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Thymosin Alpha 1 to Prevent COVID-19 Infection in Renal Dialysis Patients

A Pilot Trial of Thymalfasin (Ta1) to Prevent COVID-19 Infection in Renal Dialysis Patients

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT04428008
Acronym
Ta1
Enrollment
189
Registered
2020-06-11
Start date
2021-01-12
Completion date
2023-01-19
Last updated
2026-04-21

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

COVID-19

Keywords

COVID-19, Thymalfasin, Thymosin alpha 1, ZADAXIN, Hemodialysis

Brief summary

Thymalfasin (thymosin alpha 1 or Ta1), the active pharmaceutical ingredient in ZADAXIN® injection, is a 28-amino acid synthetic peptide, identical to natural Ta1 produced by the thymus gland. Ta1 is a biological response modifier which activates various cells of the immune system, and is therefore expected to have clinical benefits in disorders where immune responses are impaired or ineffective, including acute and chronic viral and bacterial infections, cancers, and vaccine non-responsiveness. Patients with end-stage renal disease (ESRD) on hemodialysis, in addition to their intrinsic kidney disease and frequent burden of comorbidities, also have increased risk of exposure to communicable diseases as they are treated several times each week at hemodialysis centers with several other patients and clinic staff in attendance. The majority of patients are over 60 years of age and many are receiving immunosuppressive medications. Accordingly, ESRD patients are particularly susceptible to COVID-19 infection. Ta1 has been shown to be safely administered to hemodialysis patients. It is our hypothesis that a course of Ta1 administered to individuals with ESRD will reduce the rate and severity of infection with COVID-19.

Detailed description

Patients with end-stage renal disease (ESRD) on hemodialysis, in addition to their intrinsic kidney disease and frequent burden of comorbidities, also have increased risk of exposure to communicable diseases as they are treated several times each week at hemodialysis centers with several other patients and clinic staff in attendance. The majority of patients are over 60 years of age and many are receiving immunosuppressive medications. Accordingly, ESRD patients are particularly susceptible to COVID-19 infection. Thymalfasin (thymosin alpha 1, Ta1) is a naturally occurring peptide that has been evaluated for its immunomodulatory activities and related therapeutic potential in several conditions and diseases, including infectious disease and cancer. ZADAXIN, a synthetic form of Ta1, been has been used clinically in pilot studies for treatment of severe acute respiratory syndrome (SARS) and other lung infections including acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disorder (COPD), as well as infections after bone marrow transplant\]. Larger clinical trials have shown significant efficacy for treatment of severe sepsis and hepatitis B, along with certain cancers such as melanoma, hepatocellular, and lung cancer. Ta1 has also demonstrated improvement in response to vaccines in the elderly and in patients immunocompromised by renal disease. The beneficial clinical effects of Ta1 result from activation of toll-like receptor (TLR) 9 in dendritic and other immune system cells, resulting in augmentation of T helper (Th1) function, natural killer (NK) cell activity, and increased antibody responses to T-cell dependent antigens. Importantly, Ta1 also leads to an increase in IL-10 producing regulatory T cells, which create feedback inhibition of cytokine production, hence dampening immune response and preventing a pro-inflammatory cytokine storm. It is our hypothesis that a course of Ta1 administered to individuals at high risk for COVID-19 infection (hemodialysis patients) will reduce the rate of COVID-19 infection and severity of infection with COVID-19, compared to untreated individuals in the same hemodialysis units with comparable risk. The study will also evaluate the need for hospitalization in those patients who do not become infected with COVID-19.

Interventions

Synthetic 28 amino acid peptide

Sponsors

William B. Ershler, MD
Lead SponsorOTHER
Davita Clinical Research
CollaboratorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE

Intervention model description

Subjects will be centrally randomized to receive either study treatment drug (Ta1) or no Ta1. Randomization will be stratified by site.

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Age 18 or greater * Signed informed consent * End-stage renal disease (ESRD) who receive hemodialysis 2 or more times each week and are expected to continue on dialysis indefinitely.

Exclusion criteria

* Patients on short-term hemodialysis, such as those with transient renal dysfunction associated with acute illness who are projected to have return in renal function * Patients for whom renal transplantation is anticipated within the next six months * Patients with an anticipated survival of less than 3 months * Patients with symptoms that might be attributable to COVID-19 infection * Patients who test positive for SARS-CoV2 * Patients with active infectious disease requiring antibiotics * Patients with hospitalization within the previous 3 months for acute myocardial infarction or congestive heart failure * Patients with advanced malignancy receiving cytotoxic chemotherapy * Patients with a Karnofsky Performance Scale score of less than 60 * Patients with prior history of solid organ (kidney, liver, heart, lung, pancreas) or bone marrow transplant * Patients with active autoimmune disease on immunosuppressive medication * Patients receiving Plaquenil * Participation in an investigational drug or device trial in previous 30 days * History of allergy or intolerance to Ta1 * Any other medical or psychiatric condition that, in the opinion of the Investigator, would compromise patient safety or interfere with the objectives of the protocol or completion of the protocol treatment

Design outcomes

Primary

MeasureTime frameDescription
Number of Participants With COVID-19 Infection6 monthsNumber of subjects who become infected with COVID-19 over the course of the study

Secondary

MeasureTime frameDescription
Hospitalization6 monthsNumber of participants who were hospitalized
Non-COVID-19 Infections6 monthsNumber of participants with non-COVID-19 infections
Mortality6 monthsNumber of subjects who died

Countries

United States

Participant flow

Recruitment details

There were 189 eligible participants available for study during the recruitment period.

Baseline characteristics

Characteristic
Age, Continuous60 Years
STANDARD_DEVIATION 11.9
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
Race (NIH/OMB)
Asian
1 Participants
Race (NIH/OMB)
Black or African American
70 Participants
Race (NIH/OMB)
More than one race
0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
1 Participants
Race (NIH/OMB)
Unknown or Not Reported
3 Participants
Race (NIH/OMB)
White
39 Participants
Sex: Female, Male
Female
39 Participants
Sex: Female, Male
Male
60 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
3 / 917 / 98
other
Total, other adverse events
0 / 910 / 98
serious
Total, serious adverse events
28 / 9126 / 98

Outcome results

None listed

Source: ClinicalTrials.gov · Data processed: Apr 22, 2026