A Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Safety and Efficacy of EB05 + SOC vs. Placebo + SOC in Adult Hospitalized Patients With COVID-19
COVID-19 patients who develop severe disease often develop acute respiratory distress syndrome (ARDS) as a result of a dysregulated immune response. This in turn stimulates a pro-inflammatory cascade ("cytokine storm") as well as emergency myelopoiesis.
This proinflammatory cascade is activated when viral-mediated cell damage occurs in the lungs, resulting in the release of damage-signaling alarmin molecules such as S100A8/A9 (Calprotectin), HMGB1, Resistin, and oxidized phospholipids. These damage-associated molecular patterns (DAMPs) are recognized by the pattern recognition receptor Toll-Like Receptor 4 (TLR4) found on macrophages, dendritic cells and other innate immune cells and result in additional release of pro-inflammatory molecules. Several recent studies have shown that S100A8/A9 serum levels in hospitalized COVID-19 patients positively correlate with both neutrophil count and disease severity. Taken together the DAMP-TLR4 interaction forms a central axis in the innate immune system and is a key driver of the pathological inflammation observed in COVID-19. We hypothesis that targeting the initial step in the signalling pathways of these DAMPs in innate immunity offers the best hope for controlling the exaggerated host response to SARS-CoV-2 infection.
EB05 has demonstrated safety in two clinical studies (>120 patients) and was able to block LPS-induced (TLR4 agonist) IL-6 release in humans. Given, this extensive body of evidence we believe EB05 could ameliorate ARDS due to COVID-19, significantly reducing ventilation rates and mortality.
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Type d'étude
Inscription (Réel)
Phase
- Phase 2
- Phase 3
Contacts et emplacements
Lieux d'étude
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Alberta
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Edmonton, Alberta, Canada, T6G 2B7
- University of Alberta Hospital
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British Columbia
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Vancouver, British Columbia, Canada, V5Z 1M9
- Vancouver General Hospital
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Vancouver, British Columbia, Canada, V5K 1Z9
- Vancouver Coastal Health
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Ontario
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Brampton, Ontario, Canada, L6R 3J7
- William Osler Health System
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Markham, Ontario, Canada, L3P 7P3
- Markham Stouffville Hospital
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Newmarket, Ontario, Canada, L3Y 2P9
- Southlake Regional Health Centre
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Oshawa, Ontario, Canada, L1G 2B9
- Lakeridge Health
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Ottawa, Ontario, Canada, K1Y 4E9
- Ottawa Hospital Research Institute
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Toronto, Ontario, Canada, M5G 2C4
- Toronto General Hospital
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Quebec
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Greenfield Park, Quebec, Canada, J4V 2H2
- CISS Monteregie-Centre
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Montreal, Quebec, Canada, H4A 3J1
- McGill University Health Centre
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Montreal, Quebec, Canada, H1T 2M4
- Hôpital Maisonneuve Rosemont
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Rimouski, Quebec, Canada, G5L 5T1
- Hôpital Régional de Rimouski
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California
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Fresno, California, États-Unis, 93701
- UCSF Fresno
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Fullerton, California, États-Unis, 92835
- St. Jude Medical Center/ Providence
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Florida
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Coral Gables, Florida, États-Unis, 33146
- University of Miami Hospital
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Massachusetts
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Springfield, Massachusetts, États-Unis, 01199
- Baystate Medical Center
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Michigan
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Detroit, Michigan, États-Unis, 48202
- Wayne State University
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Oregon
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Portland, Oregon, États-Unis, 97213
- Providence Portland Medical Center
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West Virginia
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Morgantown, West Virginia, États-Unis, 26506-6224
- West Virginia University Medicine Heart & Vascular Institute
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Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion Criteria:
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Men and women ≥18 years of age at the time of consent.
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Laboratory-confirmed diagnosis of COVID-19.
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Hospitalized for COVID-19 related respiratory disease.
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Patient belongs to one of the following two categories in the nine-point COVID-19 severity scale:
- Hospitalized, requiring intubation and mechanical ventilation - Level 6 of the nine-point COVID-19 severity scale.
- Hospitalized and intubated with additional organ support - pressors, RRT, ECMO - Level 7 of the nine-point COVID-19 severity scale.
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For women of childbearing potential involved in any sexual intercourse that could lead to pregnancy: Negative pregnancy test and willingness to use contraceptive (consistent with local regulations) during the study period.
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Signed informed consent obtained by any patient capable of giving consent, or, when the patient is not capable of giving consent, from his or her legal/authorized representatives.
Exclusion Criteria:
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The subject is a female who is breastfeeding or pregnant.
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Known hypersensitivity to EB05 or its excipients.
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In the opinion of the investigator, death is imminent and inevitable or patient will be discharged within the next 48 - 72 hours, irrespective of the provision of treatment.
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Experiencing cardiac arrest while hospitalized with COVID-19.
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Active participation in other immunomodulator or immunosuppressant drug clinical trials.
a. Participation in COVID-19 antiviral, anticoagulant and convalescent plasma trials may be permitted; however, the decision to enroll a patient who is participating in other clinical trials will be dealt with on a case-by-case basis.
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Treatment with immunomodulator or immunosuppressant drugs, including but not limited to TNF inhibitors and anti-IL-1 agents within 5 half-lives or 30 days (whichever is longer) before randomization. Except for the following, which are permitted:
- Treatment with immunomodulator, or immunosuppressant drugs, such as corticosteroids, as part of SOC for COVID-19
- Transplant patients
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Known other clinical conditions that contraindicate EB05 and cannot be treated or solved according to the judgment of the clinician.
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Patient has been intubated or mechanically ventilated for more than 72 hours prior to administration of the investigational product.
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Patient has been intubated and then extubated during the current hospitalization prior to administration of the investigational product.
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Patient has experienced meaningful clinical improvement in the severity of disease prior to administration of the investigational product.
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation séquentielle
- Masquage: Tripler
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
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Expérimental: Stage 1
Stage 1 (Phase II Study) For 80% power (β = 0.20), at a significance level of 5% (α =0.05) and a 1:1 randomization ratio, a total of 316 (EB05: 158, SOC: 158) evaluable patients will be required. Allowing for 20% attrition a total of 396 patients will be recruited. |
Standard of care plus single IV infusion of 15mg/kg of EB05. Standard of care plus a single IV infusion of placebo. |
|
Expérimental: Stage 2
Stage 2 (Phase III Study) For a 1:1 ratio of patients treated with EB05 vs. Placebo, a cumulative one-sided alpha of 2.5% and 90% power, to detect an Odds Ratio of 2.00, a total of 586 evaluable patients will be required for Stage 2 (Phase III study). 293 of these will be treated with EB05 + SOC and 293 treated with Placebo + SOC. Allowing for 10% attrition, a total of 644 patients will be enrolled in this Stage. |
Standard of care plus single IV infusion of 15mg/kg of EB05. Standard of care plus a single IV infusion of placebo. |
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Mortality rate at Day 28 from IP administration. (Phase 2 and 3)
Délai: 28 days
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For the current study, the primary efficacy outcome measure will be the mortality rate from IP administration. Mortality is the most clinically relevant therapeutic endpoint for this population that is on IMV. The primary endpoint will be assessed at 28-days after treatment initiation. |
28 days
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Proportion of patients with clinical improvement at Day 28 (Phase 2 and 3)
Délai: 28 days
|
The proportion of patients with clinical improvement, defined as a decrease of two points or more on the World Health Organization (WHO) 9 - point ordinal scale at Day 28 from IP administration. The severity of COVID-19 disease is classified according to the WHO 9-point ordinal scale. The minimum value of 0 is associated with an "uninfected" stage wherein no clinical or virological evidence of infection is present. The maximum value of 8 is associated with death. A higher score reflects a worse outcome. |
28 days
|
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Proportion of patients with clinical improvement at Day 60 (Phase 2)
Délai: 60 days
|
The proportion of patients with clinical improvement, defined as a decrease of two points or more on the World Health Organization (WHO) 9 - point ordinal scale at Day 60 from IP administration. The severity of COVID-19 disease is classified according to the WHO 9-point ordinal scale. The minimum value of 0 is associated with an "uninfected" stage wherein no clinical or virological evidence of infection is present. The maximum value of 8 is associated with death. A higher score reflects a worse outcome. |
60 days
|
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Mortality rate at Day 60 from IP adminstration (Phase 2 and 3)
Délai: 60 days
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The mortality rate at Day 60 from IP administration. |
60 days
|
Autres mesures de résultats
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Number of treatment-emergent adverse events (TEAEs) and serious TEAEs.
Délai: 28 and 60 days
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Safety Endpoint: Number of treatment-emergent adverse events (TEAEs) and serious TEAEs. |
28 and 60 days
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Collaborateurs et enquêteurs
Parrainer
Collaborateurs
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Réel)
Achèvement primaire (Réel)
Achèvement de l'étude (Réel)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- EB05-04-2020
Plan pour les données individuelles des participants (IPD)
Prévoyez-vous de partager les données individuelles des participants (DPI) ?
Informations sur les médicaments et les dispositifs, documents d'étude
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