Study to Evaluate the Efficacy and Safety of Ampligen in Patients With Post-COVID Conditions

A Randomized, Double Blind, Placebo Controlled Study to Evaluate the Efficacy and Safety of Ampligen® in Patients With Post-COVID Conditions

The purpose of this study is to assess the efficacy and safety of Ampligen® administered twice weekly by intravenous (IV) infusions in subjects experiencing the Post-COVID Condition of fatigue.

Study Overview

• Status: Completed
• Conditions: Long COVID; Post COVID-19 Condition
• Intervention / Treatment: Drug: Rintatolimod; Other: Placebo / Normal Saline

Detailed Description

This is a Phase 2, two-arm, randomized, double blind, placebo controlled multicenter study to evaluate the efficacy and safety of Ampligen® in patients experiencing the Post-COVID Condition of fatigue. Patients will be randomized 1:1 to receive twice weekly IV infusions of Ampligen® or placebo.

• Study Type: Interventional
• Enrollment (Actual): 80
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • California
    • Canoga Park, California, United States, 91303
      • HOPE Clinical Research
    • Inglewood, California, United States, 90301
      • 310 Clinical Research
    • San Diego, California, United States, 92120
      • Acclaim Clinical Research
  • Florida
    • Davie, Florida, United States, 33024
      • Alfa Medical Research
  • Texas
    • Dallas, Texas, United States, 75230
      • Zenos Clinical Research

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 60 years (Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Male or female adult between 18 to 60 (inclusive) years of age at time of enrollment.

2. Prior confirmed COVID-19 diagnosis by standard RT-PCR assay or equivalent testing at least 12 weeks prior to baseline.

   Note: For subjects with COVID-19 symptoms who were not tested for the presence of SARS-CoV-2, a positive serum antibody test for SARS-CoV-2 will be sufficient in subjects not vaccinated for COVID-19 or it can be shown that the positive antibody cannot be associated with the COVID-19 vaccination.

3. Laboratory confirmed negative SARS-CoV-2 (COVID-19) infection by a government approved test / kit at time of enrollment.
4. Subject meets the criteria of fatigue per the 1994 CDC Case Definition for Chronic Fatigue Syndrome (CFS): Unexplained persistent or relapsing chronic fatigue that is of new or definite onset (i.e., not lifelong), is not the result of ongoing exertion, is not substantially alleviated by rest, and results in substantial reduction in previous levels of occupational, educational, social, or personal activities. The fatigue must have persisted or recurred during 3 or more consecutive months of illness and must not have preceded the onset of the COVID-19 symptoms.
5. PROMIS® Fatigue- Short Form 7a score of ≥21 at screening and baseline.

6. Electrocardiogram (ECG) with no clinically significant findings as assessed by the Investigator.

   Note: Below are the examples of clinically significant ECG abnormalities:

   • Previous documented evidence of myocardial infarction or recent significant change in the resting EKG suggesting infarction or other acute cardiac events.
   • Current symptoms of coronary insufficiency (i.e. - angina pectoris and/or ST segment depression on EKG).
   • Evidence of uncontrolled atrial or frequent or complex ventricular ectopy, or myocardial conduction defect which would increase the risk of syncope (for example, second degree or higher A-V block).
7. Subject (or legally authorized representative) provides written informed consent prior to initiation of any study procedures.
8. Men and women of childbearing potential and their partner must agree to use two medically accepted methods of contraception (e.g., barrier contraceptives [male condom, female condom, or diaphragm with a spermicidal gel], hormonal contraceptives [implants, injectables, combination oral contraceptives, transdermal patches, or contraceptive rings], or one of the following methods of birth control (intrauterine devices, bilateral tubal occlusion, or vasectomy) or must practice complete sexual abstinence for the duration of the study (excluding women who are not of childbearing potential and men who have been sterilized).
9. Females of child-bearing potential must have a negative urine pregnancy test at Screening Visit and prior to receiving the first dose of study drug; and Male participants must agree to use contraception and refrain from donating sperm for at least 90 days after the last dose of study intervention.
10. Subject is willing and able to comply with scheduled visits, drug administration plan, laboratory tests, other study procedures and study restrictions.

Exclusion Criteria:

1. Inability to provide informed consent or to return to the Investigator's site for scheduled infusions and evaluations.
2. Exhibiting signs of moderate or severe pulmonary disease (such as COPD, asthma, or pulmonary fibrosis).
3. Ongoing requirement of oxygen therapy.
4. Pulse oxygen saturation (SpO2) of <94% on room air at the time of screening.
5. Thrombocytopenia (platelets <100×109/L), anemia (hemoglobin <9.0 g/dL), or leukopenia (WBC <3×109/L) on screening labs
6. History of splenectomy.
7. Known hypercoagulable state or at increased risk of thrombosis (e.g., due to immobility)
8. Liver cirrhosis or patient showing signs of clinical jaundice at the time of screening.
9. Transaminase (ALT or AST) >3X ULN or total bilirubin >2X ULN at screening
10. Chronic kidney disease stage 4 or requiring dialysis at the time of screening.
11. Estimated GFR <60 mL/min/1.73 m2 at the time of screening
12. NYHA Class III or IV congestive heart failure (CHF).
13. Exhibiting signs of uncontrolled hypo-or hyper-thyroidism at the time of Screening.
14. Diagnosis of autoimmune disease (e.g., SLE, rheumatoid arthritis, psoriasis) at the time of screening
15. Uncontrolled rheumatologic disorders at the time of screening.
16. Diagnosis of sleep apnea (central or obstructive) at the time of screening.
17. History of organ transplantation or are candidates for organ transplantation at the time of screening.
18. History of Chronic Fatigue Syndrome prior to COVID-19 infection.
19. History of fibromyalgia prior to COVID-19 infection.
20. History of major psychiatric disorder including psychotic or melancholic features, bipolar disorders, schizophrenia of any subtype, schizoaffective disorder, major depression delusional disorders of any subtype, dementias of any subtype, anorexia nervosa or bulimia nervosa.
21. Any malignancy within the past 5 years, excluding successfully treated basal cell carcinoma or squamous cell carcinoma without evidence of metastases.
22. Any other clinically significant serious systemic diseases, chronic or intercurrent active medical disorder and other reasons which would interfere with study conduct or study results interpretation per the Investigator.
23. Chronic or intercurrent acute medical disorder or disease making implementation or interpretation of the protocol or results difficult or unsafe per the investigator.
24. Therapy with interferons, interleukins, or other cytokines or investigational drugs within 6 weeks of beginning study medication. Subjects must give written informed consent prior to discontinuation of investigational drugs.
25. Treatment with any of the following therapies within the eight (8) weeks immediately preceding the start of study baseline or during baseline: systemic glucocorticoids (i.e., hydrocortisone, prednisone, etc.) or mineralocorticoids (i.e., fludrocortisone (Florinef), etc.), interferons, interleukin-2, systemic antivirals, gamma globulin or investigational drugs or experimental agents not yet approved for use in the United States.
26. Prior participation in an Ampligen® study.
27. Medical necessity, as determined by the patient's primary doctor or the principal investigator, to continue aspirin (ASA) or non-steroidal anti-inflammatory (NSAID) drugs for 20 consecutive days or for more than 10% of the study duration.
28. History of congestive heart failure, suspected or known dissecting aneurysm, recent systemic or pulmonary embolus or myocardial infarction (≤ 6 months), severe valvular heart disease, ventricular aneurysm, active or suspected myocarditis or pericarditis, thrombophlebitis or intracardiac thrombi, or acute infection.
29. Evidence of moderate or severe obstructive pulmonary disease.
30. Resting diastolic blood pressure > 115 mm Hg or resting systolic blood pressure > 200 mm Hg.
31. Uncontrolled metabolic disease (e.g., diabetes, thyrotoxicosis, or myxedema).
32. Concurrent use of any beta blockers and/or bronchodilators which cannot remain at a stable dosage level during baseline and the study.
33. History of alcohol or other substance abuse within two (2) years before the onset of acute COVID-19 or at any time afterward.
34. History of suicidal ideation, suicide attempt, or suicidal behavior within two (2) years of baseline. A score of 10 or greater on the PHQ-9 at Baseline indicates symptoms of depression and will exclude subject. A score of greater than zero on question nine (9) of the PHQ-9 at Baseline indicates suicidal ideation and will exclude subject.
35. Pregnant or breast feeding.
36. Participation in another study for an investigational treatment.

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: Ampligen / rintatolimod; Subjects will receive rintatolimod (intravenous [IV]), up to 400 mg twice weekly for 12 weeks.	Drug: Rintatolimod; 100 to 400 mg twice weekly; Other Names: Ampligen; poly I : poly C12U; Rintatolimod (poly I : poly C12U)
Placebo Comparator: Placebo / Saline; Subjects will receive placebo / normal saline (intravenous [IV]), up to 160 mL twice weekly for 12 weeks.	Other: Placebo / Normal Saline; 40 to 160 mL twice weekly

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline to Week 13 in PROMIS Fatigue Score (T-Score)	Change in mean fatigue T-score as measured by PROMIS® (Patient-Reported Outcomes Measurement Information System) Fatigue short form 7a that assess a range of self-reported symptoms, from mild subjective feelings of tiredness to extreme exhaustion. The lowest possible raw score is 7; the highest possible raw score is 35. Raw summed scores are converted to T-score values that are standardized such that 50 represents the average (mean) for the US general population, with a standard deviation of 10 points. The lowest possible T-score is 29.4; the highest possible T-score is 83.2. A higher T-score represents more of the concept being measured, meaning the higher the T-Score, the worse the fatigue of the individual. Scores <55 are within normal limits, 55-60 mild, 61-70 moderate, and >70 severe fatigue.	Baseline and Week 13

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline to Week 6 in PROMIS Fatigue Score (T-Score)	Change in mean fatigue T-score as measured by PROMIS® (Patient-Reported Outcomes Measurement Information System) Fatigue short form 7a that assess a range of self-reported symptoms, from mild subjective feelings of tiredness to extreme exhaustion. The lowest possible raw score is 7; the highest possible raw score is 35. Raw summed scores are converted to T-score values that are standardized such that 50 represents the average (mean) for the US general population, with a standard deviation of 10 points. The lowest possible T-score is 29.4; the highest possible T-score is 83.2. A higher T-score represents more of the concept being measured, meaning the higher the T-Score, the worse the fatigue of the individual. Scores <55 are within normal limits, 55-60 mild, 61-70 moderate, and >70 severe fatigue.	Baseline to Week 6
Change From Baseline to Week 13 in PROMIS Fatigue Score (T-Score), Excluding Response to Item Seven	Change in mean fatigue T-score as measured by PROMIS® (Patient-Reported Outcomes Measurement Information System) Fatigue short form 7a that assess a range of self-reported symptoms, from mild subjective feelings of tiredness to extreme exhaustion. For this endpoint, the last question of "How often did you have enough energy to exercise strenuously" was excluded. Therefore, the lowest possible raw score is 6; the highest possible raw score is 30. Raw summed scores are converted to T-score values that are standardized such that 50 represents the average (mean) for the US general population, with a standard deviation of 10 points. The lowest possible T-score is 33.4; the highest possible T-score is 76.8. A higher T-score represents more of the concept being measured, meaning the higher the T-Score, the worse the fatigue of the individual.	Baseline to Week 6 and 13
Change From Baseline to Week 6 and Week 13 in Distance Traveled During 6-minute Walk Test (6MWT)	The distance covered over a time of 6 minutes is used as the outcome by which to compare changes in performance capacity. The 6MWT is a sub-maximal exercise test used to assess aerobic capacity and endurance.	Baseline to week 6 and week 13
Percentage of Subjects With Minimal Clinically Important Difference (MCID)	Percentage of subjects with increase of at least 54 m from baseline in the Six-Minute Walk Test (6MWT) at the end of 12-week treatment phase presented and summarized descriptively by treatment group.	End of 12 week treatment phase
Change From Baseline to Week 6 and 13 in PROMIS Cognitive Function Converted Score (T-Score).	Change in mean cognitive function T-score as measured by PROMIS® (Patient-Reported Outcomes Measurement Information System) Cognitive Function - Abilities short form 8a that assesses self-perceived cognitive deficits. The lowest possible raw score is 8; the highest possible raw score is 40. Raw summed scores are converted to T-score values that are standardized such that 50 represents the average (mean) for the US general population, with a standard deviation of 10 points. The lowest possible T-score is 23.27; the highest possible T-score is 67.09. A higher T-score represents more of the concept being measured, meaning the higher the T-Score, the better the cognitive function of the individual. Scores >45 are within normal limits, 40-45 mild, 30-40 moderate, and <30 severe cognitive dysfunction.	Baseline to Week 6 and 13
Change From Baseline to Week 6 and 13 in PROMIS Sleep Disturbance Score (T-Score)	Change in mean sleep disturbance T-score as measured by PROMIS® (Patient-Reported Outcomes Measurement Information System) Sleep Disturbance - short form 4a that assesses self-perceived sleep quality. The lowest possible raw score is 4; the highest possible raw score is 20. Raw summed scores are converted to T-score values that are standardized such that 50 represents the average (mean) for the US general population, with a standard deviation of 10 points. The lowest possible T-score is 32; the highest possible T-score is 73.3. A higher T-score represents more of the concept being measured, meaning the higher the T-Score, the worse the sleep disturbance of the individual. Scores <55 are within normal limits, 55-60 mild, 61-70 moderate, and >70 severe fatigue.	Baseline to Week 6 and 13

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes From Baseline in COVID-19-related Symptoms Using Symptom Burden Questionnaire for Long COVID (SBQ-LC) During the Course of the Treatment Phase.	The SBQ-LC (Symptom Burden Questionnaire for Long COVID), which includes questions related to common COVID-19 symptoms, was assessed at baseline and at every odd-numbered visit from Visit 3 to Visit 25. Data at baseline and change from baseline at Week 12 (end of treatment) is reported. The converted scores reported for each symptom range from 0 to 100, with a higher score indicating worse symptom burden.	Baseline and the end of treatment phase at week 12
Change From Baseline in Cognitive Function as Measured by Montreal Cognitive Assessment (MoCA) at Weeks 4, 8, and 13 During the Treatment Phase	The change from baseline in Montreal Cognitive Assessment (MoCA) at week 4, 8, and 13 is presented and summarized descriptively by treatment group. Higher scores indicate better cognitive function; total scores equal to or higher than 26 are considered normal. Montreal Cognitive Assessment range is from 0-30, with a score of 26 or higher indicating normal cognitive function. 18-25 indicates mild cognitive impairment; 10-17 indicates moderate cognitive impairment; less than 10 indicates severe cognitive impairment.	Baseline to weeks 4, 8 and 13 during treatment phase
Hospitalizations	Number of subjects with hospitalization during treatment phase up to week 12.	During the treatment phase up to 12 weeks
Duration of Hospitalizations	Duration (days) of hospitalization during the treatment phase up to week 12.	During the treatment phase up to 12 weeks
Evaluation of Lymphocyte Profile by Flow Cytometry in Patients With Post-COVID-19 Conditions - Absolute Value of CD3+	A blood sample was collected at V2 (pre-dose), V12 (pre-dose), and V26 (Follow-up 1) for research purposes to conduct exploratory analyses of lymphocyte profile by flow cytometry. The absolute values and change from baseline data for CD3+ were evaluated.	Baseline to week 6 and 13
Evaluation of Lymphocyte Profile by Flow Cytometry in Patients With Post-COVID-19 Conditions - Absolute Value of CD3-CD56+ Natural Kill	A blood sample was collected at V2 (pre-dose), V12 (pre-dose), and V26 (Follow-up 1) for research purposes to conduct exploratory analyses of lymphocyte profile by flow cytometry. The absolute values and change from baseline data for CD3-CD56+ natural killers (NK+) were evaluated.	Baseline to week 6 and 13
Evaluation of Lymphocyte Profile by Flow Cytometry in Patients With Post-COVID-19 Conditions - CD4:CD8 Ratio	A blood sample was collected at V2 (pre-dose), V12 (pre-dose), and V26 (Follow-up 1) for research purposes to conduct exploratory analyses of lymphocyte profile by flow cytometry. The absolute values and change from baseline data for CD4:CD8 ratio were evaluated.	Baseline to week 6 and 13
Identification and Evaluation of Plasma Protein Biomarkers in Patients With Post-COVID-19 Conditions	A blood sample was collected at V2 (pre-dose) and V26 (Follow-up 1) for research purposes to conduct exploratory analyses of protein biomarkers.	Baseline and week 13

Collaborators and Investigators

• Sponsor: AIM ImmunoTech Inc.
• Collaborators: Amarex Clinical Research
• Investigators: Study Director: David R Strayer, MD, AIM ImmunoTech Inc.

Study record dates

Study Major Dates

• Study Start (Actual): June 30, 2023
• Primary Completion (Actual): November 17, 2023
• Study Completion (Actual): November 30, 2023

Study Registration Dates

• First Submitted: October 20, 2022
• First Submitted That Met QC Criteria: October 20, 2022
• First Posted (Actual): October 24, 2022

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: December 31, 2024
• Last Verified: December 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease; Anti-Infective Agents; Immunologic Factors; Physiological Effects of Drugs; Antiviral Agents; Interferon Inducers; Poly I-C; poly(I).poly(c12,U)
• Other Study ID Numbers: AMP-518

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