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Safety and Efficacy of Anti-Coronavirus Hyperimmune Intravenous Immunoglobulin for the Treatment of Adult Outpatients in Early Stages of COVID-19

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ClinicalTrials.gov Identifier: NCT04910269
Recruitment Status : Recruiting
First Posted : June 2, 2021
Last Update Posted : September 5, 2021
Sponsor:
Collaborators:
National Institute of Allergy and Infectious Diseases (NIAID)
National Institutes of Health (NIH)
International Network for Strategic Initiatives in Global HIV Trials (INSIGHT)
Information provided by (Responsible Party):
University of Minnesota

Brief Summary:

The primary objective of the Outpatient Treatment with Anti-Coronavirus Immunoglobulin (OTAC) (INSIGHT 012) trial is to compare the safety and efficacy of a single infusion of anti-COVID-19 hyperimmune intravenous immunoglobulin (hIVIG) versus placebo among adults with recently diagnosed SARS-CoV-2 infection who do not require hospitalization. The primary endpoint of this double-blind randomized trial is a five-category ordinal outcome that assesses the participant's clinical status seven days after the infusion of hIVIG or placebo.

  1. Asymptomatic and no limitations in usual activity due to COVID-19
  2. Mild COVID-19 illness or minor limitations to usual activity
  3. Moderate COVID-19 illness and with major limitations to usual activity
  4. Severe COVID-19 or serious disease manifestation from COVID-19
  5. Critical illness from COVID-19 or Death

Two strata of participants will be identified for analysis purposes. Stratum 1 will be participants who receive neutralizing monoclonal antibodies (nMAbs) as standard of care (SOC), estimated to be about 20% of participants. Stratum 2 will be participants who do not receive nMAbs, estimated to be about 80% of participants.


Condition or disease Intervention/treatment Phase
COVID SARS-CoV2 Infection Covid19 Biological: Hyperimmune immunoglobulin to SARS-CoV-2 (hIVIG) Other: Placebo Phase 3

Detailed Description:

The primary objective will be addressed by testing two hypotheses aimed at assessing whether hIVIG + standard of care (SOC) is superior to placebo + SOC for the primary ordinal endpoint at Day 7. These hypotheses will be tested for the following two groups: a) among all randomized participants (stratum 1 and 2), and b) among only participants enrolled in stratum 1. For the primary analysis, overall type 1 error will be controlled at 5% by using a 2-sided significance level of 0.035 for each hypothesis. This significance level was obtained using the correlation between the test statistics for the proportional log odds ratio for all randomized participants and for this log odds ratio for those in stratum 1. This correlation was determined to be 0.895. With this approach hIVIG will be considered superior to placebo if either of the two hypotheses is rejected.

Participants will be randomized to a single infusion of an hIVIG product (1 of 2) or placebo in a 1:1:2 allocation. After pooling data from each hIVIG product, this will result in 1:1 allocation for hIVIG versus placebo. Randomization will be stratified by study site pharmacy and the two SOC strata.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 820 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: An International Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial of the Safety and Efficacy of Anti-Coronavirus Hyperimmune Intravenous Immunoglobulin for the Treatment of Adult Outpatients in Early Stages of COVID-19
Actual Study Start Date : August 6, 2021
Estimated Primary Completion Date : August 2023
Estimated Study Completion Date : August 2023

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Treatment Group
Participants in this group will receive the investigational treatment in addition to standard of care.
Biological: Hyperimmune immunoglobulin to SARS-CoV-2 (hIVIG)
The hIVIG product is administered as a single dose of 30 grams, or 300 milliliter at a concentration of 0.1 grams/milliliter. This dose corresponds to 400 milligrams/kilogram for a 75 kilogram adult.

Placebo Comparator: Placebo Group
Participants in this group will receive a placebo in addition to standard of care.
Other: Placebo
Infusion of standard isotonic saline




Primary Outcome Measures :
  1. Clinical Status [ Time Frame: 7 days ]

    The primary outcome is to compare the safety and efficacy of a single infusion of hIVIG versus placebo on clinical status after seven days. Outcome will be reported as the percent of participants who fall into each of 5 clinical status categories as defined below.

    1. Asymptomatic and no limitations in usual activity due to COVID-19
    2. Mild COVID-19 illness or minor limitations to usual activity
    3. Moderate COVID-19 illness and with major limitations to usual activity
    4. Severe COVID-19 or serious disease manifestation from COVID-19
    5. Critical illness from COVID-19 or Death


Secondary Outcome Measures :
  1. All-cause hospitalization or death through 28 days. [ Time Frame: 28 days ]
    Outcome reported as the percent of participants who are hospitalized or who expire for any reason by day 28 post treatment.

  2. All-cause mortality through 28 days. [ Time Frame: 28 days ]
    Outcome reported as the percent of participants who expire for any reason by day 28 post treatment.

  3. Significant Disease Progression [ Time Frame: 28 days ]
    Outcome is reported as the number of participants with significant disease progression through 28 days, which is defined by fulfilling criteria for category 4 or 5 on the ordinal scale using a time to event analysis.

  4. Ordinal Scale Distribution [ Time Frame: 4, 14, 28 days ]

    Outcome will be reported as the percent of participants who fall into each of 5 clinical status categories as defined below at days 4, 14, and 28 following treatment.

    1. Asymptomatic and no limitations in usual activity due to COVID-19
    2. Mild COVID-19 illness or minor limitations to usual activity
    3. Moderate COVID-19 illness and with major limitations to usual activity
    4. Severe COVID-19 or serious disease manifestation from COVID-19
    5. Critical illness from COVID-19 or Death

  5. Disease Progression Through 7 Days [ Time Frame: 7 days ]
    Outcome is reported as the proportion of participants with any disease progression at Day 7, using a sliding dichotomous scale progression defined by a categorization on the ordinal scale that is worse than the status at entry.

  6. Significant Disease Progression Through 7 Days [ Time Frame: 7 days ]
    Outcome is reported as the proportion of participants who progress to categories 3-5 on the clinical ordinal scale at Day 7 among participants in categories 1 or 2 of the ordinal scale at entry.

  7. Disease Progression at Follow-up [ Time Frame: 7, 14, 28 days ]
    Outcome is reported as the percent of participants who experience severe disease progression during follow-up, defined by the worst health status achieved on the clinical ordinal scale at any point by Day 7, 14, and 28.

  8. Activity Limitations at Follow-up [ Time Frame: 7, 14, 28 days ]
    Outcome is reported as the percent of participants who attain their pre-COVID health status without limitations in usual activity (defined as category 1 on the ordinal scale) at Day 7, 14, and 28.

  9. Change in Viral Burden from Serum Antigen [ Time Frame: 7 days ]
    Outcome is reported as the change between Day 0 and Day 7 in viral burden as determined by serum antigen levels from nasal and saliva specimens.

  10. Change in Viral Burden from PCR [ Time Frame: 7 days ]
    Outcome is reported as the change between Day 0 and Day 7 in viral burden as determined by polymerase chain reaction (PCR) from nasal and saliva specimens.

  11. Change in SARS-CoV-2 Antibody Concentration [ Time Frame: 7 days ]
    Outcome is reported as the change in SARS-CoV-2 antibody levels between Day 0 and Day 7, including subclasses and neutralizing titers.

  12. Healthcare Utilization at Follow-up [ Time Frame: 28 days ]
    Outcome is reported as the percent of participants who had health care engagement for the purposes of medical evaluation and/or management of COVID-19 illness (e.g., via telehealth, clinic, urgent care, emergency room, or hospitalization) at 28 days follow-up.

  13. Worst Status Through 28 Days [ Time Frame: 28 days ]
    Outcome is reported as the number of participants who experience each of the following categories as their worst respiratory status through 28 days, including: a) no respiratory symptoms, b) upper respiratory symptoms, c) lower respiratory symptoms without hypoxia, c) hypoxia requiring conventional oxygen supplementation by nasal canula, d) respiratory failure requiring high-flow oxygen delivery device or non-invasive ventilation, or e) respiratory failure requiring mechanical ventilation or extra-corporeal membrane oxygenation (ECMO).

  14. Hypoxemia Through Day 7 [ Time Frame: 7 days ]
    Outcome is reported as the mean oxygen saturation (percentage) level in each group at 7 days.

  15. Additional COVID-19 Treatment [ Time Frame: 28 days ]
    Outcome is reported as the number of patients starting other treatments targeting COVID-19 through 28 days post treatment.



Information from the National Library of Medicine

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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:

  • Clinical risk based on age ≥ 55 years or an adult (age ≥ 18 years) with an immunosuppressed condition.
  • Positive test for SARS-CoV-2 within ≤5 days (if >1 test, the first positive is within ≤5 days). Tests may include an institutional-based nucleic acid amplification test (NAAT), or any protocol-approved rapid test.
  • Within ≤5 days from symptom onset, if symptomatic from current SARS-CoV-2 infection.
  • Agrees to not participate in another clinical trial for the treatment or management of SARS-CoV-2 infection through Day 7, or until hospitalized or significant disease progression if prior to Day 7 (defined by ordinal category 4 or 5).
  • Participant provides written informed consent prior to study procedures, and understands and agrees to adhere to planned study procedures through Day 28.

Ongoing immunosuppressive condition or immunosuppressive treatment, includes:

  1. Steroids equivalent to prednisone > 10 mg/day for at least the last 28 days
  2. Rheumatologic or autoimmune disorder treated with a biologic or non-biologic immunosuppressive therapy
  3. Antirejection medicine after solid organ or stem cell transplantation
  4. Cancer treatment with systemic chemotherapy, biologic and/or cell-based therapy in the last 12 months
  5. Primary or acquired severe B- or T-lymphocyte immune dysfunction
  6. HIV infection
  7. Splenectomy or functional asplenia

Exclusion Criteria:

  • Asymptomatic and had prior symptoms from the current infection that have now resolved (for >24 hours).
  • Asymptomatic and has received a vaccination for COVID-19 (≥1 dose).
  • Undergoing evaluation for possible admission to hospital for medical management (this does not include evaluation of possible hospitalization for public health purposes).
  • Evidence of pneumonia and/or hypoxia due to COVID-19 (NOTE: chest imaging is not required, but if available it should not show new infiltrates suggestive of pneumonia; hypoxia is defined by new oxygen supplementation or increase above pre-illness level).
  • Prior receipt of immunoglobulin product or passive immune therapy for SARS-CoV-2 in the past 90 days (i.e., convalescent plasma, SARS-CoV-2 monoclonal antibodies, or any IVIG).
  • Any of the following thrombotic or procoagulant conditions or disorders:

    1. acute coronary syndrome, cerebrovascular syndrome, pulmonary embolism, or deep venous thrombosis within 28 days of randomization.
    2. prothrombin gene mutation 20210, homozygous Factor V Leiden mutations, antiphospholipid syndrome, or a deficiency in antithrombin III, protein C, or protein S.
  • History of hypersensitivity to blood, plasma or IVIG excipients.
  • Known IgA deficiency or anti-IgA antibodies.
  • Medical conditions for which receipt of a 300 mL volume of IV fluid from study treatment may pose specific risk to the patient (e.g., decompensated congestive heart failure).
  • In the opinion of the investigator, any condition for which participation would not be in the best interest of the participant or that could prevent or confound protocol assessments.

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): NCT04910269


Contacts
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Contact: Gary Collins 612-626-9006 gary-c@ccbr.umn.edu

Locations
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United States, District of Columbia
MedStar Health Research Institute Recruiting
Washington, District of Columbia, United States, 20010
Contact: Washington DC ICC       otacwdc@insight-trials.org   
Principal Investigator: Glenn Wortmann, MD         
Washington DC Veterans Affairs Medical Center Recruiting
Washington, District of Columbia, United States, 20422
Contact: Washintgon ICC       otacwdc@insight-trials.org   
Principal Investigator: Virginia Kan, MD         
United States, Maryland
University of Maryland Medical System Recruiting
Baltimore, Maryland, United States, 21201
Contact: NIH-DCR ICC       otacnih@insight-trials.org   
Principal Investigator: Richard Wilkerson, MD         
United States, Michigan
Infusion Associates Recruiting
Grand Rapids, Michigan, United States, 49525
Contact: NIH-DCR ICC       otacnih@insight-trials.org   
Principal Investigator: Khan Nedd, MD         
United States, New York
Mount Sinai Beth Israel Hospital Recruiting
New York, New York, United States, 10003
Contact: Washington DC ICC       otacwdc@insight-trials.org   
Principal Investigator: Sanjana Koshy, MD         
Icahn School of Medicine at Mount Sinai Recruiting
New York, New York, United States, 10029
Contact: Washington DC ICC       otacwdc@insight-trials.org   
Principal Investigator: Judith Aberg, MD         
United States, Texas
Hendrick Medical Center Recruiting
Abilene, Texas, United States, 79601
Contact: NIH-DCR ICC       otacnih@insight-trials.org   
Principal Investigator: Daniel Canario, MD         
UT Southwestern Medical Center Recruiting
Dallas, Texas, United States, 75390
Contact: Washington DC ICC       otacwdc@insight-trials.org   
Principal Investigator: Mamta Jain, MD         
Sponsors and Collaborators
University of Minnesota
National Institute of Allergy and Infectious Diseases (NIAID)
National Institutes of Health (NIH)
International Network for Strategic Initiatives in Global HIV Trials (INSIGHT)
Investigators
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Principal Investigator: James Neaton, PhD University of Minnesota
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Responsible Party: University of Minnesota
ClinicalTrials.gov Identifier: NCT04910269    
Other Study ID Numbers: INSIGHT12
First Posted: June 2, 2021    Key Record Dates
Last Update Posted: September 5, 2021
Last Verified: September 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: A public data set will be made available at the end of the trial.
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Informed Consent Form (ICF)
Clinical Study Report (CSR)

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by University of Minnesota:
immunotherapy
hIVIG
early treatment
Additional relevant MeSH terms:
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Coronavirus Infections
Coronaviridae Infections
Nidovirales Infections
RNA Virus Infections
Virus Diseases
Immunoglobulins
Immunoglobulins, Intravenous
Antibodies
Immunologic Factors
Physiological Effects of Drugs