BCG Against Covid-19 for Prevention and Meliouration of Severity Trial (BAC to the PAST)
Bacillus Calmette-Guerin mod Covid-19 til forebyggelse og forbedring af sværhedsgradssagen
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
Dette er et fase III, dobbeltblindt, randomiseret placebokontrolleret forsøg, der sammenligner effekten af BCG-vaccination med placebos til at reducere sværhedsgraden af Covid-19. Deltagerne skal opfylde berettigelseskriterierne for at blive inkluderet i undersøgelsen. De udvalgte vil kun blive bedt om at give en blod- eller spytprøve til Covid-19 serologisk test og en Interferon gamma release assay (IGRA) test for tuberkuloseinfektion, hvis IGRA eller tuberculin skin test (TST) resultat ikke er tilgængeligt fra den tidligere år. Deltagerne vil blive randomiseret i en 1:1-allokering til at modtage intradermal administration af BCG-vaccination eller placebo ved baseline. Under opfølgningen vil undersøgelsesteamet udtrække deltagerinformation fra plejehjemsjournaler vedrørende Covid-19-lignende symptomer, diagnose, resultater samt eventuelle uønskede bivirkninger af BCG-vaccination. Efter 6 og 12 måneders opfølgning vil der blive indsamlet en ekstra blod- eller spytprøve for at udføre en Covid-19 serologisk test.
Efterforskerne vil screene 2.500 personer for at tilmelde 2.100 deltagere, hvilket resulterer i, at 1.050 får BCG-vaccine og 1.050 får placebo. Den foreslåede tilmeldingsprøvestørrelse er designet til at give 80 % kraft til at detektere 60 % vaccineeffektivitet (en relativ risiko på 0,4 blandt de vaccinerede) med 0,05 type-1 fejl i en tosidet test, forudsat en Covid-19 angrebsrate på 10 % i ældre NH og 38,5 % svær Covid-19 blandt de inficerede patienter, og en designeffekt = 1,2, og 15 % tabt i løbet af 6-måneders opfølgning. Antallet af screenede individer antager, at omkring 20 % ikke vil være berettiget til/godkender at blive tilmeldt.
Bemærk, at vaccineeffektiviteten på 60 % var baseret på det observerede tredobbelte fald i luftvejsinfektioner i den unge kohorte.
Formål: At vurdere effektiviteten af BCG-vaccination sammenlignet med placebo til at reducere alvorlig Covid-19-sygdom blandt ældre beboere på dygtige plejefaciliteter.
Primært endepunkt 1: Tilfælde af Covid-19 sygdom klassificeret som alvorlige. Alvorlig COVID-19 sygdom vil blive defineret som: COVID-19 sygdom med hospitalsindlæggelse, død eller ikke-indlagt alvorlig sygdom, hvor ikke-indlagt alvorlig sygdom er defineret som en ændring i status, herunder administration af ny supplerende ilt eller fald i iltmætning af 10%; skift fra ambulant til ikke-ambulant status på 3+ dage; ny ændring i mental status som dokumenteret i den elektroniske journal
Efterforskerne vil bruge Cox proportional-hazards-modellen til at beregne fareforhold for udviklingen af svær Covid-19 mellem BCG- og placebo-armene.
Hvis BCG-vaccine viser sig at være effektiv i denne aldersgruppe, vil det være til stor fordel for både studiedeltagere og andre ældre personer med risiko for infektion og sygdom fra Covid-19. Uden noget andet vaccinealternativ, der i øjeblikket er tilgængeligt, kunne en effektivitet på endda 50 % reducere dødsraten blandt inficerede patienter tilsvarende. BCG er blevet rapporteret at have en række andre mulige fordele, herunder reduktion i risikoen for TB-sygdom, Alzheimers sygdom og reduktion af andre luftvejsinfektioner. Fordi disse fordele ikke er blevet bevist i kliniske forsøg, vil de ikke blive præsenteret for potentielle deltagere.
Undersøgelsestype
Undersøgelsestype
Fase
Fase
- Fase 3
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inkludering:
- Beboere i en deltagende LTCF
- 70 år eller ældre
Evne til at forstå og samarbejde med studieprocedurer, herunder forbindingspleje.
- Plejehjemspersonale eller forskerholdet vil sikre, at deltagerne udfører forbindingspleje korrekt.
Undtagelse:
- Tidligere eller nuværende SARS-CoV2-infektion/Covid-19-sygdom defineret ved dokumentation af sygdom i klinisk diagram eller positiv PCR-test.
- Tidligere eller kendt aktiv TB-sygdom
- Har ikke en etableret fuldmægtig eller værge, men har kognitiv svækkelse, der ville forhindre deltageren i fuldt ud at forstå omfanget af undersøgelseskrav og -risici, eller forbyde deres evne til at give informeret samtykke.
- Fedme (Body Mass Index [BMI] > 35)
- Feber (>38 C) inden for de seneste 24 timer
Nuværende eller historisk alvorlige underliggende medicinske tilstande:
- HIV+
- Anamnese med organ- eller knoglemarvstransplantation
- Anamnese med alvorlig immundefektsygdom
- Aktiv solid eller hæmatologisk malignitet diagnosticeret inden for de seneste to år
- Tilstedeværelse af signifikant neurologisk sygdom, f.eks. Alzheimers sygdom
Modtagelse af et af følgende lægemidler:
Tager i øjeblikket immunsuppressive eller immunmodulerende lægemidler (inhalatorer og/eller prednison er acceptable at tage)
- Prednison-doserne svarende til > 2 mg/kg eller > 20 mg pr. dag af prednison administreret i >/= 2 uger er immunsuppressive og bør undgås med levende vacciner.
- Forvent at modtage kemoterapi inden for de kommende seks måneder, modtage kemoterapi inden for de seneste seks måneder eller gennemgå kemoterapi
- I øjeblikket på enhver anti-cytokinbehandling
- Tager metforminbehandling
- Mistanke om aktiv viral eller bakteriel infektion
- Planlæg at forlade plejehjemmet inden for de næste 6 måneder
- Deltager i endnu et interventionsbaseret forsøg for Covid-19
- Allergi over for enhver komponent i BCG-vaccinen eller en anafylaktisk eller allergisk reaktion på en tidligere dosis af BCG-vaccination
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: FOREBYGGELSE
- Tildeling: TILFÆLDIGT
- Interventionel model: PARALLEL
- Maskning: TRIPLE
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
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EKSPERIMENTEL: BCG-vaccine
Deltagere randomiseret til BCG-armen vil modtage BCG-vaccine.
Vaccinationsstedet er cirka halvvejs nede i den ydre side af overarmen.
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0,1 ml rekonstitueret BCG-vaccine givet intradermalt ved baseline.
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PLACEBO_COMPARATOR: Placebo arm
Placebo vil blive indgivet intradermalt på samme sted som BCG-vaccinerne: overarmen.
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.1 nL fortyndingsmiddel (saltvand) givet intradermalt ved baseline
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Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
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At vurdere effektiviteten af BCG-vaccination sammenlignet med placebo til at reducere alvorlig Covid-19-sygdom blandt ældre beboere på dygtige plejefaciliteter.
Tidsramme: 12 måneder
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Antal personer diagnosticeret med alvorlig Covid-19 sygdom som dokumenteret i den elektroniske sygdomsjournal; alvorlig Covid-19 sygdom er defineret som ethvert tilfælde af død, hospitalsindlæggelse eller ikke-hospitalisering, men som kræver ny administration af supplerende ilt eller med et fald i iltmætning på 10 %, ændring fra ambulant til ikke-ambulant i 3 eller flere dage, eller enhver ny ændring i mental sundhed.
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12 måneder
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
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At vurdere effektiviteten af BCG-vaccination sammenlignet med placebo med hensyn til at reducere følgende blandt ældre beboere på kvalificerede plejefaciliteter (efter antal tilfælde)
Tidsramme: 12 måneder
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12 måneder
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For at vurdere effektiviteten af BCG-vaccination sammenlignet med placebo til at reducere følgende blandt ældre beboere på kvalificerede plejefaciliteter (efter antal tilfælde), fortsattes
Tidsramme: 12 måneder
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5. Antal tilfælde af intensivafdelinger, defineret som antallet af indlæggelser på intensivafdeling. 6. Antal tilfælde af mekanisk ventilation med SARS-CoV-2, defineret som antallet af deltagere, der har behov for mekanisk ventilation (som dokumenteret af EPJ) og forbundet med en positiv SARS-CoV-2-test. 7. Antal tilfælde af mekanisk ventilation, defineret som antallet af deltagere med behov for mekanisk ventilation. 8. Antal tilfælde af dødsfald af alle årsager, defineret som dødsfald rapporteret af langtidsplejefaciliteten. 9. Antal tilfælde af feber eller luftvejssygdom, defineret som feber (som dokumenteret i EPJ), eller mindst ét tegn eller symptom på luftvejssygdom, herunder hoste, åndenød, åndedrætsbesvær/svigt (som dokumenteret i EPJ). |
12 måneder
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At vurdere effektiviteten af BCG-vaccination sammenlignet med placebo med hensyn til at reducere følgende blandt ældre beboere på kvalificerede plejefaciliteter (efter antal episoder)
Tidsramme: 12 måneder
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12 måneder
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At vurdere effektiviteten af BCG-vaccination sammenlignet med placebo med hensyn til at reducere følgende blandt ældre beboere på kvalificerede plejefaciliteter (efter antal dage)
Tidsramme: 12 måneder
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12 måneder
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Samarbejdspartnere
Samarbejdspartnere
Efterforskere
Efterforskere
- Ledende efterforsker: Megan B Murray, MD, ScD, Harvard Medical School (HMS and HSDM)
Publikationer og nyttige links
Generelle publikationer
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- Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020 Mar 17;323(11):1061-1069. doi: 10.1001/jama.2020.1585. Erratum In: JAMA. 2021 Mar 16;325(11):1113.
- Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, Lee M. Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. JAMA. 2020 Apr 28;323(16):1612-1614. doi: 10.1001/jama.2020.4326.
- Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, Huang H, Zhang L, Zhou X, Du C, Zhang Y, Song J, Wang S, Chao Y, Yang Z, Xu J, Zhou X, Chen D, Xiong W, Xu L, Zhou F, Jiang J, Bai C, Zheng J, Song Y. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020 Jul 1;180(7):934-943. doi: 10.1001/jamainternmed.2020.0994. Erratum In: JAMA Intern Med. 2020 Jul 1;180(7):1031.
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- Zhang Y, Xiao M, Zhang S, Xia P, Cao W, Jiang W, Chen H, Ding X, Zhao H, Zhang H, Wang C, Zhao J, Sun X, Tian R, Wu W, Wu D, Ma J, Chen Y, Zhang D, Xie J, Yan X, Zhou X, Liu Z, Wang J, Du B, Qin Y, Gao P, Qin X, Xu Y, Zhang W, Li T, Zhang F, Zhao Y, Li Y, Zhang S. Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19. N Engl J Med. 2020 Apr 23;382(17):e38. doi: 10.1056/NEJMc2007575. Epub 2020 Apr 8.
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- Darrah PA, Patel DT, De Luca PM, Lindsay RW, Davey DF, Flynn BJ, Hoff ST, Andersen P, Reed SG, Morris SL, Roederer M, Seder RA. Multifunctional TH1 cells define a correlate of vaccine-mediated protection against Leishmania major. Nat Med. 2007 Jul;13(7):843-50. doi: 10.1038/nm1592. Epub 2007 Jun 10.
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- Coronavirus infektioner
- Coronaviridae infektioner
- Nidovirales infektioner
- RNA-virusinfektioner
- Virussygdomme
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- Luftvejsinfektioner
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