Covid19
Conditions
Keywords
Omalizumab, Interferon-alpha, COVID-19, SARS-CoV-2, Coronavirus, Corona virus
Brief summary
To evaluate if omalizumab is effective in decreasing mortality in severe hospitalized COVID-19 cases.
Detailed description
Coronavirus disease 2019 (COVID-19) has affected over 88 million people, resulting in the death of at least 1.9 million individuals and numbers continue to climb exponentially. Despite these staggering numbers, there are currently very few effective treatments for COVID-19. The immune response to COVID-19 virus appears to follow 2 phases. During the incubation and early disease, interferon (ex. INF-α) signaling and adaptive immunity preclude the disease from progressing. If, and when, this immune response is impaired, the virus may cause pathologic inflammation leading to massive organ dysfunction leading to acute respiratory distress syndrome (ARDS). Omalizumab is a humanized anti-IgE antibody approved by Health Canada for the treatment of moderate-severe asthma and chronic spontaneous urticaria. Omalizumab has been shown to exhibit antiviral and anti-inflammatory effects in virally exacerbated asthma cases that may be relevant to the treatment of COVID-19. This is a double blind randomized placebo-controlled trial to evaluate the efficacy of a single dose of omalizumab in reducing all cause mortality at day 29 in severe hospitalized COVID-19 cases. Moreover, time to improvement/hospital discharge, incidence and duration of mechanical ventilation and safety will be assessed.
Interventions
BIOLOGICALOmalizumab
Single subcutaneous dose of 375mg of omalizumab and standard of care.
OTHERPlacebo
Single subcutaneous dose of normal saline in a syringe identical to that of the omalizumab arm and standard of care.
Sponsors
McGill University Health Centre/Research Institute of the McGill University Health Centre
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Positive RT-PCR assay for SARS-CoV-2; 2. COVID-19 disease requiring hospitalization 3. Dyspnea at rest or during minimal activity (sitting, talking, coughing, swallowing), OR * Respiratory rate \> 22/min, OR * PaO2 \< 65mmHg or O2Sat \< 90%, OR * Infiltrate on chest radiography (CXR) (worsening CXR if baseline abnormal) 4. Age ≥18 years; 5. Ability to provide consent or to provide consent via a substitute decision maker Patients who are pregnant may also be eligible if consent is provided. Patients who have received one of the SARS-CoV2 vaccines and/or bamlanivimab are eligible to participate in the study
Exclusion criteria
1. Known hypersensitivity to Omalizumab or its excipients 2. Inability to give consent themselves or via proxy 3. Patients who received Omalizumab or another anti-IgE molecule in the last 12 months 4. Patients receiving another monoclonal antibody to treat SARS-CoV-2/other indication prior to starting CIAO trial. However, once the study is initiated, if it is judged by the treating team/patient's doctor that patient's health/clinical status may benefit from a monoclonal antibody (e.g. tocilizumab), this will be allowed. 5. Patients who are below the age of 18
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Death or Mechanical Ventilation | 14 Days | Outcome reported as the number of patients in each arm that either experience death by any cause or mechanical ventilation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Clinical Improvement | 28 Days | Outcome reported as the time to improvement of 2 points on the 8-category ordinal scale. (World Health Organization, 2020) 8-category ordinal scale: 0- Uninfected, no clinical or virological evidence of infection 1. Ambulatory, no limitation of activities 2. Ambulatory, limitation of activities 3. Hospitalized mild disease, no oxygen therapy 4. Hospitalized mild disease, oxygen by mask or nasal prongs 5. Hospitalized severe disease, non invasive ventilation or high-flow oxygen 6. Hospitalized severe disease, intubation and mechanical ventilation 7. Hospitalized severe disease, ventilation + additional organ support - pressors, RRT, ECMO 8. Death |
| Duration of Mechanical Ventilation | 28 Days | Outcome reported as duration of mechanical ventilation in each arm. |
| Duration of Hospitalization | 28 Days | Outcome reported as the duration of hospitalization of patients in each arm. |
| Safety in COVID-19 patients | 14 Days | Outcome reported as the number of adverse events and serious adverse events that occurred in each arm. |
| Incidence of All-Cause in Hospital Mortality | 28 Days | Outcome reported as the number of patients in each arm that experience death by any cause while in hospital. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Percent of viral clearance of Omalizumab as compared to the control arm | Days 0, 2, 7, 14 | Evaluation of the virologic efficacy of omalizumab as compared to the control arm as assessed by the percent of subjects with SARS-CoV-2 detectable in OP/NP sample at days 0, 2, 7, 14. |
| Spirometry results: Forced Vital Capacity | 6 months | Evaluation of forced vital capacity, reported in liters, in both omalizumab and control arms at 6 months. |
| Spirometry results : Forced expiratory volume in one second | 6 months | Evaluation of forced expiratory volume in one second, reported in liters, in both omalizumab and control arms at 6 months. |
| Anti-Inflammatory effects of Omalizumab as compared to the control arm | Days 0, 2, 7, 14 | Assessed by measuring cytokine levels, TNF-α, IL-1, IL-6, and IFN-α in picograms per milliliter on days 0, 2, 7, 14. |
| Anti-fibrotic effects of Omalizumab as compared to the control arm | Days 0, 2, 7, 14 | Assessed by measuring TGF-β level in nanograms per milliliter on days 0, 2, 7, 14. |
Countries
Canada
Outcome results
None listed