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The Study of the Use of Nintedanib in Slowing Lung Disease in Patients With Fibrotic or Non-Fibrotic Interstitial Lung Disease Related to COVID-19 (ENDCOV-I)

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: NCT04619680
Recruitment Status : Recruiting
First Posted : November 6, 2020
Last Update Posted : April 14, 2022
Sponsor:
Collaborator:
Boehringer Ingelheim
Information provided by (Responsible Party):
Maria L Padilla, Icahn School of Medicine at Mount Sinai

Brief Summary:
This is a collaborative study between Icahn School of Medicine at Mount Sinai, Boehringer Ingelheim Pharmaceuticals and up to 9 other clinical centers across the US to determine the effect of Nintedanib on slowing the rate of lung disease in patients who have been diagnosed with COVID-19, and have ongoing lung injury more than 30 days out from their diagnosis.

Condition or disease Intervention/treatment Phase
Pulmonary Fibrosis Interstitial Lung Disease Respiratory Disease Drug: Nintedanib Drug: Placebo Phase 4

Detailed Description:

The purpose of this study is to determine the efficacy of the study drug, Nintedanib, on slowing the rate of lung disease in patients who are noted to have infiltrates, or ongoing lung injury, on chest x-ray/CT 30 days or longer from their initial symptoms. In addition, the study will also investigate patient reported outcomes using questionnaires, and the safety and tolerability of the study drug. Blood specimens will be collected to assess biomarkers and monitor drug safety.

The trial will be randomized 1:1 between Nintedanib and placebo.

Nintedanib has been approved by the FDA for the treatment of chronic fibrosing ILD with a progressive phenotype, but has not been studies in patients with post COVID 19 lung disease.

Subjects participating in this study will:

  • Attend in person visits to the study doctor's office on the date of enrollment, 15 days after enrollment, 45 days after enrollment, 90 days after enrollment, 135 days after enrollment, and 180 days after enrollment. If the participant is being enrolled in the study while hospitalized at Mount Sinai, the study doctor will travel to the hospital room.
  • Undergo a HRCT (High-resolution computed tomography) scan of the chest within 14 days of enrollment, and then again at 180 days after enrollment.
  • Have Pulmonary Function Tests within 14 days of enrollment, and then again 45, 90, 135 and 180 days after enrollment.
  • Have a six-minute walk test at baseline, day 90 and day 180 after enrollment.
  • Have blood drawn routinely while participating in this study (15 days after starting medication, then again on day 45, 90, 135 and 180).
  • Participants will not pay for physician visits, blood draws, breathing tests, CT scans or the medication for this study. Participants will receive a stipend to cover the transportation costs for your visits.

The main risks to participants are:

  1. Common side effects include: nausea, vomiting, diarrhea, stomach discomfort
  2. Loss of appetite and weight loss
  3. Liver function abnormalities (blood work will be monitored periodic intervals at scheduled blood draws as listed above)
  4. Slightly higher risk of bleeding
  5. Slightly higher risk of blood clots that can form in the blood vessels that supply oxygen to vital organs such as the brain and heart

Benefits from participation in this research include the possibility that Nintedanib may slow down/prevent progression of lung fibrosis. If the lungs can heal without fibrosis, this may result in fewer symptoms of shortness of breath, cough and need for added oxygen.

Instead of participating in this research, subjects may choose to monitor their lung condition with their doctor or participate in another research study.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 170 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Masking Description:
  • Patients will be assigned to Nintedanib or placebo by random chance in a 1:1 allocation. There is 50% chance to receive the study drug and a 50% chance to receive the placebo.
  • Randomization will be stratified by subgroup (fibrotic and non-fibrotic) to ensure treatment balance. I.e., within the fibrotic subgroup, the randomization will ensure 50% are assigned to the Nintedanib arm and 50% are assigned to the placebo arm. Similarly, treatment balance within the non-fibrotic subgroup will be ensured.
  • The study will be double blinded. No one (including the patient or the study team) will know who is receiving the study drug or the placebo. If it becomes urgently necessary for a patient's care, the study doctor will be able to find out whether the patient is taking the placebo or the study drug, Nintedanib.
  • Patients will be told whether they received the study drug, Nintedanib, or the placebo once the study is finished.
Primary Purpose: Treatment
Official Title: Early Nintedanib Deployment in COVID-19 Interstitial Lung Disease
Actual Study Start Date : November 18, 2020
Estimated Primary Completion Date : April 2024
Estimated Study Completion Date : April 2024


Arm Intervention/treatment
Experimental: Nintedanib
150 mg po twice a day
Drug: Nintedanib
150 mg PO twice a day, taken with food

Placebo Comparator: Placebo
placebo equivalent po twice a day
Drug: Placebo
placebo equivalent given twice a day




Primary Outcome Measures :
  1. Change in Forced Vital Capacity (FVC) [ Time Frame: Baseline and 180 days ]
    Change in Forced Vital Capacity (FVC) at 180 days as compared to baseline. Forced vital capacity (FVC) is the amount of air that can be forcibly exhaled from your lungs after taking the deepest breath possible, as measured by spirometry.


Secondary Outcome Measures :
  1. Number of deaths due to respiratory cause [ Time Frame: within 90-180 days ]
    Death within 90 days and 180 days from enrollment due to a respiratory cause

  2. Chest CT visual score [ Time Frame: 180 days ]
    Quantitative Change in chest CT visual score graded by blinded chest radiologists. Data driven texture analysis (DTA) is a patented deep learning method to quantify lung fibrosis. DTA score is reported in percentage ranging from 0% to 100%. A minimally clinical important difference when comparing CT scans from the same subject is 4%. A higher percentage suggests worsening lung injury.

  3. St. George's Respiratory Questionnaire (SGRQ) [ Time Frame: Day 90 ]
    The Saint George's Respiratory Questionnaire (SGRQ) is a self-reported disease-specific, health-related quality of life (QOL) questionnaire. 50-item instrument. Scores range from 0 to 100, with higher scores indicating more limitations.

  4. St. George's Respiratory Questionnaire (SGRQ) [ Time Frame: Day 180 ]
    The Saint George's Respiratory Questionnaire (SGRQ) is a self-reported disease-specific, health-related quality of life (QOL) questionnaire. 50-item instrument. Scores range from 0 to 100, with higher scores indicating more limitations.

  5. King's Brief Interstitial Lung Disease (KBILD) [ Time Frame: Day 90 ]
    The King's Brief Interstitial Lung Disease (KBILD) questionnaire is a self-administered, ILD-specific measure of health-related quality of life, comprising 15 items with three domains (Psychological (KBILD-P), Breathlessness and activities (KBILD-B), and Chest symptoms (KBILD-C)) combined in a total score (KBILD-T). The KBILD domain and total score ranges are 0-100; 100 represents best health status.

  6. King's Brief ILD (KBILD) [ Time Frame: Day 180 ]
    The King's Brief Interstitial Lung Disease (KBILD) questionnaire is a self-administered, ILD-specific measure of health-related quality of life, comprising 15 items with three domains (Psychological (KBILD-P), Breathlessness and activities (KBILD-B), and Chest symptoms (KBILD-C)) combined in a total score (KBILD-T). The KBILD domain and total score ranges are 0-100; 100 represents best health status.

  7. Leicester Cough Questionnaire (LCQ) [ Time Frame: Day 90 ]
    The LCQ is a 19 item questionnaire that assesses cough-related QOL. It has 3 domains (physical, psychological and social). The domain scores range from 1-7 and total score range is 3-21 with a higher score indicating a better quality of life.

  8. Leicester Cough Questionnaire [ Time Frame: Day 180 ]
    The LCQ is a 19 item questionnaire that assesses cough-related QOL. It has 3 domains (physical, psychological and social). The domain scores range from 1-7 and total score range is 3-21 with a higher score indicating a better quality of life.

  9. Short Form (SF) 36 Health Survey [ Time Frame: Day 90 ]
    The (36) Health Survey is a 36-item, patient-reported survey of patient health. The SF-36 is a measure of health status. Scores range from 0 - 100, with higher scores indicating less disability.

  10. SF 36 Health Survey [ Time Frame: Day 180 ]
    The (36) Health Survey is a 36-item, patient-reported survey of patient health. The SF-36 is a measure of health status. Scores range from 0 - 100, with higher scores indicating less disability.

  11. Hospital Anxiety and Depression Scale (HADS) [ Time Frame: Day 90 ]

    Questionnaire with 7 items for anxiety and 7 items for depression, each item is scored on a 4 point response 0 - 3, with full range from 0 to 42, with higher score indicating more severe anxiety or depression.

    14-items scale with responses scored from 0-3, scores for each subscale from 0 (normal) to 21 (severe symptoms). Scores for the entire scale is 0 to 42, with higher score indicating more distress.


  12. Hospital Anxiety and Depression Scale (HADS) [ Time Frame: Day 180 ]

    Questionnaire with 7 items for anxiety and 7 items for depression, each item is scored on a 4 point response 0 - 3, with full range from 0 to 42, with higher score indicating more severe anxiety or depression.

    14-items scale with responses scored from 0-3, scores for each subscale from 0 (normal) to 21 (severe symptoms). Scores for the entire scale is 0 to 42, with higher score indicating more distress.


  13. Number of participants with Increase in liver transaminases (AST and ALT) > 3 times the upper limit of normal [ Time Frame: day 90 ]
    Number of participants with Increase in liver transaminases

  14. Number of participants with Increase in liver transaminases (AST and ALT) > 3 times the upper limit of normal [ Time Frame: day 180 ]
    Number of participants with Increase in liver transaminases

  15. Number of participants with Thrombotic events [ Time Frame: day 90 ]
    Number of participants with Thrombotic events: venous or arterial thrombosis

  16. Number of participants with Thrombotic events [ Time Frame: day 180 ]
    Number of participants with Thrombotic events: venous or arterial thrombosis

  17. Number of participants with 10% weight loss over 90 days [ Time Frame: day 90 ]
    Number of participants with 10% weight loss

  18. Number of participants with 10% weight loss over 90 days [ Time Frame: day 180 ]
    Number of participants with 10% weight loss

  19. Number of participants with GI events [ Time Frame: day 90 ]
    Number of participants with Nausea/emesis/diarrhea not responsive to anti-emetics and anti-motility agents

  20. Number of participants with GI events [ Time Frame: day 180 ]
    Number of participants with Nausea/emesis/diarrhea not responsive to anti-emetics and anti-motility agents

  21. Change in 6 minute walk test [ Time Frame: Baseline and day 180 ]
    The distance covered over a time of 6 minutes at day 180 as compared to baseline.

  22. Functional Assessment of Chronic Illness Therapy- Fatigue (FACIT-F) [ Time Frame: Day 90 ]
    The FACIT-F is a 40-item measure that assesses self-reported fatigue and its impact upon daily activities and function. Questions are scored on a 5-point Likert scale. The total score range is from 0-52, with higher score indicating lower fatigue level.

  23. Functional Assessment of Chronic Illness Therapy- Fatigue (FACIT-F) [ Time Frame: Day 180 ]
    The FACIT-F is a 40-item measure that assesses self-reported fatigue and its impact upon daily activities and function. Questions are scored on a 5-point Likert scale. The total score range is from 0-52, with higher score indicating lower fatigue level.

  24. Change in Forced Vital Capacity (FVC) [ Time Frame: Baseline and Day 90 ]
    Change in Forced Vital Capacity (FVC) at 90 days as compared to baseline. Forced vital capacity (FVC) is the amount of air that can be forcibly exhaled from your lungs after taking the deepest breath possible, as measured by spirometry.

  25. Change in Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO) [ Time Frame: Baseline and Day 180 ]
    Change in Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO) at 180 days as compared to baseline. Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO) measures the transfer of carbon monoxide from alveolar gas to hemoglobin in pulmonary capillary blood. DLCO is measured by having the patient fully inhale a low concentration of carbon monoxide and an inert tracer gas.

  26. Number of deaths due to any cause [ Time Frame: within 90-180 days ]
    Number of deaths within 90 days and 180 days from enrollment due to a any cause



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:

  • Willing and able to provide written informed consent
  • Subjects Age ≥ 18
  • Initial SARS-CoV-2 infection confirmed by PCR test or positive serologies
  • Have findings consistent with interstitial lung disease found on CT scan (these may include ground glass opacities, reticulations, traction bronchiectasis, septal thickening, and early honeycombing)
  • Required one of the following after diagnosis with SARS-CoV-2: supplemental oxygen by nasal cannula, high flow oxygen, non invasive ventilation such as CPAP or BIPAP, or mechanical ventilation
  • Are at least 30 days from onset of initial SARS-CoV-2 symptoms
  • Forced Vital Capacity less than or equal to 90% predicted based on ATS/ERS criteria or DLCO less than or equal to 70%
  • Women of childbearing potential who agree to use of highly effective contraception during treatment and for three months following the last dose of nintedanib

Exclusion Criteria:

Candidates will be excluded from study entry if any of the following exclusion criteria exist at the time of the Screening Visit (prior to randomization):

  • Co-administration of other investigational agents against COVID-19
  • Active SARS-CoV-2 infection based on clinical judgment
  • Currently Pregnant or Breast Feeding
  • Current Use of Prednisone or equivalent > 10 mg/daily
  • Use of full dose anticoagulation therapy or high dose anti platelet drug therapy at screening (at the discretion of the investigator, anticoagulation therapy may be added if clinically indicated)
  • History of myocardial infarction within past 90 days
  • Life threatening bleed
  • Hemodynamic instability or shock
  • Superimposed pulmonary bacterial infection
  • Pre-existing interstitial lung disease
  • Active Hep A/B/C hepatitis as measured with PCR for viral load and/or serologies
  • Pre-existing liver disease: Including Abnormal Laboratory Liver Function: Childs Pugh B/C, AST/ALT > 3 times the upper limit of normal (ULN). If Child Pugh A, can participate on Nintedanib 100 mg by mouth twice daily.
  • Subjects with a Creatinine clearance <30 ml/min or currently on hemodialysis
  • Inability to tolerate orally administered medication (medication must be taken with meals)
  • Patients who are in the intensive care unit (ICU) or in the step-down unit on invasive or non-invasive mechanical ventilation, ECMO, or high flow nasal cannula oxygen, will not be included.
  • Any condition that in the opinion of the Investigator, constitute a risk or a contraindication for the participation of the patient into the study or that could interfere with the study objectives, conduct or evaluation.
  • Patients with known hypersensitivity to nintedanib, peanut, soy, or to any of the excipients.

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): NCT04619680


Contacts
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Contact: ENDCOVI Study Team 646-992-7222 endcovi@mssm.edu

Locations
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United States, Arizona
Banner Health Medical University - Phoenix Recruiting
Phoenix, Arizona, United States, 85006
Contact: Stephanie Iusim, MD       stephanie.iusim@bannerhealth.com   
United States, Georgia
Emory Healthcare Network Recruiting
Atlanta, Georgia, United States, 30322
Contact: Avanthika (Thanushi) Wynn       a.t.wynn@emory.edu   
United States, Maryland
The Johns Hopkins Hospital Recruiting
Baltimore, Maryland, United States, 21287
Contact: Karthik Suresh, MD       ksuresh2@jhmi.edu   
United States, New York
Mount Sinai Beth Israel Recruiting
New York, New York, United States, 10003
Contact: Maria Padilla, MD       Maria.Padilla@mssm.edu   
Contact: Jigna Zatakia       Jigna.Zatakia@mountsinai.org   
Icahn School of Medicine at Mount Sinai Recruiting
New York, New York, United States, 10029
Contact: Maria Padilla, MD       Maria.Padilla@mssm.edu   
United States, Texas
Baylor University Medical Center Dallas Recruiting
Dallas, Texas, United States, 75246
Contact: Susan Mathai, MD       susan.mathai@bswhealth.org   
Baylor College of Medicine Recruiting
Houston, Texas, United States, 77030
Contact: Ivan Rosas, MD       ivan.rosas@bcm.edu   
United States, Utah
University of Utah Recruiting
Salt Lake City, Utah, United States, 84108
Contact: Sean Callahan, MD       Sean.Callahan@hsc.utah.edu   
Sponsors and Collaborators
Icahn School of Medicine at Mount Sinai
Boehringer Ingelheim
Investigators
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Principal Investigator: Maria Padilla, MD Icahn School of Medicine at Mount Sinai
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Responsible Party: Maria L Padilla, Professor, Icahn School of Medicine at Mount Sinai
ClinicalTrials.gov Identifier: NCT04619680    
Other Study ID Numbers: GCO 20-2147
First Posted: November 6, 2020    Key Record Dates
Last Update Posted: April 14, 2022
Last Verified: April 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: All of the individual participant data collected during the trial, after deidentification.
Supporting Materials: Clinical Study Report (CSR)
Time Frame: Beginning 3 months and ending 5 years following article publication.
Access Criteria: Investigators whose proposed use of the data has been approved by an independent review committee ("learned intermediary") identified for this purpose. Proposals should be directed to Maria.Padilla@mssm.edu. To gain access, data requestors will need to sign a data access agreement. Data are available for 5 years at a third party website

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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 Maria L Padilla, Icahn School of Medicine at Mount Sinai:
COVID-19
Infiltrates
SARS CoV-2
lung
scarring
fibrosis
Additional relevant MeSH terms:
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COVID-19
Lung Diseases
Pulmonary Fibrosis
Lung Diseases, Interstitial
Respiration Disorders
Respiratory Tract Diseases
Fibrosis
Respiratory Tract Infections
Infections
Pneumonia, Viral
Pneumonia
Virus Diseases
Coronavirus Infections
Coronaviridae Infections
Nidovirales Infections
RNA Virus Infections
Pathologic Processes
Nintedanib
Antineoplastic Agents
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action