and Transplant, Oxford, United Kingdom

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2022
• Primary Completion (Actual): January 18, 2024
• Study Completion (Actual): June 17, 2024

Study Registration Dates

• First Submitted: March 3, 2022
• First Submitted That Met QC Criteria: March 8, 2022
• First Posted (Actual): March 9, 2022

Study Record Updates

• Last Update Posted (Actual): October 29, 2024
• Last Update Submitted That Met QC Criteria: October 25, 2024
• Last Verified: October 1, 2024

More Information

Terms related to this study

• 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
• Other Study ID Numbers: COVIC-19

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