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Efficacy, Safety, Tolerability, and Biomarkers of Ibudilast (MN-166) in Patients Hospitalized With COVID-19 at Risk for ARDS

A Randomized, Double-Blind, Placebo-Controlled, Parallel Group Study to Evaluate the Efficacy, Safety, Tolerability, Biomarkers and Pharmacokinetics of Ibudilast (MN-166) in COVID-19 Subjects at Risk for Developing Acute Respiratory Distress Syndrome

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT04429555
Enrollment
34
Registered
2020-06-12
Start date
2021-01-11
Completion date
2024-08-07
Last updated
2024-10-30

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

Conditions

Pneumonia, Viral

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

DRUGPlacebo

0 mg (5 matching capsules) twice daily for 7 days

Sponsors

MediciNova
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)

Intervention model description

Randomized, double-blind, placebo-controlled, parallel-group study.

Eligibility

Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No

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

MeasureTime frameDescription
Number of Participants Free From Respiratory Failure at Day 7Day 7Participants 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 7Day 7Number (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

MeasureTime frameDescription
Number of Participants Receiving Mechanical Ventilation or IntubationDays 7, 14, and 28Number (percentage) of participants receiving mechanical ventilation or intubation after starting study drug.
All-cause MortalityDay 1 to Day 60Number of reported participant deaths
Number of Participants Discharged From Hospital at Days 7, 14, and 28Days 7, 14, and 28Number (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

ArmCount
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
Total34

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyDeath02
Overall StudyOther20

Baseline characteristics

CharacteristicTotalIbudilast (MN-166)Placebo
Age, Continuous59.88 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 Participants7 Participants3 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
24 Participants10 Participants14 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Black or African American
3 Participants1 Participants2 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
1 Participants1 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
7 Participants5 Participants2 Participants
Race (NIH/OMB)
White
23 Participants10 Participants13 Participants
Region of Enrollment
United States
34 Participants17 Participants17 Participants
Sex: Female, Male
Female
17 Participants9 Participants8 Participants
Sex: Female, Male
Male
17 Participants8 Participants9 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 172 / 17
other
Total, other adverse events
13 / 1714 / 27
serious
Total, serious adverse events
5 / 1714 / 17

Outcome results

Primary

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

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Ibudilast (MN-166)Number of Participants Free From Respiratory Failure at Day 712 Participants
PlaceboNumber of Participants Free From Respiratory Failure at Day 76 Participants
Primary

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

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Ibudilast (MN-166)Number of Participants With at Least a 1-point Improvement in Clinical Status on Day 712 Participants
PlaceboNumber of Participants With at Least a 1-point Improvement in Clinical Status on Day 78 Participants
Secondary

All-cause Mortality

Number of reported participant deaths

Time frame: Day 1 to Day 60

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Ibudilast (MN-166)All-cause Mortality0 Participants
PlaceboAll-cause Mortality2 Participants
Secondary

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

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Ibudilast (MN-166)Number of Participants Discharged From Hospital at Days 7, 14, and 28Day 711 Participants
Ibudilast (MN-166)Number of Participants Discharged From Hospital at Days 7, 14, and 28Day 1413 Participants
Ibudilast (MN-166)Number of Participants Discharged From Hospital at Days 7, 14, and 28Day 2813 Participants
PlaceboNumber of Participants Discharged From Hospital at Days 7, 14, and 28Day 2814 Participants
PlaceboNumber of Participants Discharged From Hospital at Days 7, 14, and 28Day 75 Participants
PlaceboNumber of Participants Discharged From Hospital at Days 7, 14, and 28Day 1411 Participants
Secondary

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

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Ibudilast (MN-166)Number of Participants Receiving Mechanical Ventilation or IntubationDay 71 Participants
Ibudilast (MN-166)Number of Participants Receiving Mechanical Ventilation or IntubationDay 141 Participants
Ibudilast (MN-166)Number of Participants Receiving Mechanical Ventilation or IntubationDay 281 Participants
PlaceboNumber of Participants Receiving Mechanical Ventilation or IntubationDay 73 Participants
PlaceboNumber of Participants Receiving Mechanical Ventilation or IntubationDay 142 Participants
PlaceboNumber of Participants Receiving Mechanical Ventilation or IntubationDay 281 Participants

Source: ClinicalTrials.gov · Data processed: Apr 4, 2026