Skip to content

Crizanlizumab for Treating COVID-19 Vasculopathy

Crizanlizumab for Treating COVID-19 Vasculopathy

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT04435184
Acronym
CRITICAL
Enrollment
54
Registered
2020-06-17
Start date
2020-07-09
Completion date
2021-01-04
Last updated
2021-11-09

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

Conditions

COVID-19

Keywords

coronavirus

Brief summary

The purpose of this trial is to test the efficacy and safety of crizanlizumab in patients hospitalized with COVID-19.

Detailed description

Infection with severe acute respiratory syndrome (SARS) coronavirus 2 (CoV-2) causes coronavirus disease 2019 (COVID-19). The clinical course of COVID-19 is variable, and some patients develop severe pneumonia, multi-organ failure, and shock. Severe COVID-19 is characterized by a hyper-inflammatory and hyper-thrombotic state. We propose that this state is caused by viral injury of the vascular endothelium, leading to endothelial release of von Willebrand Factor (VWF) and P-selectin, which in turn drive thrombosis and vascular inflammation. Crizanlizumab is a monoclonal antibody that targets P-selectin. Crizanlizumab can decrease inflammation by binding to P-selectin, blocking leucocyte and platelet adherence to the vessel wall. We now plan to test the safety and efficacy of crizanlizumab in decreasing biomarkers of inflammation and thrombosis in a placebo-controlled, double-blind randomized clinical trial

Interventions

Crizanlizumab 5.0 mg/kg in 100 ml IV once.

OTHER0.9% saline

0.9% saline 100 ml IV once.

Sponsors

Novartis
CollaboratorINDUSTRY
Socar Research SA
CollaboratorNETWORK
Brigham and Women's Hospital
CollaboratorOTHER
Johns Hopkins University
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Intervention model description

Double-blind, placebo-controlled, randomized interventional trial.

Eligibility

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

Inclusion criteria

1. Willing to provide written informed consent 2. Willing to comply with all study procedures and be available for the duration of the study 3. Male or female ≥ 18 years of age 4. SARS-CoV-2 infection (COVID-19) within the past 10 d documented by laboratory test (nucleic acid test (NAT) or reverse transcriptase-polymerase chain reaction (RT-PCR)) 5. Currently hospitalized 6. Symptoms of acute respiratory infection (at least one of the following: cough, fever \> 37.5°C, dyspnea, sore throat, anosmia), 7. Radiographic evidence of pulmonary infiltrates 8. Requiring supplemental oxygen or the peripheral capillary oxygenation saturation (SpO2) \< 94% on room air at screening 9. Elevated D-Dimer \> 0.49 mg/L 10. Negative pregnancy test for females of childbearing potential

Exclusion criteria

1. Use of home oxygen at baseline 2. Current use of mechanical ventilation 3. Inability to provide consent 4. Do not intubate status 5. Prisoner or incarcerated 6. Pregnancy or Breast Feeding 7. Participation in other interventional therapy trials for COVID-19. 8. International normalized ratio (INR) \> 3 or activated partial thromboplastin time (aPTT) \> 60

Design outcomes

Primary

MeasureTime frameDescription
Soluble P-selectin LevelDay 3 after randomization or day of hospital discharge, whichever is earlierLevel of soluble P-selectin in ng/mL.

Secondary

MeasureTime frameDescription
D-dimer LevelDay 3 after randomizationLevel of D-dimer in mg/L.
VWF LevelDay 3 after randomizationLevel of von Willebrand Factor (VWF) antigen in IU/mL.
CRP LevelDay 3 after randomizationLevel of C-reactive protein (CRP) in mg/dL.
Soluble P-selectin LevelDay 7 after randomizationLevel of soluble P-selectin in ng/mL.
Time to Hospital DischargeUp to 30 days after randomizationTime (days) to hospital discharge
Safety of Crizanlizumab as Assessed by Adverse EventsUp to day 14 after randomizationSafety of crizanlizumab will by assessed by adverse events, serious adverse events, and suspected unexpected serious adverse reactions.
Change in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsDays 3, 7 and 14 after randomizationChange in the clinical status over 14 days as measured by an ordinal scale that is the first assessment of the clinical status on a given study day. The scale is as follows: 0 = Uninfected; no viral RNA detected 1. = Ambulatory; asymptomatic; viral RNA detected 2. = Ambulatory; symptomatic; independent 3. = Ambulatory; symptomatic; assistance needed 4. = Hospitalized; no oxygen therapy 5. = Hospitalized; oxygen by mask or nasal prongs 6. = Hospitalized; oxygen by non-invasive ventilation (NIV) or high flow 7. = Hospitalized; intubation and mechanical ventilation, partial pressure of oxygen / fraction of inspired oxygen (pO2/FIO2) ≥ 150 or oxygen saturation / FIO2 (SpO2/FIO2) ≥ 200 8. = Hospitalized; intubation and mechanical ventilation, pO2/FIO2 \< 150 or SpO2/FIO2 \< 200 or vasopressors 9. = Hospitalized; intubation and mechanical ventilation, pO2/FIO2 \< 150 or SpO2/FIO2 \< 200 and vasopressors, dialysis, or extracorporeal membrane oxygenation (ECMO) 10. = Dead

Countries

United States

Participant flow

Recruitment details

From July 15, 2020 through November 27, 2020, 583 patients were screened at 3 hospitals within the Johns Hopkins Health System. A total of 54 patients who fulfilled study entry criteria were randomized to receive crizanlizumab (n = 27) or placebo (n = 27).

Pre-assignment details

Out of the 27 assigned to receive crizanlizumab, 2 did not receive crizanlizumab because of early discharge or early intubation. Out of the 27 assigned to receive placebo, 2 did not receive placebo because of early discharge or withdrawn consent.

Participants by arm

ArmCount
Crizanlizumab
Crizanlizumab is a monoclonal antibody targeting P-selectin. Crizanlizumab 5.0 mg/kg in 100 ml IV once. Crizanlizumab: Crizanlizumab 5.0 mg/kg in 100 ml IV once.
22
Placebo Saline
0.9% saline 100 ml IV once. 0.9% saline: 0.9% saline 100 ml IV once.
20
Total42

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall Studyfollow-up blood draws missing35

Baseline characteristics

CharacteristicPlacebo SalineTotalCrizanlizumab
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
8 Participants11 Participants3 Participants
Age, Categorical
Between 18 and 65 years
12 Participants31 Participants19 Participants
Age, Continuous54.6 years
STANDARD_DEVIATION 13.4
56.2 years
STANDARD_DEVIATION 15.5
58 years
STANDARD_DEVIATION 17.7
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
1 Participants1 Participants0 Participants
Race (NIH/OMB)
Black or African American
6 Participants20 Participants14 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
13 Participants21 Participants8 Participants
Region of Enrollment
United States
20 Participants42 Participants22 Participants
Sex: Female, Male
Female
9 Participants18 Participants9 Participants
Sex: Female, Male
Male
11 Participants24 Participants13 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 250 / 25
other
Total, other adverse events
7 / 255 / 25
serious
Total, serious adverse events
0 / 251 / 25

Outcome results

Primary

Soluble P-selectin Level

Level of soluble P-selectin in ng/mL.

Time frame: Day 3 after randomization or day of hospital discharge, whichever is earlier

ArmMeasureValue (MEAN)Dispersion
CrizanlizumabSoluble P-selectin Level7 ng/mLStandard Deviation 7
Placebo SalineSoluble P-selectin Level39 ng/mLStandard Deviation 18
Secondary

Change in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) Trials

Change in the clinical status over 14 days as measured by an ordinal scale that is the first assessment of the clinical status on a given study day. The scale is as follows: 0 = Uninfected; no viral RNA detected 1. = Ambulatory; asymptomatic; viral RNA detected 2. = Ambulatory; symptomatic; independent 3. = Ambulatory; symptomatic; assistance needed 4. = Hospitalized; no oxygen therapy 5. = Hospitalized; oxygen by mask or nasal prongs 6. = Hospitalized; oxygen by non-invasive ventilation (NIV) or high flow 7. = Hospitalized; intubation and mechanical ventilation, partial pressure of oxygen / fraction of inspired oxygen (pO2/FIO2) ≥ 150 or oxygen saturation / FIO2 (SpO2/FIO2) ≥ 200 8. = Hospitalized; intubation and mechanical ventilation, pO2/FIO2 \< 150 or SpO2/FIO2 \< 200 or vasopressors 9. = Hospitalized; intubation and mechanical ventilation, pO2/FIO2 \< 150 or SpO2/FIO2 \< 200 and vasopressors, dialysis, or extracorporeal membrane oxygenation (ECMO) 10. = Dead

Time frame: Days 3, 7 and 14 after randomization

ArmMeasureGroupCategoryValue (COUNT_OF_PARTICIPANTS)
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 771 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 343 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 780 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 390 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 790 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 363 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 7100 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 3100 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 14</= 3 (discharged)21 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 7</= 3 (discharged)9 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 1440 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 3</= 3 (discharged)3 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 1450 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 745 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 1461 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 370 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 1470 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 756 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 1480 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 3513 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 1490 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 761 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 14100 Participants
CrizanlizumabChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 380 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 14100 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 3</= 3 (discharged)2 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 347 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 357 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 364 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 370 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 380 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 390 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 7</= 3 (discharged)13 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 743 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 753 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 761 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 770 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 780 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 790 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 7100 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 14</= 3 (discharged)19 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 1440 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 1450 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 1460 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 1470 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 1481 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 1490 Participants
Placebo SalineChange in Clinical Status as Assessed by the World Health Organization (WHO) Ordinal Scale for Coronavirus Disease 2019 (COVID-19) TrialsWHO Clinical Status: Day 3100 Participants
Secondary

CRP Level

Level of C-reactive protein (CRP) in mg/dL.

Time frame: Day 3 after randomization

ArmMeasureValue (MEDIAN)
CrizanlizumabCRP Level4.4 mg/dL
Placebo SalineCRP Level4.5 mg/dL
Secondary

CRP Level

Level of C-reactive protein (CRP) in mg/dL.

Time frame: Day 7 after randomization

ArmMeasureValue (MEDIAN)
CrizanlizumabCRP Level2.4 mg/dL
Placebo SalineCRP Level2.1 mg/dL
Secondary

CRP Level

Level of C-reactive protein (CRP) in mg/dL.

Time frame: Day 14 after randomization

ArmMeasureValue (MEDIAN)
CrizanlizumabCRP Level2.5 mg/dL
Placebo SalineCRP Level1.3 mg/dL
Secondary

D-dimer Level

Level of D-dimer in mg/L.

Time frame: Day 7 after randomization

ArmMeasureValue (MEDIAN)
CrizanlizumabD-dimer Level1.6 mg/L
Placebo SalineD-dimer Level0.7 mg/L
Secondary

D-dimer Level

Level of D-dimer in mg/L.

Time frame: Day 14 after randomization

ArmMeasureValue (MEDIAN)
CrizanlizumabD-dimer Level1.5 mg/L
Placebo SalineD-dimer Level0.7 mg/L
Secondary

D-dimer Level

Level of D-dimer in mg/L.

Time frame: Day 3 after randomization

ArmMeasureValue (MEDIAN)
CrizanlizumabD-dimer Level1.6 mg/L
Placebo SalineD-dimer Level0.7 mg/L
Secondary

Safety of Crizanlizumab as Assessed by Adverse Events

Safety of crizanlizumab will by assessed by adverse events, serious adverse events, and suspected unexpected serious adverse reactions.

Time frame: Up to day 14 after randomization

ArmMeasureValue (NUMBER)
CrizanlizumabSafety of Crizanlizumab as Assessed by Adverse Events7 total adverse events
Placebo SalineSafety of Crizanlizumab as Assessed by Adverse Events6 total adverse events
Secondary

Soluble P-selectin Level

Level of soluble P-selectin in ng/mL.

Time frame: Day 14 after randomization

ArmMeasureValue (MEAN)Dispersion
CrizanlizumabSoluble P-selectin Level12 ng/mLStandard Deviation 10
Placebo SalineSoluble P-selectin Level48 ng/mLStandard Deviation 24
Secondary

Soluble P-selectin Level

Level of soluble P-selectin in ng/mL.

Time frame: Day 7 after randomization

ArmMeasureValue (MEAN)Dispersion
CrizanlizumabSoluble P-selectin Level10 ng/mLStandard Deviation 8
Placebo SalineSoluble P-selectin Level48 ng/mLStandard Deviation 17
Secondary

Time to Hospital Discharge

Time (days) to hospital discharge

Time frame: Up to 30 days after randomization

ArmMeasureValue (MEAN)Dispersion
CrizanlizumabTime to Hospital Discharge8.1 daysStandard Deviation 4.4
Placebo SalineTime to Hospital Discharge6.2 daysStandard Deviation 3.2
Secondary

VWF Level

Level of von Willebrand Factor (VWF) antigen in IU/mL.

Time frame: Day 3 after randomization

ArmMeasureValue (MEDIAN)
CrizanlizumabVWF Level2.9 IU/mL
Placebo SalineVWF Level2.8 IU/mL
Secondary

VWF Level

Level of VWF antigen in IU/mL.

Time frame: Day 14 after randomization

ArmMeasureValue (MEDIAN)
CrizanlizumabVWF Level2.7 IU/mL
Placebo SalineVWF Level4.6 IU/mL
Secondary

VWF Level

Level of VWF antigen in IU/mL.

Time frame: Day 7 after randomization

ArmMeasureValue (MEDIAN)
CrizanlizumabVWF Level3.9 IU/mL
Placebo SalineVWF Level3.6 IU/mL

Source: ClinicalTrials.gov · Data processed: Feb 20, 2026