Study of the Safety, Tolerability and Efficacy of NP-101 in Treating High Risk Participants Who Are Covid-19 Positive. (BOSS-002)

A Randomized, Double-Blind, Placebo-Controlled, Multicenter, Phase IIa/IIb Study to Evaluate the Safety, Tolerability, and Efficacy of NP-101 in Treating High-Risk Participants Who Have Tested Positive for Novel Coronavirus 2019.

The goal of this clinical trial is to evaluate the safety, tolerability, and efficacy of NP-101 in treating high-risk participants who have tested positive for Covid-19. The main question[s] it aims to answer are:

• To evaluate the safety of NP-101, as well as establish the maximum tolerated dose in high risk Covid-19 positive patients.

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Study Overview

• Status: Terminated
• Conditions: COVID-19
• Intervention / Treatment: Other: Placebo; Drug: NP-101

Detailed Description

This is a Phase IIa/IIb multicenter, interventional, randomized, double-blind, placebo-controlled study designed to evaluate the safety, tolerability, and efficacy of NP-101 in outpatient high-risk COVID-19 positive participants. Blinding roles: Participants, Investigators and Sponsor

The study is comprised of two parts (Phase IIa and Phase IIb) and four cohorts. The first part of the trial (IIa) involves three cohorts and is a dose escalation study designed to select the maximum tolerated dose for use in the second part (IIb) of the study. In the dose escalation (Phase IIa) portion of the trial (n= 60), qualified participants will be enrolled in a parallel dose escalation design and randomized in a 3:1 [active+best supportive care (BSC):placebo+BSC]ratio to one of three cohorts of 20 participants each (15 active +BSC, 5 placebo + BSC). Cohort 1 (15 participants taking 600 mg capsules for a total daily dose of 3 grams of NP-101 plus BSC and 5 participants taking placebo plus BSC), and Cohort 2 (15 participants taking 600 mg capsules for a total daily dose of 4.8 g of NP-101+ BSC and 5 participants taking placebo plus BSC will run concurrently since acceptable safety data for the 3 g dose was obtained in an earlier phase II study.

Cohort 1 will receive either 3 g Total Daily Dose (TDD) of NP-101 + BSC or Placebo+ BSC, Cohort 2 will receive either 4.8 g TDD of NP-101 +BSC or placebo + BSC) and Cohort 3 (15 participants taking 600 mg capsules for a total daily dose of 6 g of NP-101 + BSC and 5 participants taking placebo plus BSC.) Safety will be evaluated according to the terms of the Statistical Analysis Plan (SAP). In the second portion of the trial (Phase IIb), Participants enrolled in Cohort 4 (n= 248) will be randomized in a ratio of 1:1 (active+BSC : placebo+BSC) and will receive the Maximum Tolerated Daily Dose (MTDD) as determined by the parameters set by the SAP and approved by the pharmacovigilance team.

• Study Type: Interventional
• Enrollment (Actual): 170
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Florida
    • Miami, Florida, United States, 33142
      • L&A Morales Healthcare/ Enrique Villa, MD Principal Investigator
  • Illinois
    • Berwyn, Illinois, United States, 60402
      • Research Network America
  • Texas
    • Houston, Texas, United States, 77074
      • Clinical Trial Network
    • Pearland, Texas, United States, 77584
      • Pearland Family Wellness Clinic

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Provision of signed and dated informed consent form
• A resting SpO2 of >93% on room air.
• Stated willingness to comply with all study procedures and availability for the duration of the study
• Male or female, aged 18 and over, presenting with mild to moderate clinical symptoms of Covid- 19 infection (per FDA guidance - see appendix 3) with symptom onset within 5 days prior to the day of randomization
• Positive COVID-19 infection confirmed by RT-PCR within the last 5 days of the day of randomization
• A score of ≥ 2 (moderate) on a minimum of 1 symptom on the PRO Symptom Survey on the day of randomization
• Ability to take oral medication and be willing to adhere to the dosing regimen (Twice a day - BID for 14 days)
• For females of reproductive potential: negative pregnancy test at screening and use of highly effective contraception method during study participation and for an additional 4 weeks after the end of study drug administration
• For males of reproductive potential: use of condoms or other methods to ensure effective contraception with partner during study participation and for an additional 4 weeks after the end of study drug administration
• Agreement to adhere to Lifestyle Considerations (see section 5.3) throughout study duration

• To be considered high risk, participants should have at least one of the following conditions:

  • age ≥60 years;
  • active cancer
  • chronic kidney disease;
  • chronic lung disease including COPD
  • Obesity (BMI ≥30)
  • serious heart conditions [heart failure, coronary artery disease, or cardiomyopathies];
  • Diabetes (type 1 or type 2)
  • Immunocompromised state (weakened immune system or autoimmune diseases)
  • Chronic liver disease
  • Cystic fibrosis
  • HIV infection
  • Smoking, current or former
  • Sickle cell disease or thalassemia
  • Solid organ or blood stem cell transplant
  • Stroke or cerebrovascular disease

Exclusion Criteria:

• Current or recent (within 4 weeks) treatment with any corticosteroids; however, inhaled steroids, which are used to treat acute or chronic bronchial inflammation, will be permitted
• Severe Covid-19 symptoms (severe per FDA classification - see appendix 3)
• Requires immediate admission to hospital for any reason
• Pregnancy or lactation
• Known allergic reactions to components of black seed oil or thymoquinone
• Treatment with another investigational drug or other investigational intervention within 2 weeks of study start and throughout study duration.

• Significant hepatic disease (ALT/AST> 4 times the ULN); any laboratory parameter >/= 4 times the ULN or platelet count <100,000/µ L or neutrophilic granulocyte absolute count

  o <500/mm3

• History of moderate to severe CKD, (i.e. on hemodialysis or has an estimated glomerular filtration rate less than 45mL/min) at the time of enrollment
• Participants with inflammatory bowel disease (such as Crohn's) that could affect the intestinal absorption of NP-101 enteric coated capsules.
• Known uncontrolled HIV (with a recent viral load > 50 copies/mL or CD4<200 cells/mm3 or known active uncontrolled Hepatitis B (defined as HBsAg-positive or detectable HBV DNA viral load) or known active Hepatitis C (defined as detectable HCV RNA viral load) infection
• Influenza diagnosis (confirmed by testing) during screening or within prior 14 days
• Any uncontrolled condition(s) or diagnosis, both physical or psychological, or physical exam finding that precludes participation, as per investigator
• Current treatment with CYP2C9 substrates (see Appendix 5)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Active Drug Treatment; Phase IIa - Dose escalation. 3g cohort and 4.8g cohort run simultaneously, followed by a 6 g cohort. Administered in 600 g capsules of NP-101 for a total daily dose of 3g, 4.8g and 6g adminstered BID. Administered for 14 days.Establish MTDD Phase IIB - Continue study with MTDD as established above.	Drug: NP-101; NP-101 is an organically derived, GMP manufactured product covered under IND #152687.; Other Names: TQ Formula
Placebo Comparator: Placebo; As above, except dosed with matching placebo capsules.	Other: Placebo; Identical placebo

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Establishment of MTDD	Number of DLTS (Dose Limiting Toxicities) in the NP-101 arm at each dose compared to placebo and the safety threshold. This outcome measure ONLY APPLIES TO the Phase-IIa (Dose-finding) component of the trial.	Fourteen days per dose (Phase IIA Only)
Safety and Tolerability of NP-101 vs Placebo (Phase IIa and IIb)	Evaluation of the number of overall adverse events, related adverse reactions, adverse events leading to discontinuation of study drug, hospitalization, or death.	Through Day 45
Time to Sustained Clinical Recovery	This outcome measure ONLY APPLIES TO the Phase-IIb (efficacy) component of the trial per protocol. Therefore, the six arms of the Phase-IIa (dose-finding phase, three dose levels of NP-101 and placebo investigated) were not part of this data entry. This outcome measure is defined as the difference of Sustained Clinical Recovery (SCR) rates on Day 5 in patients taking the MTDD of NP-101 vs Placebo.	Through Day 5

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Difference of Change in Log2 of Viral Load From Baseline to Day-7 Between NP-101 and Placebo	This outcome measure ONLY APPLIES TO the Phase-IIb (efficacy) component of the trial per protocol. Therefore, the six arms of the Phase-IIa (dose-finding phase, three dose levels of NP-101 and placebo investigated) were not part of this data entry. With this outcome measure, we aim to compare the change in viral load and cycle threshold profiles from Randomization to Day 7 and Day 14 in participants taking the MED of NP-101 as compared to placebo. As Viral Load and Cycle Threshold values were not available on Day-14 as the RT-PCR assessment of Covid-19 was negative, we are able to provide the change only from Baseline to Day-7.	Enrollment to Day-7 on study
Difference of Change in ORF1 Gene From Baseline to Day-7 Between NP-101 and Placebo	This outcome measure ONLY APPLIES TO the Phase-IIb (efficacy) component of the trial per protocol. Therefore, the six arms of the Phase-IIa (dose-finding phase, three dose levels of NP-101 and placebo investigated) were not part of this data entry. With this outcome measure, we aim to compare the change in viral load and cycle threshold profiles from Randomization to Day 7 and Day 14 in participants taking the MED of NP-101 as compared to placebo. As Viral Load and Cycle Threshold values were not available on Day-14 as the RT-PCR assessment of Covid-19 was negative, we are able to provide the change only from Baseline to Day-7	Enrollment to Day-7
Difference in Change of E-Gene From Baseline to Day-7 Between N101 and Placebo	This outcome measure ONLY APPLIES TO the Phase-IIb (efficacy) component of the trial per protocol. Therefore, the six arms of the Phase-IIa (dose-finding phase, three dose levels of NP-101 and placebo investigated) were not part of this data entry. With this outcome measure, we aim to compare the change in viral load and cycle threshold profiles from Randomization to Day 7 and Day 14 in participants taking the MED of NP-101 as compared to placebo. As Viral Load and Cycle Threshold values were not available on Day-14 as the RT-PCR assessment of Covid-19 was negative, we are able to provide the change only from Baseline to Day-7.	From Enrollment to Day-7
Differenc in Change of N-Gene From Baseline to Day-7 Between NP-101 and Placebo	This outcome measure ONLY APPLIES TO the Phase-IIb (efficacy) component of the trial per protocol. Therefore, the six arms of the Phase-IIa (dose-finding phase, three dose levels of NP-101 and placebo investigated) were not part of this data entry. . With this outcome measure, we aim to compare the change in viral load and cycle threshold profiles from Randomization to Day 7 and Day 14 in participants taking the MED of NP-101 as compared to placebo. As Viral Load and Cycle Threshold values were not available on Day-14 as the RT-PCR assessment of Covid-19 was negative, we are able to provide the change only from Baseline to Day-7.	From enrollment to Day-7
RT-PCR Negative/Undetectable Rate at Day 7	This outcome measure ONLY APPLIES TO the Phase-IIb (efficacy) component of the trial per protocol. Therefore, the six arms of the Phase-IIa (dose-finding phase, three dose levels of NP-101 and placebo investigated) were not part of this data entry. In this objective, we aim to compare the percentage of RT-PCR negative/undetectable (i.e., viral clearance) on Day 7 and Day 14 in participants taking the MED of NP-101 as compared to placebo	Days 0 to 7
RT-PCR Negative/Undetectable on Day-14	This outcome measure ONLY APPLIES TO the Phase-IIb (efficacy) component of the trial per protocol. Therefore, the six arms of the Phase-IIa (dose-finding phase, three dose levels of NP-101 and placebo investigated) were not part of this data entry. In this objective, we aim to compare the percentage of RT-PCR negative/undetectable (i.e., viral clearance) on Day 7 and Day 14 in participants taking the MED of NP-101 as compared to placebo	Day 0 to Day-14
Median Time to Sustained Clinical Recovery	This outcome measure ONLY APPLIES TO the Phase-IIb (efficacy) component of the trial per protocol. Therefore, the six arms of the Phase-IIa (dose-finding phase, three dose levels of NP-101 and placebo investigated) were not part of this data entry. In this aim, we compare the median days from randomization to the attainment of Sustained Clinical Recovery between NP-101 and Placebo arms	From Day-0 to Day-28
Median Day to Complete Clinical Recovery	This outcome measure ONLY APPLIES TO the Phase-IIb (efficacy) component of the trial per protocol. Therefore, the six arms of the Phase-IIa (dose-finding phase, three dose levels of NP-101 and placebo investigated) were not part of this data entry. In this aim, we compare the median days from randomization to the attainment of Sustained Clinical Recovery between NP-101 and Placebo arms	From Day-0 to Day-28
Median Days to Complete Clinical Resolution	This outcome measure ONLY APPLIES TO the Phase-IIb (efficacy) component of the trial per protocol. Therefore, the six arms of the Phase-IIa (dose-finding phase, three dose levels of NP-101 and placebo investigated) were not part of this data entry. In this aim, we compare the median days from randomization to the attainment of the complete clinical resolution between NP-101 and Placebo.	From Day-0 to Day-28
Difference of the Change From Randomization to Day-7 of Absolute Counts of CD4+ and CD8+ Markers Between NP-101 and Placebo Arms.	This outcome measure ONLY APPLIES TO the Phase-IIb (efficacy) component of the trial per protocol. Therefore, the six arms of the Phase-IIa (dose-finding phase, three dose levels of NP-101 and placebo investigated) were not part of this data entry. In this objective, we aim to compare the change in effector immune cells, specifically CD4+ and CD8+ T lymphocytes, from Randomization to Day 7 and Day 14 in participants taking the MED of NP-101 as compared to placebo. We have a total of 36 markers for CD4+ and CD8+ Flow cytometry markers are combinations of the following immune cell types having various immune responses singly or in combination: CD3, CD5, CD8, CD16, CD19, CD45, CCR7, and CXCR3. The flow-cytomerty markers include the immune cell types: CD3, CD4, CD8, CD16, CD19, CD45, CCR7, and CXCR3. Markers are absolute counts of cells per cubic milimeter.	From Day-0 to Day-7
Difference of the Change From Randomization to Day-7 ın the Ratio of the Absolute Counts of CD4+ and CD8+ Markers Between NP-101 and Placebo Arms.	This outcome measure ONLY APPLIES TO the Phase-IIb (efficacy) component of the trial per protocol. Therefore, the six arms of the Phase-IIa (dose-finding phase, three dose levels of NP-101 and placebo investigated) were not part of this data entry. In this objective, we aim to compare the change in the ratio of CD4+ and CD8+ T lymphocytes, from Randomization to Day 7 and Day 14 in participants taking the MED of NP-101 as compared to placebo. Both CD4+ and CD8+ are measured as absolute counts of cells per cubic milimeter.	From Day-0 to Day-7
Difference of the Change From Randomization to Day-7 of Percentages of CD4+ and CD8+ Markers Between NP-101 and Placebo Arms.	This outcome measure ONLY APPLIES TO the Phase-IIb (efficacy) component of the trial per protocol. Therefore, the six arms of the Phase-IIa (dose-finding phase, three dose levels of NP-101 and placebo investigated) were not part of this data entry. In this objective, we aim to compare the change in effector immune cells, specifically CD4+ and CD8+ T lymphocytes, from Randomization to Day 7 and Day 14 in participants taking the MED of NP-101 as compared to placebo. We have a total of 36 markers for CD4+ and CD8+ Flow cytometry markers are combinations of the following immune cell types having various immune responses singly or in combination: CD3, CD5, CD8, CD16, CD19, CD45, CCR7, and CXCR3. The flow-cytomerty markers include the immune cell types: CD3, CD4, CD8, CD16, CD19, CD45, CCR7, and CXCR3. These marker entries represent the percentages of the combination of these immune cell types or their percentages in the biological sample.	From Day-0 to Day-7 Cell Percentages
Difference of the Change From Randomization to Day-14 of Absolute Counts of CD4+ and CD8+ Markers Between NP-101 and Placebo Arms.	This outcome measure ONLY APPLIES TO the Phase-IIb (efficacy) component of the trial per protocol. Therefore, the six arms of the Phase-IIa (dose-finding phase, three dose levels of NP-101 and placebo investigated) were not part of this data entry. In this objective, we aim to compare the change in effector immune cells, specifically CD4+ and CD8+ T lymphocytes, from Randomization to Day 7 and Day 14 in participants taking the MED of NP-101 as compared to placebo. We have a total of 36 markers for CD4+ and CD8+. Flow cytometry markers are combinations of the following immune cell types having various immune responses singly or in combination: CD3, CD5, CD8, CD16, CD19, CD45, CCR7, and CXCR3. The flow-cytomerty markers include the immune cell types: CD3, CD4, CD8, CD16, CD19, CD45, CCR7, and CXCR3. Markers are absolute count of cells per cubic milimeter.	From Day*0 to Day-14
Difference of the Change From Randomization to Day-14 ın the Ratio of the Absolute Counts of CD4+ and CD8+ Markers Between NP-101 and Placebo Arms.	This outcome measure ONLY APPLIES TO the Phase-IIb (efficacy) component of the trial per protocol. Therefore, the six arms of the Phase-IIa (dose-finding phase, three dose levels of NP-101 and placebo investigated) were not part of this data entry. In this objective, we aim to compare the change in the ratio of CD4+ and CD8+ T lymphocytes, from Randomization to Day 7 and Day 14 in participants taking the MED of NP-101 as compared to placebo. Both CD4+ and CD8+ are measured as absolute counts of cells per cubic milimeter.	From Day-0 to Day-14
Difference of the Change From Randomization to Day-14 of Percentages of CD4+ and CD8+ Markers Between NP-101 and Placebo Arms.	This outcome measure ONLY APPLIES TO the Phase-IIb (efficacy) component of the trial per protocol. Therefore, the six arms of the Phase-IIa (dose-finding phase, three dose levels of NP-101 and placebo investigated) were not part of this data entry. In this objective, we aim to compare the change in effector immune cells, specifically CD4+ and CD8+ T lymphocytes, from Randomization to Day 7 and Day 14 in participants taking the MED of NP-101 as compared to placebo. We have a total of 36 markers for CD4+ and CD8+. Flow cytometry markers are combinations of the following immune cell types having various immune responses singly or in combination: CD3, CD5, CD8, CD16, CD19, CD45, CCR7, and CXCR3. The flow-cytomerty markers include the immune cell types: CD3, CD4, CD8, CD16, CD19, CD45, CCR7, and CXCR3. These Markers represent the percentages of the combination of these immune cell types or their percentages in the biological sample.	From Day-0 to Day-14
Proportion of Participants With Symptom Progression	This outcome measure ONLY APPLIES TO the Phase-IIb (efficacy) component of the trial per protocol. Therefore, the six arms of the Phase-IIa (dose-finding phase, three dose levels of NP-101 and placebo investigated) were not part of this data entry. In this objective, we aim to compare the rate of disease progression measured by the worsening by the Covid-19 symptoms from 'none' or 'mild' to 'moderate' or 'severe' and remaining at that level for at least two days before alleviation or resolution, or the experience of hospitalization or death due to Covid-19 symptom worsening in participants taking the MED of NP-101 versus placebo	From Day-0 to Day28
Proportion of Paticipants With Long-Covid Symptoms	This outcome measure ONLY APPLIES TO the Phase-IIb (efficacy) component of the trial per protocol. Therefore, the six arms of the Phase-IIa (dose-finding phase, three dose levels of NP-101 and placebo investigated) were not part of this data entry. In this objective, we aim to compare the rate of Long- Covid symptoms in participants taking the MED of NP-101 versus placebo. A patient will be classified as having experienced symptoms indicative of Long- Covid if they reported any new or ongoing mild, moderate, or severe Long- Covid symptoms captured on the daily symptom questionnaire, on any of the following days: Day 30 ± 2 days, Day 37 ± 2 days, or Day 45 ± 2 days	Day-29 to Day-45

Collaborators and Investigators

• Sponsor: Novatek Pharmaceuticals
• Investigators: Study Director: Ahmed Kaseb, MD, Novatek Pharmaceuticals

Study record dates

Study Major Dates

• Study Start (Actual): February 22, 2023
• Primary Completion (Actual): May 9, 2025
• Study Completion (Actual): May 9, 2025

Study Registration Dates

• First Submitted: March 23, 2023
• First Submitted That Met QC Criteria: March 23, 2023
• First Posted (Actual): March 27, 2023

Study Record Updates

• Last Update Posted (Actual): August 13, 2026
• Last Update Submitted That Met QC Criteria: July 23, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Outpatient; COVID-19; High Risk
• 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: BOSS-Covid-19-002

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