Pneumonia, Viral
Conditions
Keywords
COVID-19, Acute respiratory distress syndrome, Pneumonia
Brief summary
The goal of this study is to evaluate the effects of Ibudilast (MN-166) versus placebo in hospitalized patients infected with COVID-19 at risk for developing acute respiratory distress syndrome (ARDS) receiving standard of care (including anticoagulation therapy) by measuring the following outcomes: 1) the need for oxygen therapy at Days 7, 14, and 28, 2) clinical status as measured by the National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale at Days 7, 14, and 28, and 3) safety (as measured by incidence of adverse events and clinical laboratory findings) and tolerability of Ibudilast.
Detailed description
This is a randomized (1:1) double-blind, placebo-controlled, parallel-group study evaluating the efficacy of Ibudilast to prevent ARDS in hospitalized patients infected with COVID-19 who are at risk for developing ARDS. The study will consist of a Screening Phase, Double-Blind Treatment Phase, and Follow-up Phase. Following the Screening Phase, if the participant meets eligibility criteria, they will be randomly assigned to Ibudilast or matching placebo. Participants will receive Ibudilast 100 mg/d (50 mg twice a day) or placebo every day for 7 days. Upon completion of the 7-day Treatment Phase, subject will be followed-up at Day 14 and at Day 28. Participants discharged prior to Day 7 will be given the remainder of their study medication (Ibudilast or placebo) to be taken at home twice daily until Day 7 and will be given a pulse oximeter to measure their oxygen levels once daily until Day 14. The following screening assessments will be performed upon signing the Informed Consent Form (ICF): inclusion/exclusion criteria review, physical exam, vital signs and oxygen use, clinical status using the NIAID ordinal scale, 12-lead ECG, blood collection for plasma biomarkers. A complete blood count (CBC), comprehensive metabolic panel (CMP), D-dimer and coagulation tests will also be drawn. A serum pregnancy test will be given to pre-menopausal female participants. Concomitant medications taken within the last 7 days prior to study drug administration will be recorded. During the Treatment Phase, hospitalized participants will be treated with Ibudilast or placebo for a 7-day period plus standard of care and anticoagulation therapy. During the Treatment Phase, participants will undergo study-related procedures including physical exam, ECG, oxygen use assessment, biomarkers and pharmacokinetic sample draws, CBC, CMP, D-dimer blood collection, clinical status using the NIAID scale, and information on adverse events and concomitant medications will be recorded. On Study Day 14, conduct physical examination, clinical status, vital signs and oxygen use, ECG, CBC, CMP, D-dimer, and coagulation tests, biomarkers, AE and concomitant medications review. On Day 28, participant's clinical status and survival status will be recorded. If the participant is discharged before Day 7, they will be given the remainder of their study drug to take at home for up to 7 days, and the Sponsor will supply a pulse oximeter to participants to measure their oxygen levels once daily until Day 14.
Interventions
50 mg (5 x 10 mg capsules) twice daily for 7 days
0 mg (5 matching capsules) twice daily for 7 days
Sponsors
Study design
Intervention model description
Randomized, double-blind, placebo-controlled, parallel-group study.
Eligibility
Inclusion criteria
* SARS-CoV-2 infection confirmed with WHO criteria (including a positive PCR of any specimen, e.g., blood, respiratory, stool, urine, or any other body fluid) * Chest imaging (radiograph, computerized tomography (CT) scan or lung ultrasound) with abnormalities consistent with COVID-19 pneumonia * Oxygen saturation (SpO2) ≤92% on room air (RA), respiratory rate ≥24 breaths per min on RA, and/or requirement for supplemental oxygen * At least 1 risk factor which may put patient at higher risk for more severe illness from COVID-19: Age \> 65, underlying serious heart disease, chronic lung disease, moderate to severe asthma, body mass index of ≥40, or diabetes
Exclusion criteria
* Suspected active bacterial, fungal, viral, or other cause of respiratory failure other than COVID-19 * Subject is already intubated and on ventilator support * Known or suspected immunosuppression with immunosuppressant medications or chemotherapeutic agents * Patient is receiving dialysis treatment * On a home ventilator support or continuous domiciliary oxygen therapy for baseline lung disease * Active tuberculosis infection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Free From Respiratory Failure at Day 7 | Day 7 | Participants were considered responders if they did not meet the need for supplemental oxygen requirements (invasive mechanical ventilation, non-invasive ventilation, high-flow oxygen, or ECMO, CPAP, BiPAP, nasal cannula) at the end of the 7-day double-blind treatment. |
| Number of Participants With at Least a 1-point Improvement in Clinical Status on Day 7 | Day 7 | Number (percentage) of participants with at least a 1-point improvement in clinical status on Day 7. Clinical status is measured by the National Institute of Allergy and Infectious Disease (NIAID) 8-Point Ordinal Scale: 1=Not hospitalized, no limitations on activities; 2=Not hospitalized, limitation on activities and/or requiring home oxygen; 3=Hospitalized, not requiring supplemental oxygen - no longer requires ongoing medical care; 4=Hospitalized, not requiring supplemental oxygen - requiring ongoing medical care (COVID-19 related or otherwise) 5=Hospitalized, Hospitalized, requiring supplemental oxygen; 6=Hospitalized, on non-invasive ventilation or high flow oxygen devices; 7=Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO); 8=Death. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Receiving Mechanical Ventilation or Intubation | Days 7, 14, and 28 | Number (percentage) of participants receiving mechanical ventilation or intubation after starting study drug. |
| All-cause Mortality | Day 1 to Day 60 | Number of reported participant deaths |
| Number of Participants Discharged From Hospital at Days 7, 14, and 28 | Days 7, 14, and 28 | Number (percentage) of participants discharged from hospital at Days 7, 14, and 28 |
Countries
United States
Participant flow
Pre-assignment details
* Full Analysis Set (FAS) will include all participants randomly assigned to Ibudilast or placebo. * Safety Analysis Set (SAS) will include all randomized subjects who received at least one dose of study drug and had at least one post-dose safety assessment. * Per Protocol Analysis (PP): will consist of the FAS subjects excluding those with major protocol violations. In this clinical trial, FAS, SAS, and PP analysis sets included all participants.
Participants by arm
| Arm | Count |
|---|---|
| Ibudilast (MN-166) 50 mg (10 mg strength): 5 capsules taken by mouth twice daily for 7 days. | 17 |
| Placebo 0 mg: 5 capsules taken by mouth twice daily for 7 days. | 17 |
| Total | 34 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 0 | 2 |
| Overall Study | Other | 2 | 0 |
Baseline characteristics
| Characteristic | Total | Ibudilast (MN-166) | Placebo |
|---|---|---|---|
| Age, Continuous | 59.88 years STANDARD_DEVIATION 11.63 | 58.71 years STANDARD_DEVIATION 11.32 | 61.06 years STANDARD_DEVIATION 12.16 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 10 Participants | 7 Participants | 3 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 24 Participants | 10 Participants | 14 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 3 Participants | 1 Participants | 2 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 7 Participants | 5 Participants | 2 Participants |
| Race (NIH/OMB) White | 23 Participants | 10 Participants | 13 Participants |
| Region of Enrollment United States | 34 Participants | 17 Participants | 17 Participants |
| Sex: Female, Male Female | 17 Participants | 9 Participants | 8 Participants |
| Sex: Female, Male Male | 17 Participants | 8 Participants | 9 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 17 | 2 / 17 |
| other Total, other adverse events | 13 / 17 | 14 / 27 |
| serious Total, serious adverse events | 5 / 17 | 14 / 17 |
Outcome results
Number of Participants Free From Respiratory Failure at Day 7
Participants were considered responders if they did not meet the need for supplemental oxygen requirements (invasive mechanical ventilation, non-invasive ventilation, high-flow oxygen, or ECMO, CPAP, BiPAP, nasal cannula) at the end of the 7-day double-blind treatment.
Time frame: Day 7
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Ibudilast (MN-166) | Number of Participants Free From Respiratory Failure at Day 7 | 12 Participants |
| Placebo | Number of Participants Free From Respiratory Failure at Day 7 | 6 Participants |
Number of Participants With at Least a 1-point Improvement in Clinical Status on Day 7
Number (percentage) of participants with at least a 1-point improvement in clinical status on Day 7. Clinical status is measured by the National Institute of Allergy and Infectious Disease (NIAID) 8-Point Ordinal Scale: 1=Not hospitalized, no limitations on activities; 2=Not hospitalized, limitation on activities and/or requiring home oxygen; 3=Hospitalized, not requiring supplemental oxygen - no longer requires ongoing medical care; 4=Hospitalized, not requiring supplemental oxygen - requiring ongoing medical care (COVID-19 related or otherwise) 5=Hospitalized, Hospitalized, requiring supplemental oxygen; 6=Hospitalized, on non-invasive ventilation or high flow oxygen devices; 7=Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO); 8=Death.
Time frame: Day 7
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Ibudilast (MN-166) | Number of Participants With at Least a 1-point Improvement in Clinical Status on Day 7 | 12 Participants |
| Placebo | Number of Participants With at Least a 1-point Improvement in Clinical Status on Day 7 | 8 Participants |
All-cause Mortality
Number of reported participant deaths
Time frame: Day 1 to Day 60
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Ibudilast (MN-166) | All-cause Mortality | 0 Participants |
| Placebo | All-cause Mortality | 2 Participants |
Number of Participants Discharged From Hospital at Days 7, 14, and 28
Number (percentage) of participants discharged from hospital at Days 7, 14, and 28
Time frame: Days 7, 14, and 28
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Ibudilast (MN-166) | Number of Participants Discharged From Hospital at Days 7, 14, and 28 | Day 7 | 11 Participants |
| Ibudilast (MN-166) | Number of Participants Discharged From Hospital at Days 7, 14, and 28 | Day 14 | 13 Participants |
| Ibudilast (MN-166) | Number of Participants Discharged From Hospital at Days 7, 14, and 28 | Day 28 | 13 Participants |
| Placebo | Number of Participants Discharged From Hospital at Days 7, 14, and 28 | Day 28 | 14 Participants |
| Placebo | Number of Participants Discharged From Hospital at Days 7, 14, and 28 | Day 7 | 5 Participants |
| Placebo | Number of Participants Discharged From Hospital at Days 7, 14, and 28 | Day 14 | 11 Participants |
Number of Participants Receiving Mechanical Ventilation or Intubation
Number (percentage) of participants receiving mechanical ventilation or intubation after starting study drug.
Time frame: Days 7, 14, and 28
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Ibudilast (MN-166) | Number of Participants Receiving Mechanical Ventilation or Intubation | Day 7 | 1 Participants |
| Ibudilast (MN-166) | Number of Participants Receiving Mechanical Ventilation or Intubation | Day 14 | 1 Participants |
| Ibudilast (MN-166) | Number of Participants Receiving Mechanical Ventilation or Intubation | Day 28 | 1 Participants |
| Placebo | Number of Participants Receiving Mechanical Ventilation or Intubation | Day 7 | 3 Participants |
| Placebo | Number of Participants Receiving Mechanical Ventilation or Intubation | Day 14 | 2 Participants |
| Placebo | Number of Participants Receiving Mechanical Ventilation or Intubation | Day 28 | 1 Participants |