CRISIS2: A Phase 2 Study of the Safety and Antiviral Activity of Brequinar in Non-hospitalized Pts With COVID-19 (CRISIS2)

• ClinicalTrials.gov Identifier: NCT04575038
• Recruitment Status: Completed
• First Posted: October 5, 2020
• Results First Posted: April 19, 2022
• Last Update Posted: April 19, 2022
• Sponsor: Clear Creek Bio, Inc.
• Information provided by (Responsible Party): Clear Creek Bio, Inc.

Study Description

Brief Summary:

This study will assess the efficacy and safety of DHODHi (brequinar) as an antiviral via 5 days of treatment of participants with positive COVID-19 and at least one symptom of COVI019 in an out-patient setting. The study is multi-center, randomized, and placebo-controlled.

Condition or disease	Intervention/treatment	Phase
COVID-19 Infection	Drug: Brequinar; Drug: Placebo	Phase 2

Detailed Description:

Brequinar is a potent DHODH inhibitor that has been previously studied in more than 1,000 cancer, psoriasis, and organ transplant patients. Brequinar has been found to have potent in vitro antiviral activity against many RNA viruses including SARS-CoV-2. The antiviral activity of brequinar against SARS-CoV-2 is likely due to DHODH inhibition and shows nanomolar potency and a high selectivity index in inhibiting viral replication in in vitro studies.

The CRISIS2 trial will study out-patients (non-hospitalized patients) who have a positive SARS-CoV-2 test and are symptomatic. Subjects will be randomized to receive standard of care (SOC) + 5 days of brequinar or SOC + 5 days of placebo. The purpose of this study is to determine if the in vitro antiviral activity of brequinar can be duplicated in patients infected with SARS-CoV-2 by measuring the effect of brequinar on viral shedding. Importantly, the safety and tolerability of brequinar will also be determined in these patients. The results of this proof-of-concept study will inform future studies that will help determine if brequinar is a safe and effective drug for the treatment of SARS-CoV-2 infection.

This will be a phase II randomized, placebo-controlled, double blind, multi-center study with approximately 100 subjects. All subjects will receive standard of care (SOC) per institutional guidelines for treatment of patients with COVID-19 infection. In addition to SOC, the subjects will self-administer one capsule once daily for 5 days.

Subjects will have a Screening Visit followed as soon as possible with Study Day 1. Study visits (virtual or in person) will take place at Screening and on specified days. The visits that include bloodwork must be conducted at the study site or arrangements made for sample collection at the subject's home or other appropriate location. Other visits/visit activities for that visit may be conducted remotely using telemedicine or other remote technique. Subjects are to self-collect a viral load sample, obtain their respiratory rate, heart rate, body temperature and SpO2, and complete a symptom assessment checklist on specified days.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 115 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Intervention Model Description: Randomized 1:1 brequinar 100 mg or placebo
• Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
• Masking Description: Double blind
• Primary Purpose: Treatment
• Official Title: The CRISIS2 Study: A Phase 2, Randomized, Double Blind, Placebo-controlled, Multi-center Study Assessing the Safety and Anti-coronavirus Response of Suppression of Host Nucleotide Synthesis in Out-patient Adults With SARS-CoV-2
• Actual Study Start Date: November 19, 2020
• Actual Primary Completion Date: April 28, 2021
• Actual Study Completion Date: April 28, 2021

Arms and Interventions

Arm	Intervention/treatment
Experimental: Brequinar 100 mg; Brequinar oral capsules 100 mg x 5 days	Drug: Brequinar; Dihydroorotate dehydrogenase inhibitor (DHODHi)
Placebo Comparator: Placebo; Placebo for Brequinar capsules x 5 days	Drug: Placebo; Placebo capsules

Outcome Measures

Primary Outcome Measures :

1. Log10 SARS-CoV-2 Viral Load [ Time Frame: Days 4, 8, 12, 15, 22, and 29 ]
   Median Change from Baseline in Quantitative Log10 SARS-CoV-2 viral load at Days 4, 8, 12, 15, 22, and 29.

Secondary Outcome Measures :

1. Rates of AEs and SAEs Including Laboratory Assessments [ Time Frame: Through Day 29 ]
   Safety measured by number of participants with AEs and SAEs including laboratory assessments.
2. Viral Shedding Duration [ Time Frame: Through Day 36 ]
   Duration of viral shedding was defined as the time to viral clearance (two consecutive negative test results) for the Microbiology Evaluable Set population.
3. Hospital Admission [ Time Frame: Day 29 ]
   Percentage of subjects requiring admission as an inpatient for >24 hours

Eligibility Criteria

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

Criteria

Inclusion Criteria:

1. Willing and able to provide informed consent for the trial, written, electronic, verbal or other method deemed acceptable by the institution and IRB.
2. 18 years of age or older.
3. Laboratory-confirmed SARS-CoV-2 infection as determined by real time polymerase chain reaction (RT-PCR) or other FDA-approved commercial or public health assay.
4. Out-patient (never hospitalized as an in-patient for COVID-19 or was evaluated/treated for COVID-19 only in the Emergency Room with a stay of < 24 hours)
5. The effects of brequinar on the developing human fetus are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Men and women treated or enrolled on this protocol must also agree to use adequate contraception for the duration of study participation, and for 90 days after completion of brequinar administration.
6. Male subjects must agree to refrain from sperm donation and female subjects must agree to refrain from ovum donation from initial study drug administration until 90 days after the last dose of brequinar.
7. Must have at least one COVID-19 symptom including but not limited to fever, cough, sore throat, malaise, headache, muscle pain, gastrointestinal symptoms, shortness of breath, dyspnea, anosmia, dysgeusia, or other symptom commonly associated with COVID-19 in the opinion of the investigator. Symptom onset must be ≤7 days prior to first dose. Subject must have one or more symptoms at first dose.
8. Able to swallow capsules.

Exclusion Criteria:

1. Any physical examination findings and/or history of any illness that, in the opinion of the study investigator, might confound the results of the study or pose an additional risk to the patient
2. Nursing women or women of childbearing potential (WOCBP) with a positive pregnancy test
3. Treatment with another DHODH inhibitor (e.g., leflunomide, teriflunomide) or other agents known to cause bone marrow suppression leading to thrombocytopenia
4. Platelets ≤150,000 cell/mm3
5. Hemoglobin < 10 gm/dL
6. Absolute neutrophil count < 1500 cells/mm3
7. Renal dysfunction, i.e., creatinine clearance < 30 mL/min
8. AST or ALT > 2 x ULN, or total bilirubin > ULN. Gilbert's Syndrome is allowed.
9. Bleeding disorders or blood loss requiring transfusion in the six weeks preceding enrollment
10. Ongoing gastrointestinal ulcer, or gastrointestinal bleeding within 6 weeks of randomization.
11. Chronic hepatitis B infection, active hepatitis C infection, active liver disease and/or cirrhosis per subject report.
12. Heart failure, current uncontrolled cardiovascular disease, including unstable angina, uncontrolled arrhythmias, major adverse cardiac event within 6 months (e.g. stroke, myocardial infarction, hospitalization due to heart failure, or revascularization procedure).

Contacts and Locations

Locations

United States, Alabama

Central Alabama Research

Homewood, Alabama, United States, 35209

United States, California

Ark Clinical Research

Long Beach, California, United States, 90806

United States, Florida

Doral Medical Research

Doral, Florida, United States, 33166

United States, New Jersey

South Jersey Infectious Disease

Somers Point, New Jersey, United States, 08244

United States, North Carolina

Monroe Biomedical Research

Monroe, North Carolina, United States, 28112

Wilmington Health

Wilmington, North Carolina, United States, 28401

United States, Ohio

Remington-Davis, Inc.

Columbus, Ohio, United States, 43215

Toledo Institute of Clinical Research

Toledo, Ohio, United States, 43617

United States, South Carolina

VitaLink - Gaffney

Gaffney, South Carolina, United States, 29615

Self Regional Healthcare Research Center - Self Medical Group

Greenwood, South Carolina, United States, 29646

VitaLink Research

Spartanburg, South Carolina, United States, 29303

United States, Tennessee

Clinical Trials Center of Middle Tennessee

Franklin, Tennessee, United States, 37067

United States, Texas

Centex Studies, Inc. - McAllen

McAllen, Texas, United States, 78504

United States, Utah

Synexus Clinical Research US, Inc. - Olympus Family Medicine

Salt Lake City, Utah, United States, 84117

Sponsors and Collaborators

Clear Creek Bio, Inc.

  Study Documents (Full-Text)

Documents provided by Clear Creek Bio, Inc.:

Study Protocol  [PDF] November 19, 2020

Statistical Analysis Plan  [PDF] November 4, 2020

More Information

• Responsible Party: Clear Creek Bio, Inc.
• ClinicalTrials.gov Identifier: NCT04575038
• Other Study ID Numbers: CCB-CRISIS-02
• First Posted: October 5, 2020
• Results First Posted: April 19, 2022
• Last Update Posted: April 19, 2022
• Last Verified: April 2022

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:

COVID-19; Pneumonia, Viral; Pneumonia; Respiratory Tract Infections; Infections; Virus Diseases; Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Lung Diseases; Respiratory Tract Diseases; Brequinar; Antineoplastic Agents; Enzyme Inhibitors; Molecular Mechanisms of Pharmacological Action; Immunosuppressive Agents; Immunologic Factors; Physiological Effects of Drugs