COVID-19 Pneumonia
Conditions
Brief summary
The novel coronavirus (SARS-CoV-2) is a new strain of coronavirus found in human in 2019, which causes epidemic worldwide. Novel coronavirus disease (COVID-19) causes acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in patients with severe COVID-19. Pulmonary edema is the key detrimental feature of ALI/ARDS. Autopsy of patients died from COVID-19 reported that, pulmonary mucus exudation was more severe and obvious than SARS infection. Pulmonary CT scanning and pathological findings also suggest that pulmonary edema caused by inflammatory exudation is a distinguished feature of COVID-19. Vascular endothelial growth factor (VEGF), also known as vascular permeability factor (VPF), is known as the most potent factor to increase vascular permeability, with the induction effect 50,000 times stronger than histamine. Bevacizumab is an anti-VEGF recombinant humanized monoclonal antibody, which has been used in anti-tumor treatment since 2004, with considerable reliability and clinical safety. This trial will provide high level evidence to answer whether bevacizumab is efficacy and safe medication for patients with severe COVID-19.
Detailed description
Evident increase of VEGF levels in serum has been displayed on novel pneumonia patients. The investigators also conducted a pilot study of 93 patients with severe COVID-19 that confirmed the significantly elevated level of plasma and serum VEGF. At the beginning of 2020, the investigators proposed the concept of using anti-VEGF treatment for patients with severe COVID-19 and conducted a pilot study (NCT04275414). Among the 27 enrolled participants treated with bevacizumab, it was found that the clinical recovery status, PaO2/FiO2, and pulmonary exudation on imaging were significantly improved than the external controls in the same center during the same period. This provides good preliminary basis for this RCT.
Interventions
DRUGBevacizumab
Bevacizumab (7.5mg/kg BW) + Saline (100ml) Bevacizumab will be administered in a single dose with no less than 90 minutes of intravenous infusion under ECG monitoring.
OTHERPlacebo
Placebo (7.5mg/kg BW) + Saline (100ml) The placebo drug will be administered in a single dose with no less than 90 minutes of intravenous infusion under ECG monitoring.
OTHERStandard care
Standard care, including prophylactic doses of low molecular weight heparin or unfractionated heparin without contraindications, and therapeutic doses of anticoagulants with the evidence of thrombosis risk or occurrence.
Sponsors
China-Japan Friendship Hospital
Renmin Hospital of Wuhan University
Second Affiliated Hospital of Xi'an Jiaotong University
Zhejing Provincial People's Hospital
First Affiliated Hospital of Wenzhou Medical University
Anqing Municipal Hospital
First Affiliated Hospital of Wannan Medical College
The Fourth Affiliated Hospital Zhejing University School of Medicine
Shandong Provincial Hospital
Linyi People's Hospital
Jining Medical University
Jining First People's Hospital
Weifang Second People's Hospital
Weifang Medical University
Yantai Yuhuangding Hospital
Weihai Municipal Hospital
Rizhao People's Hospital
Qingdao Municipal Hospital
Qilu Hospital of Shandong University (Qingdao)
Weifang People's Hospital
Weifang Hospital of Traditional Chinese Medicine
Zibo Central Hospital
Zibo Municipal Hospital
Qilu Hospital of Shandong University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age: ≥18 years old, both genders; 2. Confirmed COVID-19 diagnosis (any body fluid tested positive for SARS-CoV-2 nucleic acid by PCR, or positive for SARS-CoV-2 antigen); 3. Respiratory rate ≥ 30 times/min, partial pressure of oxygen (PaO2)/ fraction of inspiration O2 (FiO2)≤ 300mmHg (1mmHg = 0.133kPa), or SpO2 ≤ 93% at rest without supplemental oxygen; 4. Article (3) above is newly appeared within 7 days; 5. Chest radiography or computed tomography shows bilateral chest infiltrates.
Exclusion criteria
1. Unable to obtain informed consent. 2. Physician with more than 5 years of clinical experience determines that death was inevitable within 24 hours. 3. Severe hepatic dysfunction (Child Pugh score ≥ C, or AST\> 5 times the upper limit); Severe renal dysfunction (estimated glomerular filtration rate ≤ 30mL/ min/1.73 m2) or receive continuous renal replacement therapy, hemodialysis, or peritoneal dialysis. 4. Uncontrolled hypertension (sitting systolic blood pressure\> 160mmHg, or diastolic blood pressure\>100mmHg); previous history of hypertension crisis or hypertensive encephalopathy. 5. Poorly controlled heart diseases, such as NYHA class II and above cardiac insufficiency, unstable angina pectoris, myocardial infarction within 1 year before enrollment, supraventricular or ventricular arrhythmia need treatment or intervention. 6. Severe or above chronic obstructive pulmonary disease (GOLD grade, FEV1/FVC \< 0.5). 7. Hereditary bleeding tendency or coagulopathy; 8. Arterial/venous thromboembolic events within 6 months before enrollment, such as ischemic stroke, transient ischemic attack, deep venous thrombosis, pulmonary embolism, etc. Severe vascular disease (including aneurysms or arterial thrombosis requiring surgery) within 6 months before enrollment. 9. Unhealed wounds, active gastric ulcers or fractures. Gastrointestinal perforation, gastrointestinal fistula, abdominal abscess, visceral fistula formation within 6 months before enrollment. Major surgery (including preoperative Chest biopsy) or major trauma (such as a fracture) within 28 days before enrollment. May have surgery during the trial. 10. Severe, active bleeding such as hemoptysis, gastrointestinal bleeding, central nervous system bleeding, and nosebleeds within 1 month before enrollment. 11. Malignant tumors within 5 years before enrollment. 12. Allergic to bevacizumab or its components. 13. Active tuberculosis, uncontrollable infection, untreated active hepatitis or HIV-positive patients. 14. Pregnant and lactating women and those planning to get pregnant. 15. Participated in other clinical trials, not considered suitable for this study by the researchers.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The time from randomization to clinical improvement | 28 days | The time from randomization to an improvement of two points (from the status at randomization) on a seven-category ordinal scale or live discharge from the hospital, whichever comes first. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of mechanical ventilation (days) | From date of randomization until the date of discharge, up to 28 days | Days of mechanical ventilation |
| Duration of non-invasive ventilator or nasal high flow oxygen inhalation | From date of randomization until the date of discharge, up to 28 days | Days of non-invasive ventilator or nasal high flow oxygen inhalation |
| All-cause mortality | From date of randomization until the date of discharge, up to 60 days | All-cause mortality |
| Time to reach level 1 on the seven-category ordinal scale | up to 60 days | Days from randomization to the clinical status of reaching level 1 on the seven--category ordinal scale |
| PaO2/FiO2 level | day 1, day 3, day 7 and day 14 after randomization, or before discharge | The ratio of partial pressure of oxygen to fraction of inspiration O2 |
| Intubation rate | From date of randomization until the date of discharge, up to 28 days | Intubation rate |
| Improvement of lymphocyte count | day 7 and day 14 after randomization, or before discharge | The change of the level of lymphocyte count compared to baseline |
| Improvement of CRP | day 7 and day 14 after randomization, or before discharge | The change of the level of C-reactive protein compared to baseline |
| Improvement of LDH | day 7 and day 14 after randomization, or before discharge | The change of the level of lactate dehydrogenase compared to baseline |
| SAE, AE | From date of randomization until the date of discharge, up to 28 days | Serious adverse event, adverse event |
| Improvement of pulmonary lesions | day 7 and day 14 after randomization, or before discharge | The change of volumes of pulmonary exudation shown on CT compared to baseline |
Countries
China
Contacts
Primary ContactJiaojiao Pang, Dr
Outcome results
None listed