- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06305793
RECOVER-AUTONOMIC: Platform Protocol, Appendix A (IVIG) (RECOVER-AUTO)
RECOVER-AUTONOMIC (IVIG): Randomized Trial of the Effect of IVIG Versus Placebo on Long COVID Symptoms
This study is a platform protocol designed to be flexible so that it is suitable for a wide range of settings within health care systems and in community settings where it can be integrated into COVID-19 programs and subsequent treatment plans.
This protocol is a prospective, multi-center, multi-arm, randomized, controlled platform trial evaluating various interventions for use in the treatment of autonomic dysfunction symptoms, including cardiovascular complications and postural orthostatic tachycardia syndrome (POTS), in Post-Acute Sequelae of SARS-CoV-2 infection (PASC) participants. The interventions tested will include non-pharmacologic care and pharmacologic therapies with study drugs.
Study Overview
Status
Intervention / Treatment
Detailed Description
The hypothesis is that some of the autonomic dysfunction symptoms are immune-mediated, so immunotherapy and other applicable therapies will result in improvement in autonomic symptoms.
Interventions will be added to the platform protocol as appendices. Each appendix will leverage all elements of the platform protocol, with additional elements described in the individual appendix.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Orshi Moy
- Phone Number: 919-668-7520
- Email: recoverresearch@duke.edu
Study Contact Backup
- Name: Barrie L Harper, BSMT(ASCP)PMP
- Email: recoverresearch@duke.edu
Study Locations
-
-
North Carolina
-
Durham, North Carolina, United States, 27710
- All sites listed under NCT06305780
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- See NCT06305780 for RECOVER-AUTO: Platform Protocol level inclusion criteria which applies to this appendix (or sub-study)
Additional Appendix A (IVIG Sub-study) Level Inclusion Criteria:
- Abnormal active standing test defined as presence of orthostatic tachycardia (an increase of 30 beats per minute (bpm) or more in HR within 10 minutes upon standing without orthostatic hypotension) and experiencing orthostatic symptoms
- COMPASS-31 Score > 40
Exclusion Criteria:
- See NCT06305780 for RECOVER-AUTO: Platform Protocol level exclusion criteria which applies to this appendix (or sub-study)
Additional Appendix A (IVIG Sub-study) Level Exclusion Criteria:
- Current or previous IVIG treatment
- Contraindication to intravenous immunoglobulin.
- Known allergic reactions to blood products including IVIG and/or subcutaneous immunoglobulin (SCIG), such as history of clinically relevant hemolysis after IVIG infusion, aseptic meningitis, recurrent severe headache, hypersensitivity, severe generalized or severe local skin reactions
- Selective IgA deficiency
- Current and recent (within 5 half-lives) use of high-dose corticosteroids (for example for prior solid organ transplant), omalizumab, anti-TNF-alpha inhibitors
- Use of immunosuppressants such as Plaquenil, or low-dose steroid (prednisone, no more than 10mg a day) will be excluded unless the participant is on stable (>4 weeks) dose
- Significant thrombotic events after the acute phase of COVID-19 and/or within 6 months of enrollment
- Veins that are not viable for infusions
- Not willing to adhere to dosing schedule for IVIG infusions for 9 months
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: IVIG + Coordinated Care
IVIG (Gamunex); 2g /kg monthly for 9 months (36 weeks)
|
Participants will receive IVIG for 9 months (36 weeks) with a follow-up period for an additional 3 months (total study duration for 12 months).
Participants will receive coordinated non-pharmacologic care for a duration of 3 months, concurrent with IVIG administration.
Coordinated non-pharmacologic care involves volume expansion through high salt diet, water intake, abdominal binder, exercise/rehabilitation, motivation, education, and assisted care through care coordinator.
|
Experimental: IVIG Placebo + Coordinated Care
Saline: Same dosage as IVIG; monthly for 9 months (36 weeks)
|
Participants will receive coordinated non-pharmacologic care for a duration of 3 months, concurrent with IVIG administration.
Coordinated non-pharmacologic care involves volume expansion through high salt diet, water intake, abdominal binder, exercise/rehabilitation, motivation, education, and assisted care through care coordinator.
Normal saline given intravenously will be the control (placebo) product. Blinding IV bag and tubing covers will be used for both IVIG and Placebo. Participants will receive placebo for 9 months (36 weeks) with a follow-up period for an additional 3 months (total study duration for 12 months). |
Experimental: IVIG + Usual Care
IVIG (Gamunex); 2g /kg monthly for 9 months (36 weeks)
|
Participants will receive IVIG for 9 months (36 weeks) with a follow-up period for an additional 3 months (total study duration for 12 months).
Participants will receive usual non-pharmacologic care (control) for a duration of 3 months, concurrent with IVIG administration.
|
Experimental: IVIG Placebo + Usual Care
Saline: Same dosage as IVIG; monthly for 9 months (36 weeks)
|
Normal saline given intravenously will be the control (placebo) product. Blinding IV bag and tubing covers will be used for both IVIG and Placebo. Participants will receive placebo for 9 months (36 weeks) with a follow-up period for an additional 3 months (total study duration for 12 months).
Participants will receive usual non-pharmacologic care (control) for a duration of 3 months, concurrent with IVIG administration.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Orthostatic Hypotension Questionnaire (OHQ)/Orthostatic Intolerance Questionnaire (OIQ) Composite Score
Time Frame: Baseline to End of Intervention (9 months)
|
The OHQ / OIQ is a measure of orthostatic intolerance and includes a 6-item symptom assessment (OHSA) and the 4-item Daily Activity Scale (OHDAS).
Each item is scored from 0 (none/no interference) to 10 (worst possible/complete interference), describing the preceding week.
The OHSA composite score is the average of the first 6 non-zero items and the OHDAS composite score is the average of the last 4 non-zero items.
The OHQ/OIQ composite score is the average of the OHSA and OHDAS composite scores.
The OHQ/OIQ scales at post-baseline are calculated using only those items that were included in the baseline scores.
|
Baseline to End of Intervention (9 months)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Composite Autonomic Symptoms Score 31 (COMPASS-31)
Time Frame: Baseline to End of Intervention (9 months)
|
The COMPASS-31 is a patient reported outcome that measures autonomic symptoms across multiple domains commonly seen in patients with PASC.
Scores range from 0-100 with higher values representing severe symptoms.
|
Baseline to End of Intervention (9 months)
|
Change in Malmo POTS Symptom Score
Time Frame: Baseline to End of Intervention (9 months)
|
The Malmo POTS symptom score assesses symptom burden in postural orthostatic tachycardia syndrome (POTS).
It is a self-rating, 12-item score (0-10 per item, total range 0-120) based on patients' own perception of symptoms through visual analogue scale assessment.
Higher scores represent more pronounced symptoms.
|
Baseline to End of Intervention (9 months)
|
Change in Active Stand Test
Time Frame: Baseline to End of Intervention (9 months)
|
Participants will remain supine for 10 minutes, and data will be acquired at 5 and 10 minutes.
Standing test should be performed with HR and BP monitoring at 1, 3, 5 and 10 minutes
|
Baseline to End of Intervention (9 months)
|
Change in blood pressure
Time Frame: Baseline to End of Intervention (9 months)
|
measured during Active Stand Test
|
Baseline to End of Intervention (9 months)
|
Change in heart rate (HR)
Time Frame: Baseline to End of Intervention (9 months)
|
measured during Active Stand Test
|
Baseline to End of Intervention (9 months)
|
Change in 6-min Walk Test
Time Frame: Baseline to End of Intervention (9 months)
|
Normal walking speed will be measured using a standard 6 minute walk
|
Baseline to End of Intervention (9 months)
|
Change in Patient-Reported Outcomes Measurement Information System (PROMIS-29) + 2 Questionnaire
Time Frame: Baseline to End of Intervention (9 months)
|
The PROMIS-29 consists of 29 items that assess general domains of health and functioning, including overall physical health, mental health, social health, pain, fatigue, and overall perceived quality of life. The PROMIS-29+2 is used to calculate a preference score (PROPr) by the addition of two Cognitive Function Ability items. Scores will be reported as T scores ranging from 0 to 100, with a score of 60 being 1 standard deviation above the mean. Higher scores indicate worse overall health. |
Baseline to End of Intervention (9 months)
|
Change in step count as measured by a wearable device
Time Frame: Baseline to End of Intervention (9 months)
|
measured by activity tracker
|
Baseline to End of Intervention (9 months)
|
Change in heart rate as measured by a wearable device
Time Frame: Baseline to End of Intervention (9 months)
|
measured by activity tracker
|
Baseline to End of Intervention (9 months)
|
Proportion of participants who experience individual (SAEs
Time Frame: Baseline to Follow-up (12 months)
|
These will be analyzed in the safety population.
|
Baseline to Follow-up (12 months)
|
Proportion who experience any one or more ( Serious Adverse Event) SAEs
Time Frame: Baseline to Follow-up (12 months)
|
These will be analyzed in the safety population.
|
Baseline to Follow-up (12 months)
|
Incidence of SAEs leading to discontinuation
Time Frame: Baseline to Follow-up (12 months)
|
These will be analyzed in the safety population.
|
Baseline to Follow-up (12 months)
|
Incidence of Events of Special Interest (ESIs)
Time Frame: Baseline to Follow-up (12 months)
|
Each study drug may have a unique list of ESIs
|
Baseline to Follow-up (12 months)
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Changes in Autonomic Function Testing
Time Frame: Baseline to End of Intervention (9 months)
|
|
Baseline to End of Intervention (9 months)
|
Change in Vanderbilt Orthostatic Symptoms Score (VOSS)
Time Frame: Baseline to End of Intervention (9 months)
|
The VOSS consists of 9 orthostatic symptoms rated on a scale of 0 (no symptom) to 10 (worst the participant has experienced) at the end of each Head-up Tilt test.
Scores range from 0-90 with higher scores representing worse symptoms.
|
Baseline to End of Intervention (9 months)
|
Change in PASC Symptom Questionnaire
Time Frame: Baseline to End of Intervention (9 months)
|
Participants will be asked to complete a questionnaire that asks about the presence of PASC symptoms.
This questionnaire includes additional PASC symptoms that are not directly related to autonomic dysfunction.
|
Baseline to End of Intervention (9 months)
|
Collaborators and Investigators
Sponsor
Investigators
- Study Chair: Christopher Grainger, MD, Duke Clinical Research Institute
- Study Chair: Cyndya Shibao, MD, Vanderbilt University Medical Center
- Study Chair: Peter Novak, MD, Harvard
- Study Chair: Pam Taub, MD, University of California, San Diego
- Study Chair: Tae Chung, MD, Johns Hopkins University
Publications and helpful links
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pathologic Processes
- Coronavirus Infections
- Coronaviridae Infections
- Nidovirales Infections
- RNA Virus Infections
- Virus Diseases
- Infections
- Respiratory Tract Infections
- Respiratory Tract Diseases
- Pneumonia, Viral
- Pneumonia
- Lung Diseases
- Disease Attributes
- Chronic Disease
- Post-Infectious Disorders
- COVID-19
- Post-Acute COVID-19 Syndrome
- Physiological Effects of Drugs
- Immunologic Factors
- Antibodies
- Immunoglobulins
- Immunoglobulins, Intravenous
- gamma-Globulins
- Rho(D) Immune Globulin
Other Study ID Numbers
- Pro00112597_A
- OTA-21-015G (Other Identifier: NIH Grant to RTI; RTI subcontracting with DCRI)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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.
Clinical Trials on Long COVID
-
Miami VA Healthcare SystemNot yet recruiting
-
Endourage, LLCRecruitingLong COVID | Long Covid19 | Post-Acute COVID-19 | Long Haul COVID | Long-Haul COVID-19 | Post-Acute COVID-19 SyndromeUnited States
-
University Hospital, AkershusRecruiting
-
Anxiety Relief CenterCompleted
-
Rutger LalieuDaVinci KliniekRecruitingLong COVID | Long Covid19 | Long COVID-19 Syndrome | Long Covid 19Netherlands
-
Lundquist Institute for Biomedical Innovation at...RecruitingLong Haul COVID or Post Acute Sequella of COVID - PASC (U09.9)United States
-
National Institutes of Health Clinical Center (CC)CompletedAcute and Long Term Effects of COVID-19 on Systemic Inflammation | Acute and Long Term Effects of COVID-19 on Lung Function | Acute and Long Term Effects of COVID-19 on Cardiac Function | Acute and Long Term Effects of COVID-19 on Kidney Function | Acute and Long Term Effects of COVID-19...United States
-
Lawson Health Research InstituteWestern UniversityNot yet recruitingFatigue | Post-COVID-19 Syndrome | Long Covid19 | Post-COVID Syndrome | Long-COVID
-
University Hospital, AngersNot yet recruiting
-
Kanecia Obie ZimmermanEnrolling by invitationLong COVID | Long Covid19 | Long Covid-19United States
Clinical Trials on IVIG (intravenous immunoglobulin)
-
The University of Hong KongQueen Elizabeth Hospital, Hong Kong; Queen Mary Hospital, Hong Kong; Pamela Youde... and other collaboratorsCompleted
-
Johns Hopkins UniversityTerminatedAutoimmunity | Dysmotility SyndromeUnited States
-
University of PittsburghBayer; Shadyside Hospital FoundationTerminatedClostridium Difficile-associated Diarrhea (CDAD)United States
-
National Institute of Allergy and Infectious Diseases...CompletedInfluenzaUnited States
-
National Institute of Allergy and Infectious Diseases...University of Minnesota; International Network for Strategic Initiatives in...CompletedInfluenza A | Influenza BUnited States, Australia, Denmark, United Kingdom
-
University of MinnesotaCSL Behring; BriovaRx Infusion ServicesCompletedChronic Inflammatory Demyelinating PolyneuropathyUnited States
-
National Institute of Neurological Disorders and...CompletedDemyelinating Diseases | ParaproteinemiasUnited States
-
University of Texas Southwestern Medical CenterGrifols Biologicals, LLC; Dysautonomia InternationalCompletedPostural Tachycardia SyndromeUnited States
-
Assiut UniversityCompleted
-
University of Massachusetts, WorcesterCompletedMultiple System AtrophyUnited States