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Evaluation of the Efficacy of Nicotine Patches in SARS-CoV2 (COVID-19) Infection in Intensive Care Unit Patients (NICOVID-REA)

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ClinicalTrials.gov Identifier: NCT04598594
Recruitment Status : Completed
First Posted : October 22, 2020
Last Update Posted : June 22, 2021
Sponsor:
Information provided by (Responsible Party):
Assistance Publique - Hôpitaux de Paris

Study Description
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Brief Summary:

There is currently no known treatment for COVID19. Active smokers are infrequent among patients with COVID-19 which has led our team to hypothesize that nicotine is responsible for this protective effect via the nicotinic acetylcholine receptor (nAChR). In fact, nAChR possess the ability to modulate ACE2 expression, the cellular doorway for SARS-CoV2. nAChR modulation by the virus would be responsible for the numerous clinical signs observed in COVID-19, including the cytokine storm manifested in intensive care hyperinflammatory patients.

Based on epidemiological data and experimental data from scientific literature, our team hypothesize that nicotine could inhibit the penetration and propagation of SARS-CoV2. Our team also claim that nicotine could attenuate the hyperinflammatory response and cytokine storm leading to acute respiratory failure and a probable multi-organ failure associated with COVID19.


Condition or disease Intervention/treatment Phase
Covid19 SARS-Associated Coronavirus as Cause of Disease Classified Elsewhere Drug: Patch, Nicotine Drug: Patch, Placebo Phase 3

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 220 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: Evaluation of the Efficacy of Nicotine Patches in SARS-CoV2 (COVID-19) Infection in Intensive Care Unit Patients
Actual Study Start Date : November 6, 2020
Actual Primary Completion Date : April 29, 2021
Actual Study Completion Date : June 20, 2021

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
Experimental: Nicotine patch Drug: Patch, Nicotine
Two patches of 7 mg/day Treatment at 14 mg/day during mechanical ventilation since after first successful extubation then, dose decreasing: Week 1: 10,5 mg/day Week 2 : 7 mg/day Week 3 : 3,5 mg/day
Placebo Comparator: Placebo patch Drug: Patch, Placebo
Two patches of 7 mg/day Treatment at 14 mg/day during mechanical ventilation since after first successful extubation then, dose decreasing: Week 1: 10,5 mg/day Week 2 : 7 mg/day Week 3 : 3,5 mg/day


Outcome Measures
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Primary Outcome Measures :
  1. Mortality [ Time Frame: Day 28 ]

Secondary Outcome Measures :
  1. Mortality [ Time Frame: Day 60 ]
  2. Time before successful extubation [ Time Frame: Day 60 ]
    Without reintubation or death in the following 48 hours for tracheotomized patients: alive and not ventilated for 48 hours (with death and LATA in competitive risks).

  3. Number of days living without invasive mechanical ventilation [ Time Frame: Day 28 ]
  4. Composite score incorporating death and the number of days living without mechanical ventilation [ Time Frame: Day 60 ]
    This is a ranked composite score that incorporates death and days free from mechanical ventilation through day 28, calculated in such a manner that death constitutes a worse outcome than fewer days off the ventilator.16 Time free from mechanical ventilation was calculated as the number of days between successful liberation from the ventilator and study day 60. Each patient was compared with every other patient in the study and assigned a score (tie: 0, win: +1, loss: -1) for each pairwise comparison based on whom fared better

  5. Mean evolution of blood gases [ Time Frame: Day 1 to Day 14 ]
    measured each day from day 1 to day 14

  6. Mean evolution of Tidal Volume (ventilator parameters) [ Time Frame: Day 1 to Day 14 ]
    measured each day from day 1 to day 14

  7. Mean evolution of respiratory rate (ventilator parameters) [ Time Frame: Day 1 to Day 14 ]
    measured each day from day 1 to day 14

  8. Mean evolution of Positive Expiratory Pressure (ventilator parameters) [ Time Frame: Day 1 to Day 14 ]
    measured each day from day 1 to day 14

  9. Mean evolution of plateau pressure (ventilator parameters) [ Time Frame: Day 1 to Day 14 ]
    measured each day from day 1 to day 14

  10. Mean evolution of fraction of inspired oxygen (ventilator parameters) [ Time Frame: Day 1 to Day 14 ]
    measured each day from day 1 to day 14

  11. Evolution of the Sequential Organ Failure Assessment (SOFA) score and its components by organ [ Time Frame: Day 1 to Day 28 ]
    A higher score indicate a worse outcome

  12. Number of days alive without organ failure [ Time Frame: Day 28, day 60 ]
  13. Duration of hospitalization in intensive care unit [ Time Frame: From day 1 up to 3 months ]
  14. Duration of hospitalization in hospital [ Time Frame: From day 1 up to 3 months ]
  15. Number of days alive and out of the ICU and hospital [ Time Frame: Day 28, day 60 ]
  16. Evolution of viral load [ Time Frame: Day 7, Day 14 or day of ICU discharge if before day 14 ]
    samples taken on D7 and D14 or the day of discharge from intensive care unit if before D14

  17. Proportion of active smoker or active vapers or taking nicotine substitutes documented by examination [ Time Frame: 2 weeks after treatment decrease, 8 weeks after treatment decrease ]
  18. Proportion of active smoker or active vapers or taking nicotine substitutes documented by urinary cotinine [ Time Frame: 2 weeks after treatment decrease, 8 weeks after treatment decrease ]
  19. Mean score of Desire to smoke defined by French Tobacco Craving scale [ Time Frame: 2 weeks after treatment decrease, 8 weeks after treatment decrease ]
  20. Mean score of Withdrawal symptoms scale [ Time Frame: 2 weeks after treatment decrease, 8 weeks after treatment decrease ]
  21. Mean score of Hospital anxiety and depression scale [ Time Frame: 2 weeks after treatment decrease, 8 weeks after treatment decrease ]
  22. Post traumatic stress disorder scale [ Time Frame: 2 weeks after treatment decrease, 8 weeks after treatment decrease ]
  23. Mean score of Insomnia severity scale [ Time Frame: 2 weeks after treatment decrease ]
  24. Cotinin rate in blood [ Time Frame: 8 weeks after treatment decrease ]

Eligibility Criteria
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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. Patient ≥ 18 years
  2. Documented diagnosis of COVID 19 (according to the tests referenced on the list published on the website : https://covid-19.sante.gouv.fr.tests)
  3. Hospitalized in intensive care unit, intubated and mechanically ventilated for less than 48 hours
  4. Non-smoker and non-vaping or abstinent patient for at least 12 months
  5. Obtain written informed consent from a relative / relative / support person. In the absence of a close/relative/trusted person, the patient may be included according to the emergency procedure by the investigating doctor.
  6. Affiliated to a social security scheme or beneficiary of such a scheme (AME excluded)

Exclusion Criteria:

  1. Chronic respiratory failure defined by PaCO2> 60 mmHg in ambulatory patients (respiratory parameters at baseline).
  2. Mechanical ventilation at home (non-invasive mechanical ventilation or via a tracheostomy) with the exception of CPAP / BIPAP used only for sleep apnea syndromes
  3. Predictable mechanical ventilation duration <48 hours
  4. Moribund patient or death expected on the day of randomization, or with a SAPS II score> 90
  5. Cerebral deficiency with dilated areactive pupils or irreversible neurological pathology.
  6. Other concomitant severe pathology with an estimated life expectancy of less than 1 year
  7. Treatment with nicotine replacement therapy or varenicline or bupropion ongoing

  8. Contraindication for nicotine patches:

    • Pregnant or breastfeeding women
    • Allergy to nicotine or to one of the excipients of the transdermal patch
    • Generalized skin pathologies
    • Cerebrovascular accident or acute coronary syndrome for less than 3 months
    • Pheochromocytoma
    • Unstable or worsening angor
    • Severe cardiac arrhythmia (Defined by wearing an automatic implantable defibrillator)
    • Known severe heart failure (Defined, for this study, by systolic LV dysfunction with an LV ejection fraction (LVEF) of less than 30%)
    • Severe renal failure (Defined by KDIGO stage 3)
    • Severe hepatic impairment (Defined by a factor V <30%)
    • Arteriopathy obliterating of the lower limbs stage III and IV
    • Uncontrolled hyperthyroidism
    • Gastroduodenal esophagitis or ulcer undergoing treatment or active
  9. Patient under guardianship or curatorship
  10. Patient deprived of liberty by judicial or administrative decision
  11. Patient included in another interventional trial evaluating a health product
Contacts and Locations
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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): NCT04598594


Locations
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Sponsors and Collaborators
Assistance Publique - Hôpitaux de Paris
Investigators
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Principal Investigator: Alain COMBES, MD Assistance Publique - Hôpitaux de Paris
More Information
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Responsible Party: Assistance Publique - Hôpitaux de Paris
ClinicalTrials.gov Identifier: NCT04598594    
Other Study ID Numbers: APHP200537
2020-003723-42 ( EudraCT Number )
First Posted: October 22, 2020    Key Record Dates
Last Update Posted: June 22, 2021
Last Verified: June 2021

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Assistance Publique - Hôpitaux de Paris:
Covid19
SARS-CoV2
Mechanical ventilation
ICU
Nicotine
Additional relevant MeSH terms:
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COVID-19
Severe Acute Respiratory Syndrome
Infections
Respiratory Tract Infections
Pneumonia, Viral
Pneumonia
Virus Diseases
Coronavirus Infections
Coronaviridae Infections
Nidovirales Infections
RNA Virus Infections
Lung Diseases
 Respiratory Tract Diseases
Nicotine
Ganglionic Stimulants
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Nicotinic Agonists
Cholinergic Agonists
Cholinergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action