CD2H COVID-19

Intravenous Aviptadil for Critical COVID-19 With Respiratory Failure

Purpose

Novel Corona Virus (SARS-CoV-2) is known to cause Respiratory Failure, which is the hallmark of Acute COVID-19, as defined by the new NIH/FDA classification. Approximately 50% of those who develop Critical COVID-19 die, despite intensive care and mechanical ventilation. Patients with Critical COVID-19 and respiratory failure, currently treated with high flow nasal oxygen, non-invasive ventilation or mechanical ventilation will be treated with ZYESAMI (aviptadil), a synthetic form of Human Vasoactive Intestinal Polypeptide (VIP) plus maximal intensive care vs. placebo + maximal intensive care. Patients will be randomized to intravenous Aviptadil will receive escalating doses from 50 -150 pmol/kg/hr over 12 hours.

Conditions

Critical COVID-19 With Respiratory Failure
Acute Respiratory Distress Syndrome (ARDS)
Corona Virus Infection
Acute Lung Injury

Eligibility

Eligible Ages: Between 18 Years and 100 Years
Eligible Genders: All
Accepts Healthy Volunteers: No

Inclusion Criteria

Critical COVID-19 with respiratory failure - Physician determination that patient is on maximal conventional medical therapy

Exclusion Criteria

Pregnancy (pregnant women may apply for open label treatment under compassionate care IND 2. Age <18 years 3. Mechanical ventilation for more than 7 days in primary cohort. Mechanical ventilation>21 days in the exploratory cohort 4. Mean Arterial Pressure < 65 mm Hg with use of pressor per ICU protocol 5. Irreversible condition (other than COVID-19) with projected fatal course 6. ECMO 7. Current or recent (within 30 d) enrollment in another investigational trial of anti-IL6 drug; 8. Active diagnosis of Acquired immune deficiency syndrome; 9. Transplant patients currently immunosuppressed; 10. Chemotherapy-induced neutropenia (granulocyte count <1000/mm3); 11. Cardiogenic shock; congestive heart failure - NYHA Class 3 or 4; 12. Recent myocardial infarction - within last 6 months and troponin > 0.5 13. Anuria (urine output < 50 ml/d) or other signs of multi-organ failure 14. Severe liver disease with portal hypertension; 15. Recent stroke or head trauma within last 12 months 16. Increased intracranial pressure, or other serious neurologic disorder; 17. Liquid Diarrhea more than 3x/day; defined as more than 3 non-bloody watery stools within a 24-hour period, requiring additional fluid and electrolyte supplementation

Study Design

Phase: Phase 2/Phase 3
Study Type: Interventional
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Multicenter trial, initially conducted at a single center with a safety/futility assessment following enrollment of 30 patients, expanded to 196 total patients at 12 study sites
Primary Purpose: Treatment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking Description: Randomized, placebo-controlled trial with identical drug and placebo infusion bags

Arm Groups

Arm	Description	Assigned Intervention
Experimental Aviptadil IV in escalating doses + standard of care	Patients will be administered Aviptadil IV in escalating doses of 50 pmol, 100 pmol, 150 pmol/kg/hr	Drug: Aviptadil by intravenous infusion + standard of care Aviptadil by intravenous infusion + standard of care (SOC). SOC is defined not to include extracorporeal mechanical oxygenation. Those requiring ECMO will be withdrawn from the study as treatment failures. Other names: ZYESAMI (aviptadil) +SOC
Experimental Placebo + standard of care	Patients will first be treated with placebo infusion + maximal intensive care	Drug: Normal Saline Infusion + standard of care Saline by intravenous infusion + standard of care (SOC). SOC is defined not to include extracorporeal mechanical oxygenation. Those requiring ECMO will be withdrawn from the study as treatment failures. Other names: Placebo+SOC

Recruiting Locations

More Details

NCT ID: NCT04311697
Status: Completed
Sponsor: APR Applied Pharma Research s.a.

Detailed Description

Acute Lung Injury, which triggers Critical COVID-19 is a known lethal complication of Corona Virus (SARS-CoV-2) infection. Conventional medical therapy, including intensive care and respiratory support is associated with an 80% mortality. Aviptadil, a synthetic form of Human Vasoactive Intestinal Polypeptide (VIP) has been awarded FDA Orphan Drug Designation for the treatment of ARDS and admitted to the FDA CoronaVirus Technology Accelerator Program. VIP binds to VPAC1 receptors on the pulmonary Alveolar Type II (ATII) cell. ATII cells comprise only 5% of lung epithelial cells but are critical for oxygen transfer, surfactant production, and maintenance of Alveolar Type 1 cells. 70% of VIP binds to this receptor. The Type II cell is also the cell selectively attacked by the SARS-CoV-2 virus via the ACE2 surface receptor. Nonclinical studies demonstrate that VIP is highly concentrated in the lung and specifically bound to the ATII cell, where it prevents NMDA-induced caspase-3 activation in the lung, inhibits IL6 and TNFa production, protects against HCl-induced pulmonary edema, and upregulates surfactant production, These and other effects have been observed in numerous animal model systems of lung injury in mice, rats, guinea pigs, sheep, swine, and dogs. In these models, Aviptadil restores barrier function at the endothelial/alveolar interface and thereby protects the lung and other organs from failure. Aviptadil ihas a demonstrated 20 year history of safety in phase 2 trials for Sarcoid, Pulmonary Fibrosis, Bronchospasm, and a phase I trial in ARDS. In that phase I trial, 8 patients with severe ARDS on mechanical ventilation were treated with ascending doses of VIP. Seven of the 8 patients were successfully extubated and were alive at the five day timepoint. Six left the hospital and one died of an unrelated cardiac event. Five phase 2 trials of aviptadil have been conducted under European regulatory authority. Numerous healthy volunteer studies have shown that i.v. infusion of Aviptadil is well tolerated with few adverse effects including alterations in blood pressure, heart rate, or ECG. In addition to published studies of human use, Aviptadil has been used on a compounded basis in certain ICUs for many years in the belief that it preserves life and restores function in pulmonary hypertension, ARDS, and Acute Lung Injury (ALI). In this study, patients who are hospitalized for Critical COVID-19 infection with respiratory failure will be randomly allocated to Aviptadil administered by intravenous infusion in addition to maximal intensive care vs. maximal intensive care alone. Primary endpoints will be improvement in blood oxygenation and mortality.

Notice

Study information shown on this site is derived from ClinicalTrials.gov (a public registry operated by the National Institutes of Health). The listing of studies provided is not certain to be all studies for which you might be eligible. Furthermore, study eligibility requirements can be difficult to understand and may change over time, so it is wise to speak with your medical care provider and individual research study teams when making decisions related to participation.