COVID-19
Conditions
Keywords
COVID-19, COVID 19, Coronaviridae Infections, Coronavirus Infections, RNA Virus Infections, Virus Diseases, Nidovirales Infections, SARS-CoV-2, SARS Coronavirus, ACTIV-3, ACTIV3, TICO
Brief summary
This study looks at the safety and effectiveness of LY3819253 in treating COVID-19 in people who have been hospitalized with the infection. Participants in the study will be treated with either LY3819253 plus current standard of care (SOC), or with placebo plus current SOC. This is ACTIV-3/TICO Treatment Trial H1.
Detailed description
This is a treatment trial of the ACTIV-3/TICO master protocol (NCT04501978) to evaluate the safety and efficacy of LY3819253 in hospitalized patients infected with COVID-19. This is a randomized, blinded, controlled sub-study of LY3819253 plus current standard of care (SOC) against placebo plus current SOC. The placebo arm may be shared across other sub-studies of the ACTIV-3/TICO master protocol. When more than one drug is being tested at the same time, participants will be randomly allocated to treatments or placebo. Randomization will be stratified by study site pharmacy and disease severity. There are 2 disease severity strata: Participants without organ failure (severity stratum 1) and participants with organ failure (severity stratum 2). An independent Data and Safety Monitoring Board (DSMB) will regularly review interim analyses and summarize safety and efficacy outcomes. The pace of enrollment with be initially restricted, and there will be an early review of safety data by the DSMB. At the outset of the trial, only participants in disease severity stratum 1 will be enrolled. This will continue until approximately 300 participants are enrolled and followed for 5 days. The exact number will vary according to the speed of enrollment and the timing of DSMB meetings. Prior to expanding enrollment to also include patients in disease severity stratum 2, safety will be evaluated and a pre-specified futility assessment by the DSMB will be carried out using 2 ordinal outcomes assessed at Day 5. If LY3819253 passes the futility assessment, enrollment of participants will be expanded, seamlessly and without any data unblinding, to include participants in disease severity stratum 2 as well as those in disease severity stratum 1. Future interim analyses will be based on the primary endpoint of sustained recovery and will use pre-specified guidelines to determine early evidence of benefit, harm, or futility for the investigational agent. Participants will be followed for 18 months following randomization. This trial will be conducted in several hundred clinical sites. Participating sites are affiliated with networks funded by the United States National Institutes of Health (NIH) and the US Department of Veterans Affairs.
Interventions
BIOLOGICALLY3819253
LY3819253 is a neutralizing immunoglobulin G (IgG)-1 monoclonal antibody (mAb) to the receptor binding domain (RBD) of the S protein of SARS-CoV-2
BIOLOGICALPlacebo
Commercially available 0.9% sodium chloride solution
BIOLOGICALRemdesivir
Antiviral agent
Sponsors
International Network for Strategic Initiatives in Global HIV Trials (INSIGHT)
University of Copenhagen
Medical Research Council
Kirby Institute
Washington D.C. Veterans Affairs Medical Center
Advancing Clinical Therapeutics Globally for HIV/AIDS and Other Infections
National Heart, Lung, and Blood Institute (NHLBI)
US Department of Veterans Affairs
Prevention and Early Treatment of Acute Lung Injury
Cardiothoracic Surgical Trials Network
Eli Lilly and Company
University of Minnesota
National Institute of Allergy and Infectious Diseases (NIAID)
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
Refer to the master protocol (NCT04501978)
Exclusion criteria
Refer to the master protocol (NCT04501978) Additional Criteria: Non-pregnant female participants who are of reproductive potential and male participants who are able to father a child must abstain from male/female sexual intercourse or agree to use two forms of effective contraception, where at least one form is highly effective (less than 1% failure rate), for the entirety of the study and for 90 days after investigational agent is administered. Highly effective methods of contraception (less than 1% failure rate) include, but are not limited to: * combination oral contraceptives * implanted contraceptives * intrauterine devices Effective methods of contraception include, but are not limited to: * diaphragms and cervical caps with spermicide * cervical sponges * condoms with spermicide NOTE: * Use of male and female condoms as a double barrier method is not considered acceptable due to the high failure rate when these barrier methods are combined. * Barrier protection methods without concomitant use of a spermicide are not an effective or acceptable method of contraception. * Periodic abstinence (e.g., calendar, ovulation, symptothermal, postovulation methods), and withdrawal are not acceptable methods of contraception. Participants not of reproductive potential are eligible without requiring the use of a contraceptive method. Participant-reported history is acceptable documentation of surgical sterilization and menopause. Participants with pregnant partners should use condoms during vaginal intercourse through 90 days after investigational agent administration. Participants should refrain from sperm donation through 90 days after investigational agent administration. NOTE: Reproductive potential is defined as patients who have reached menarche, who have not been post-menopausal for at least 12 consecutive months with follicle-stimulating hormone (FSH) ≥ 40 IU/ml or 24 consecutive months if an FSH is not available, who have not undergone surgical sterilization, who do not have other clinical condition that could induce amenorrhea, who are not taking medications such as oral contraceptives, hormones, gonadotropin releasing hormone, antiestrogens, selective estrogen receptor modulators (SERMs) or chemotherapy that could induce amenorrhea. Individuals with permanent infertility due to an alternate medical cause (e.g. Mullerian agenesis, androgen insensitivity), investigator discretion should be applied.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Sustained Recovery | Through Day 90 | Sustained recovery defined as being discharged from the index hospitalization, followed by being alive and home for 14 consecutive days prior to Day 90. |
| Number of Participants With an Ordinal Outcome on Day 5 | Status on Day 5 | Ordinal outcome with 7 mutually exclusive categories |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Who Died From All Causes | Through Day 90 | All-cause mortality |
| Number of Participants With a Safety Outcome Through Day 5 | Through Day 5 | Death, SAE, clinical organ failure, serious infections, or Grade 3 or 4 event through Day 5 |
| Number of Participants With a Safety Outcome Through Day 28 | Through Day 28 | Death, SAE, clinical organ failure, serious infections, or Grade 3 or 4 event through Day 28 |
| Number of Participants With a Safety Outcome Through Day 90 | Through Day 90 | Death, SAE, clinical organ failure, serious infections through Day 90 |
Countries
Denmark, Singapore, Spain, United States
Participant flow
Recruitment details
Subjects were enrolled from 31 sites in 3 countries (Denmark, Singapore, USA). The first subject was enrolled on 5 Aug 2020 and the last subject was enrolled on 13 Oct 2020.
Participants by arm
| Arm | Count |
|---|---|
| LY3819253 Plus SOC * LY3819253 7000 mg solution (10 vials of 20 mL solution containing 700 mg each); administered by IV infusion
* Remdesivir is provided to all study participants as SOC unless contraindicated for an individual patient; administered by IV infusion
LY3819253: LY3819253 is a neutralizing immunoglobulin G (IgG)-1 monoclonal antibody (mAb) to the receptor binding domain (RBD) of the S protein of SARS-CoV-2
Remdesivir: Antiviral agent | 163 |
| Placebo Plus SOC * Placebo administered by IV infusion
* Remdesivir is provided to all study participants as SOC unless contraindicated for an individual patient; administered by IV infusion
Placebo: Commercially available 0.9% sodium chloride solution
Remdesivir: Antiviral agent | 151 |
| Total | 314 |
Baseline characteristics
| Characteristic | LY3819253 Plus SOC | Placebo Plus SOC | Total |
|---|---|---|---|
| Age, Continuous | 60.4 years STANDARD_DEVIATION 14.2 | 58.9 years STANDARD_DEVIATION 16.3 | 59.6 years STANDARD_DEVIATION 15.2 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 41 Participants | 33 Participants | 74 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 122 Participants | 118 Participants | 240 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Race American Indian or Alaska Native | 3 Participants | 0 Participants | 3 Participants |
| Race/Ethnicity, Customized Race Asian | 6 Participants | 7 Participants | 13 Participants |
| Race/Ethnicity, Customized Race Black or African American | 32 Participants | 34 Participants | 66 Participants |
| Race/Ethnicity, Customized Race More than one race | 1 Participants | 1 Participants | 2 Participants |
| Race/Ethnicity, Customized Race Native Hawaiian or Pacific Islander | 1 Participants | 1 Participants | 2 Participants |
| Race/Ethnicity, Customized Race Only ethnicity reported | 26 Participants | 16 Participants | 42 Participants |
| Race/Ethnicity, Customized Race Other | 4 Participants | 4 Participants | 8 Participants |
| Race/Ethnicity, Customized Race White | 90 Participants | 88 Participants | 178 Participants |
| Sex: Female, Male Female | 66 Participants | 71 Participants | 137 Participants |
| Sex: Female, Male Male | 97 Participants | 80 Participants | 177 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 13 / 163 | 11 / 151 |
| other Total, other adverse events | 41 / 163 | 27 / 151 |
| serious Total, serious adverse events | 9 / 163 | 12 / 151 |
Outcome results
Primary
Number of Participants With an Ordinal Outcome on Day 5
Ordinal outcome with 7 mutually exclusive categories
Time frame: Status on Day 5
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| LY3819253 Plus SOC | Number of Participants With an Ordinal Outcome on Day 5 | 7 = Death | 1 Participants |
| LY3819253 Plus SOC | Number of Participants With an Ordinal Outcome on Day 5 | 6 = Invasive ventilation, ECMO, mechanical circulatory support, new renal replacement therapy | 8 Participants |
| LY3819253 Plus SOC | Number of Participants With an Ordinal Outcome on Day 5 | 5 = Non-invasive ventilation or high flow oxygen | 24 Participants |
| LY3819253 Plus SOC | Number of Participants With an Ordinal Outcome on Day 5 | 4 = Supplement oxgen (≥4 L/min or ≥4 L/min above baseline, but not high flow oxygen) | 18 Participants |
| LY3819253 Plus SOC | Number of Participants With an Ordinal Outcome on Day 5 | 3 = Supplement oxgen (<4 L/min or <4 L/min above baseline, but not high flow oxygen) | 30 Participants |
| LY3819253 Plus SOC | Number of Participants With an Ordinal Outcome on Day 5 | 2 = Limiting symptoms due to COVID-19, but not need of new or increased oxygen from baseline | 51 Participants |
| LY3819253 Plus SOC | Number of Participants With an Ordinal Outcome on Day 5 | 1 = No limiting symptoms due to COVID-19 | 31 Participants |
| Placebo Plus SOC | Number of Participants With an Ordinal Outcome on Day 5 | 4 = Supplement oxgen (≥4 L/min or ≥4 L/min above baseline, but not high flow oxygen) | 11 Participants |
| Placebo Plus SOC | Number of Participants With an Ordinal Outcome on Day 5 | 7 = Death | 0 Participants |
| Placebo Plus SOC | Number of Participants With an Ordinal Outcome on Day 5 | 1 = No limiting symptoms due to COVID-19 | 35 Participants |
| Placebo Plus SOC | Number of Participants With an Ordinal Outcome on Day 5 | 6 = Invasive ventilation, ECMO, mechanical circulatory support, new renal replacement therapy | 5 Participants |
| Placebo Plus SOC | Number of Participants With an Ordinal Outcome on Day 5 | 3 = Supplement oxgen (<4 L/min or <4 L/min above baseline, but not high flow oxygen) | 33 Participants |
| Placebo Plus SOC | Number of Participants With an Ordinal Outcome on Day 5 | 5 = Non-invasive ventilation or high flow oxygen | 22 Participants |
| Placebo Plus SOC | Number of Participants With an Ordinal Outcome on Day 5 | 2 = Limiting symptoms due to COVID-19, but not need of new or increased oxygen from baseline | 45 Participants |
Primary
Number of Participants With Sustained Recovery
Sustained recovery defined as being discharged from the index hospitalization, followed by being alive and home for 14 consecutive days prior to Day 90.
Time frame: Through Day 90
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| LY3819253 Plus SOC | Number of Participants With Sustained Recovery | 144 Participants |
| Placebo Plus SOC | Number of Participants With Sustained Recovery | 136 Participants |
Secondary
Number of Participants Who Died From All Causes
All-cause mortality
Time frame: Through Day 90
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| LY3819253 Plus SOC | Number of Participants Who Died From All Causes | 13 Participants |
| Placebo Plus SOC | Number of Participants Who Died From All Causes | 11 Participants |
Secondary
Number of Participants With a Safety Outcome Through Day 28
Death, SAE, clinical organ failure, serious infections, or Grade 3 or 4 event through Day 28
Time frame: Through Day 28
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| LY3819253 Plus SOC | Number of Participants With a Safety Outcome Through Day 28 | 52 Participants |
| Placebo Plus SOC | Number of Participants With a Safety Outcome Through Day 28 | 42 Participants |
Secondary
Number of Participants With a Safety Outcome Through Day 5
Death, SAE, clinical organ failure, serious infections, or Grade 3 or 4 event through Day 5
Time frame: Through Day 5
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| LY3819253 Plus SOC | Number of Participants With a Safety Outcome Through Day 5 | 45 Participants |
| Placebo Plus SOC | Number of Participants With a Safety Outcome Through Day 5 | 28 Participants |
Secondary
Number of Participants With a Safety Outcome Through Day 90
Death, SAE, clinical organ failure, serious infections through Day 90
Time frame: Through Day 90
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| LY3819253 Plus SOC | Number of Participants With a Safety Outcome Through Day 90 | 45 Participants |
| Placebo Plus SOC | Number of Participants With a Safety Outcome Through Day 90 | 41 Participants |