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Losartan for Patients With COVID-19 Requiring Hospitalization

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT04312009
Recruitment Status : Recruiting
First Posted : March 17, 2020
Last Update Posted : May 11, 2020
Sponsor:
Collaborator:
Bill and Melinda Gates Foundation
Information provided by (Responsible Party):
University of Minnesota

Brief Summary:
This is a multi-center, double-blinded study of COVID-19 infected patients requiring inpatient hospital admission randomized 1:1 to daily Losartan or placebo for 7 days or hospital discharge.

Condition or disease Intervention/treatment Phase
Corona Virus Infection Acute Respiratory Distress Syndrome SARS-CoV Infection Drug: Losartan Other: Placebo Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 200 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Randomized Controlled Trial of Losartan for Patients With COVID-19 Requiring Hospitalization
Actual Study Start Date : April 13, 2020
Estimated Primary Completion Date : April 1, 2021
Estimated Study Completion Date : April 1, 2021


Arm Intervention/treatment
Experimental: Losartan
Participants in this arm will receive the study drug, Losartan.
Drug: Losartan
Losartan; 50 mg daily; oral administration
Other Name: Cozaar

Placebo Comparator: Placebo
Participants in this arm will receive a placebo treatment.
Other: Placebo
Placebo (microcrystalline methylcellulose, gelatin capsule); oral administration




Primary Outcome Measures :
  1. Difference in Estimated (PEEP adjusted) P/F Ratio at 7 days [ Time Frame: 7 days ]
    Outcome calculated from the partial pressure of oxygen or peripheral saturation of oxygen by pulse oximetry divided by the fraction of inspired oxygen (PaO2 or SaO2 : FiO2 ratio). PaO2 is preferentially used if available. A correction is applied for endotracheal intubation and/or positive end-expiratory pressure. Patients discharged prior to day 7 will have a home pulse oximeter send home for measurement of the day 7 value, and will be adjusted for home O2 use, if applicable. Patients who died will be applied a penalty with a P/F ratio of 0.


Secondary Outcome Measures :
  1. Daily Hypotensive Episodes [ Time Frame: 10 days ]
    Outcome reported as the mean number of daily hypotensive episodes (MAP < 65 mmHg) prompting intervention (indicated by a fluid bolus >=500 mL) per participant in each arm.

  2. Hypotension Requiring Vasopressors [ Time Frame: 10 days ]
    Outcome reported as the number of participants in each arm requiring the use of vasopressors for hypotension.

  3. Acute Kidney Injury [ Time Frame: 10 days ]

    Outcome reported as the number of participants in each arm who experience acute kidney injury as defined by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines:

    Increase in serum creatinine by 0.3mg/dL or more within 48 hours OR Increase in serum creatinine to 1.5 times baseline or more within the last 7 days OR Urine output less than 0.5 mL/kg/h for 6 hours.


  4. Sequential Organ Failure Assessment (SOFA) Total Score [ Time Frame: 10 days ]
    The SOFA assessment is used to track a person's risk status during stay in the Intensive Care Unit (ICU). The score is based on six different scores, one each for the respiratory, cardiovascular, hepatic, coagulation, renal, and neurological systems. Each organ system is assigned a point value from 0 (normal) to 4 (high degree of dysfunction/failure). Total score is calculated by entering patient data into a SOFA calculator, a widely-available software. Total scores range from 0-24, with higher scores indicating greater chance of mortality.

  5. Oxygen Saturation / Fractional Inhaled Oxygen (F/S) [ Time Frame: 10 days ]
    Oxygen saturation (percent) is measured by pulse oximeter. Fraction of inspired oxygen (FiO2) (unitless) is the volumetric fraction of oxygen to other gases in respiratory support. The F/S ratio is unitless.

  6. 28-Day Mortality [ Time Frame: 28 days ]
    Outcome reported as the number of participants who have expired at 28 days post enrollment.

  7. 90-Day Mortality [ Time Frame: 90 days ]
    Outcome reported as the number of participants who have expired at 90 days post enrollment.

  8. ICU Admission [ Time Frame: 10 days ]
    Outcome reported as the number of participants in each arm who require admission to the Intensive Care Unit (ICU).

  9. Number of Ventilator-Free Days [ Time Frame: 10 days ]
    Outcome reported as the mean number of days participants in each arm did not require mechanical ventilation during an in-patient hospital admission.

  10. Number of Therapeutic Oxygen-Free Days [ Time Frame: 10 days ]
    Outcome reported as the mean number of days participants in each arm did not require therapeutic oxygen usage during an in-patient hospital admission.

  11. Number of Vasopressor-Free Days [ Time Frame: 10 days ]
    Outcome reported as the mean number of days participants in each arm did not require vasopressor usage during an in-patient hospital admission.

  12. Length of ICU Stay [ Time Frame: 10 days ]
    Outcome reported as the mean length of stay (in days) in the Intensive Care Unit (ICU) for participants in each arm.

  13. Length of Hospital Stay [ Time Frame: 10 days ]
    Outcome reported as the mean length of in-patient hospital stay (in days) for participants in each arm.

  14. Incidence of Respiratory Failure [ Time Frame: 10 days ]
    Outcome reported as the number of participants requiring BiPAP OR high flow nasal cannula OR mechanical ventilation OR extracorporeal membranous oxygenation (ECMO) utilization during in-patient hospital care in each arm.

  15. Change in PROMIS Dyspnea Functional Limitations [ Time Frame: 10 days ]

    The PROMIS Dyspnea (shortness of breath) item banks and pools assess self-reported Functional Limitations, Severity, Activity Motivation, Activity Requirements, Airborne Exposure, Assistant Devices Resources, Characteristics, Emotional Response, Task Avoidance and Time Extension as they related to dyspnea.

    In the 33-item Functional Limitations bank, 33 daily activities are rated in terms of degree of difficulty while engaging in the activity over the past 7 days (0 = no difficulty, 1 = a little difficulty, 2 = some difficulty, 3 = much difficulty). Total scores range from 0 to 99, with higher scores reflecting greater functional limitations.


  16. Change in PROMIS Dyspnea Severity [ Time Frame: 10 days ]

    The PROMIS Dyspnea (shortness of breath) item banks and pools assess self-reported Functional Limitations, Severity, Activity Motivation, Activity Requirements, Airborne Exposure, Assistant Devices Resources, Characteristics, Emotional Response, Task Avoidance and Time Extension as they related to dyspnea.

    The 33-item Severity bank assesses the severity of difficulty breathing during various specific activities (the same 33 activities assessed in Dyspnea Functional Limitations). Each activity is rated in terms of degree of dyspnea (0 = no shortness of breath, 1 = mildly short of breath, 2 = moderately short of breath, 3 = severely short of breath) while engaging in the activity over the past 7 days. Total scores range from 0 to 99 with higher scores reflecting greater levels of dyspnea during daily activity.


  17. Disease Severity Rating [ Time Frame: 10 days ]
    Outcome reported as the number of participants in each arm who fall into each of 7 categories. Lower scores indicate greater condition severity. The ordinal scale is an assessment of the clinical status at the first assessment of a given study day. The scale is as follows: 1) Death; 2) Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO); 3) Hospitalized, on non-invasive ventilation or high flow oxygen devices; 4) Hospitalized, requiring supplemental oxygen; 5) Hospitalized, not requiring supplemental oxygen; 6) Not hospitalized, limitation on activities; 7) Not hospitalized, no limitations on activities.

  18. Viral Load by Nasopharyngeal Swab Day 9 [ Time Frame: 9 days ]
    Nasopharyngeal swabs will be collected every third day for the duration of study participation. Viral load is measured as number of viral genetic copies per mL.

  19. Viral Load by Nasopharyngeal Swab Day 15 [ Time Frame: 15 days ]
    Nasopharyngeal swabs will be collected every third day for the duration of study participation. Viral load is measured as number of viral genetic copies per mL.

  20. Viral Load by Blood Day 9 [ Time Frame: 9 days ]
    Blood will be collected every third day for viral load assessment for the duration of study participation. Viral load is measured as number of viral genetic copies per mL.

  21. Viral Load by Blood Day 15 [ Time Frame: 15 days ]
    Blood will be collected every third day for viral load assessment for the duration of study participation. Viral load is measured as number of viral genetic copies per mL.



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Presumptive positive laboratory test for Covid-19 based on local laboratory standard
  • Admission to the hospital with a respiratory Sequential Organ Failure Assessment (SOFA) score >=1 and increased oxygen requirement compared to baseline among those on home O2
  • Randomization within 24 hours of presentation of hospital admission or within 24 hours of a positive test result, whichever is later

Exclusion Criteria:

  • Randomization > 24 hours of admission order
  • Currently taking an angiotensin converting enzyme inhibitor (ACEi) or Angiotensin receptor blocker (ARB)
  • Prior reaction or intolerance to an ARB or ACE inhibitor, including but not limited to angioedema
  • Pregnancy or breastfeeding
  • Lack of negative urine or serum pregnancy test
  • Not currently taking a protocol-allowed version of contraception: intrauterine device, Depo-formulation of hormonal contraception (e.g. medroxyprogesterone acetate / Depo-Provera), subcutaneous contraceptive (e.g. Nexplanon), daily oral contraceptives with verbalized commitment to taking daily throughout the study period; use of condoms or agree to abstain from sexual intercourse during the study. All patients of child bearing potential enrolled in this fashion will be informed of the teratogenic risks. If enrolled under LAR, they will be informed of the risks after regaining capacity.
  • Patient reported history or electronic medical record history of kidney disease, defined as:

    1. Any history of dialysis
    2. History of chronic kidney disease stage III or IV
    3. Estimated Glomerular Filtration Rate (eGFR) of < 30ml/min/1.73 m2 at the time of randomization
  • Severe dehydration at the time of enrollment in the opinion of the investigator or bedside clinician
  • Most recent mean arterial blood pressure prior to enrollment <65 mmHg
  • Patient reported history or electronic medical record history of severe liver disease, defined as:

    1. Cirrhosis
    2. History of hepatitis B or C
    3. Documented AST or ALT > 3 times the upper limit of normal measured within 24 hours prior to randomization
  • Potassium >5.0 within 24 hours prior to randomization unless a repeat value was <=5.0
  • Treatment with aliskiren
  • Inability to obtain informed consent from participant or legally authorized representative

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04312009


Contacts
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Contact: Christopher Tignanelli, MD 612-624-4373 Covid19trial@umn.edu
Contact: Michael Puskarich, MD, MS 612-624-4373 Covid19trial@umn.edu

Locations
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United States, Minnesota
Hennepin County Medical Center Recruiting
Minneapolis, Minnesota, United States, 55415
M Health Fairview University of Minnesota Medical Center Recruiting
Minneapolis, Minnesota, United States, 55455
Sub-Investigator: Jeffrey Chipman, MD         
Sub-Investigator: Ron Reikoff, MD         
University of Minnesota Recruiting
Minneapolis, Minnesota, United States, 55455
Sub-Investigator: Timothy Schacker, MD         
Sub-Investigator: Nicholas Ingraham, MD         
Sub-Investigator: David Wacker, MD         
Sub-Investigator: Michelle Biros, MD, MS         
Sponsors and Collaborators
University of Minnesota
Bill and Melinda Gates Foundation
Investigators
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Principal Investigator: Christopher Tignanelli, MD University of Minnesota
Principal Investigator: Michael Puskarich, MD, MS University of Minnesota
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Responsible Party: University of Minnesota
ClinicalTrials.gov Identifier: NCT04312009    
Other Study ID Numbers: SURG-2020-28675
INV-017069 ( Other Grant/Funding Number: Bill and Melinda Gates Foundation )
First Posted: March 17, 2020    Key Record Dates
Last Update Posted: May 11, 2020
Last Verified: May 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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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
Keywords provided by University of Minnesota:
COVID-19
Corona Virus
SARS-COV-2
Additional relevant MeSH terms:
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Infection
Communicable Diseases
Coronavirus Infections
Severe Acute Respiratory Syndrome
Respiratory Distress Syndrome, Newborn
Respiratory Distress Syndrome, Adult
Acute Lung Injury
Lung Diseases
Respiratory Tract Diseases
Respiration Disorders
Infant, Premature, Diseases
Infant, Newborn, Diseases
Virus Diseases
Lung Injury
Coronaviridae Infections
Nidovirales Infections
RNA Virus Infections
Respiratory Tract Infections
Losartan
Anti-Arrhythmia Agents
Antihypertensive Agents
Angiotensin II Type 1 Receptor Blockers
Angiotensin Receptor Antagonists
Molecular Mechanisms of Pharmacological Action