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Safety, Tolerability and Efficacy of Molnupiravir (EIDD-2801) to Eliminate Infectious Virus Detection in Persons With COVID-19

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. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT04405570
Recruitment Status : Completed
First Posted : May 28, 2020
Results First Posted : February 16, 2022
Last Update Posted : February 16, 2022
Sponsor:
Collaborator:
Merck Sharp & Dohme LLC
Information provided by (Responsible Party):
Ridgeback Biotherapeutics, LP

Brief Summary:
This was a phase IIa, double-blind, placebo-controlled, randomized trial, designed to compare the safety, tolerability, and antiviral activity of EIDD-2801 (molnupiravir) versus placebo as measured by SARS-CoV-2 viral RNA detection in symptomatic adult outpatients with COVID-19.

Condition or disease Intervention/treatment Phase
SARS-CoV-2 Infection, COVID-19 Drug: Molnupiravir 200 mg Drug: Molnupiravir 400 mg Drug: Molnupiravir 800 mg Drug: Placebo (PBO) Phase 2

Detailed Description:

This was a phase IIa, double-blind, placebo-controlled, randomized trial, designed to compare the safety, tolerability, and antiviral activity of molnupiravir versus placebo as measured by SARS-CoV-2 viral RNA detection in symptomatic adult outpatients with COVID-19. The study was a multicenter trial that was conducted in the United States.

In this study, 204 participants were randomized and 202 received molnupiravir or placebo orally twice a day (BID) for 5 days. The study enrolled participants in 5 parts with each part evaluating molnupiravir doses of either 200 mg BID, 400 mg BID, or 800 mg BID. Doses were chosen based on emerging virology and safety data from this and ongoing studies. New dose groups were started after the selected dose had been studied for safety in a Phase 1 study.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 204 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: A Phase IIa Randomized, Double-Blind, Placebo-Controlled Trial to Evaluate the Safety, Tolerability and Efficacy of EIDD-2801 to Eliminate SARS-CoV-2RNA Detection in Persons With COVID-19
Actual Study Start Date : June 19, 2020
Actual Primary Completion Date : February 21, 2021
Actual Study Completion Date : February 21, 2021

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Molnupiravir 200 mg
Molnupiravir 200 mg, twice daily (BID) for 5 days
Drug: Molnupiravir 200 mg
Oral capsule of molnupiravir

Experimental: Molnupiravir 400 mg
Molnupiravir 400 mg, twice daily (BID) for 5 days
Drug: Molnupiravir 400 mg
Oral capsule of molnupiravir

Experimental: Molnupiravir 800 mg
Molnupiravir 800 mg, twice daily (BID) for 5 days
Drug: Molnupiravir 800 mg
Oral capsule of molnupiravir

Placebo Comparator: Placebo (PBO) twice daily (BID) for 5 days Drug: Placebo (PBO)
placebo oral capsule




Primary Outcome Measures :
  1. Number of Participants Until First Non-detectable SARS-CoV-2 in Nasopharyngeal (NP) Swabs [ Time Frame: 28 days ]

    The number of participants until first non-detectable SARS-CoV-2 in nasopharyngeal (NP) swabs will be estimated for each randomized arm (drug versus placebo), using Kaplan-Meier methods with a corresponding log-rank test.

    Non detectable defined as "a viral load below the limit of quantification


  2. Time to Clearance of SARS-CoV-2 in Nasopharyngeal Swabs [ Time Frame: 28 days ]

    The distribution of days until first non-detectable SARS-CoV-2 in nasopharyngeal (NP) swabs will be estimated for each randomized arm (drug versus placebo), using Kaplan-Meier methods with a corresponding log-rank test.

    Non detectable defined as "a viral load below the limit of quantification


  3. Number of Participants With Adverse Events (AEs) Grade 3 or Higher or Leading to Discontinuation of Study Treatment [ Time Frame: 28 days ]
    1) any AEs leading to early discontinuation of blinded treatment (active or placebo), 2) study drug-related discontinuation of treatment, 3) new grade 3 or higher AEs (not already present at baseline), and 4) study drug-related new grade 3 or higher AEs.


Secondary Outcome Measures :
  1. Number of Participants With Any Adverse Events (AEs), Grade 2 or Higher [ Time Frame: 28 days ]
    Measure the safety and tolerability of EIDD-2801 by estimating the occurrence of Grade 2 or higher AE and drug related AEs.



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:

  1. Able to provide informed consent prior to initiation of any study procedures.
  2. ≥18 years of age at Screening.
  3. Study treatment is expected to begin within ≤168 hours from first symptom onset.
  4. Ability to swallow pills.
  5. Documentation of confirmed active SARS-CoV-2 infection, as determined by a molecular or non-molecular ("rapid") test conducted at any clinic or laboratory that had a Clinical Laboratory Improvement Amendments (CLIA) certification or its equivalent from a sample collected ≤96 hours prior to study entry.
  6. Was experiencing at least one of the following SARS-CoV-2 infection symptoms at the time of enrollment: fever (could be subjective including feeling feverish or having chills) OR signs/symptoms of respiratory illness (including but not limited to upper respiratory congestion, loss of sense of smell or taste, sore throat OR lower respiratory illness - cough, shortness of breath).
  7. Agreed to not participate in another interventional clinical trial for the treatment of SARS-CoV-2 during the study period (28 days) unless hospitalized.
  8. Agreed to not obtain investigational medications outside of the molnupiravir study.
  9. Agreed to the sampling detailed in the schedule of evaluations and to comply with study requirements including contraception requirements.
  10. A female participant was eligible to participate if she was not pregnant or breastfeeding and at least one of the following conditions applied:

    • Was not a woman of childbearing potential (WOCBP) OR
    • Was a WOCBP and using a contraceptive method that is highly effective (a low user dependency method OR a user-dependent method in combination with a barrier method), or was abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long-term and persistent basis), as described in Appendix 2 of the study protocol during the intervention period and for at least 50 days after the last dose of study intervention. The investigator evaluated the potential for contraceptive method failure (ie, noncompliance, recently initiated) in relationship to the first dose of study intervention.
    • A WOCBP must have had a negative highly sensitive pregnancy test (serum or urine) within 24 hours before the first dose of study intervention.
    • Additional requirements for pregnancy testing during and after study intervention were provided in the study protocol.
    • The investigator was responsible for review of medical history, menstrual history, and recent sexual activity to decrease the risk for inclusion of a woman with an early undetected pregnancy.
    • Contraceptive use by women was to be consistent with local regulations regarding the methods of contraception for those participating in clinical studies.
    • Given the elevated risk of venous thrombotic events in patients hospitalized with COVID-19 (Benson et al, 2020; Spratt et al, 2020), estrogen-containing contraceptives could not be started to fulfill the contraceptive requirement of this study at any time during participant's participation. If contraceptives were interrupted as standard of care management of COVID-19 patients and resumed at a later time point, such as at hospital discharge, then abstinence was practiced for the defined period of back-up contraception per the contraceptive product labeling. After this period, contraceptive use had to adhere to the guidance in Appendix 2 of the study protocol.
  11. Male participants were eligible to participate if they agreed to the following during the intervention period and for at least 100 days after the last dose of study intervention:

    • Refrained from donating sperm

PLUS either:

  • Were abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long term and persistent basis) and agreed to remain abstinent.

OR

  • Had to agree to use contraception unless confirmed to be azoospermic (vasectomized or secondary to medical cause [Appendix 2 of the study protocol]) as detailed below:

    • Agreed to use a male condom plus partner use of an additional contraceptive method when having penile-vaginal intercourse with a WOCBP who was not pregnant. Note: Men with a pregnant or breastfeeding partner had to agree to remain abstinent from penile-vaginal intercourse or use a male condom during each episode of penile-vaginal penetration.
    • Contraceptive use by men was to be consistent with local regulations regarding the methods of contraception for those participating in clinical studies.

Exclusion Criteria:

  1. Need for hospitalization or immediate medical attention in the clinical opinion of the study investigator.
  2. Hemoglobin <10 g/dL in men and <9 g/dL in women.
  3. Platelet count <100,000/ µL or received a platelet transfusion within 5 days prior to enrollment.
  4. Was on dialysis or has an estimated glomerular filtration rate <30 mL/min/1.73 m^2
  5. Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) >3x upper limit normal (ULN).
  6. History of or current hospitalization for COVID-19. Note: Individuals hospitalized and then discharged, even if only hospitalized for 1 day, were excluded.
  7. History of kidney disease as evidenced by estimated creatinine clearance value <30 mL/min.
  8. History of significant liver disease in the opinion of the site investigator or active hepatitis B or active hepatitis C. Human immunodeficiency virus (HIV) that is advanced (CD4<200/mm^3) and/or on treatment with nucleos(t)ide analogues.
  9. Use of therapeutic interventions with possible anti-SARS-CoV-2 activity within 30 days prior to study entry, (e.g., remdesivir, lopinavir/ritonavir fixed dose combination, ribavirin, chloroquine, hydroxychloroquine, and convalescent plasma), or participation in a clinical trial involving any of these drugs whether for treatment or prophylaxis.
  10. Receipt of a SARS-CoV-2 vaccination prior to study entry.
  11. Known allergy/sensitivity or any hypersensitivity to components of molnupiravir, or its formulation.
  12. Active drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements.
  13. History of recent (within the past 3 months) hemorrhagic cerebrovascular accident) or major bleed.
  14. Presence of a condition, that in the opinion of the investigator, would place the subject at increased risk from study participation.

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): NCT04405570


Locations
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United States, California
Valley Clinical Trials, Inc.
Northridge, California, United States, 91325
FOMAT Medical Research
Oxnard, California, United States, 93030
Southern California Emergency Medicine
Yucaipa, California, United States, 92399
United States, Florida
Indago Research and Health Center, Inc.
Hialeah, Florida, United States, 33012
United States, Louisiana
NOLA Research Works, LLC
New Orleans, Louisiana, United States, 70115
United States, North Carolina
University of North Carolina School of Medicine
Chapel Hill, North Carolina, United States, 27599
Duke University Medical Center
Durham, North Carolina, United States, 27710
Wake Forest Baptist Medical Center
Winston-Salem, North Carolina, United States, 27157
United States, Texas
Care United Research, LLC
Forney, Texas, United States, 75126
United States, Washington
Fred Hutchinson Cancer Research Center
Seattle, Washington, United States, 98109
Sponsors and Collaborators
Ridgeback Biotherapeutics, LP
Merck Sharp & Dohme LLC
  Study Documents (Full-Text)

Documents provided by Ridgeback Biotherapeutics, LP:
Study Protocol  [PDF] November 15, 2020
Statistical Analysis Plan  [PDF] February 18, 2021

Additional Information:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: Ridgeback Biotherapeutics, LP
ClinicalTrials.gov Identifier: NCT04405570    
Other Study ID Numbers: EIDD-2801-2003
First Posted: May 28, 2020    Key Record Dates
Results First Posted: February 16, 2022
Last Update Posted: February 16, 2022
Last Verified: February 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: There is not a plan to make IPD available.

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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COVID-19
Respiratory Tract Infections
Infections
Pneumonia, Viral
Pneumonia
Virus Diseases
Coronavirus Infections
Coronaviridae Infections
Nidovirales Infections
RNA Virus Infections
Lung Diseases
Respiratory Tract Diseases