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History of Changes for Study: NCT04311697
Intravenous Aviptadil for Critical COVID-19 With Respiratory Failure (COVID-AIV)
Latest version (submitted August 27, 2020) on ClinicalTrials.gov
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Study Record Versions
Version A B Submitted Date Changes
1 March 14, 2020 None (earliest Version on record)
2 March 16, 2020 Contacts/Locations, Outcome Measures and Study Status
3 March 23, 2020 Arms and Interventions, Contacts/Locations, Outcome Measures, Study Description and Study Status
4 March 24, 2020 Study Design, Arms and Interventions, Outcome Measures, Study Description, Contacts/Locations and Study Status
5 April 1, 2020 Contacts/Locations, Oversight, Sponsor/Collaborators and Study Status
6 April 3, 2020 Contacts/Locations and Study Status
7 April 8, 2020 Contacts/Locations, Oversight and Study Status
8 April 21, 2020 Contacts/Locations, Study Description and Study Status
9 May 15, 2020 Recruitment Status, Study Status, Contacts/Locations, Study Design and Study Description
10 June 1, 2020 Recruitment Status, Contacts/Locations, Study Status, Conditions and Study Description
11 June 2, 2020 Arms and Interventions, Conditions, Study Description, Study Identification, Eligibility and Study Status
12 June 30, 2020 IPDSharing, Sponsor/Collaborators, Study Status and Contacts/Locations
13 July 27, 2020 Study Status
14 August 27, 2020 Contacts/Locations, Outcome Measures and Study Status
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Changes (Merged) for Study: NCT04311697
June 2, 2020 (v11) -- June 30, 2020 (v12)

Changes in: IPDSharing, Sponsor/Collaborators, Study Status and Contacts/Locations

Study Identification
Unique Protocol ID: COVID-AIV
Brief Title: Intravenous Aviptadil for Critical COVID-19 With Respiratory Failure (COVID-AIV)
Official Title: Intravenous Aviptadil for Critical COVID-19 With Respiratory Failure
Secondary IDs:
Study Status
Record Verification: May 2020
Overall Status: Recruiting
Study Start: May 15, 2020
Primary Completion: August 2020 [Anticipated]
Study Completion: September 2020 [Anticipated]
First Submitted: March 14, 2020
First Submitted that
Met QC Criteria:
March 14, 2020
First Posted: March 17, 2020 [Actual]
Last Update Submitted that
Met QC Criteria:
June 2 30, 2020
Last Update Posted: June 4 July 2, 2020 [Actual]
Sponsor/Collaborators
Sponsor: NeuroRx, Inc.
Responsible Party: Sponsor
Collaborators: Relief Therapeutics Holding SA
Lavin Consulting, LLC
Target Health Inc. International Business Machines (IBM)
Oversight
U.S. FDA-regulated Drug: Yes
U.S. FDA-regulated Device: No
Data Monitoring: Yes
Study Description
Brief Summary: Novel Corona Virus (SARS-CoV-2) is known to cause Respiratory Failure, which is the hallmark of Acute COVID-19, as defined by the new NIH/FDA classification. Approximately 50% of those who develop Critical COVID-19 die, despite intensive care and mechanical ventilation. Patients with Critical COVID-19 and respiratory failure, currently treated with high flow nasal oxygen, non-invasive ventilation or mechanical ventilation will be treated with Aviptadil, a synthetic form of Human Vasoactive Intestinal Polypeptide (VIP) plus maximal intensive care vs. placebo + maximal intensive care. Patients will be randomized to intravenous Aviptadil will receive escalating doses from 50 -150 pmol/kg/hr over 12 hours.
Detailed Description:

Acute Lung Injury, which triggers Critical COVID-19 is a known lethal complication of Corona Virus (SARS-CoV-2) infection. Conventional medical therapy, including intensive care and respiratory support is associated with an 80% mortality. Aviptadil, a synthetic form of Human Vasoactive Intestinal Polypeptide (VIP) has been awarded FDA Orphan Drug Designation for the treatment of ARDS and admitted to the FDA CoronaVirus Technology Accelerator Program.

VIP binds to VPAC1 receptors on the pulmonary Alveolar Type II (ATII) cell. ATII cells comprise only 5% of lung epithelial cells but are critical for oxygen transfer, surfactant production, and maintenance of Alveolar Type 1 cells. 70% of VIP binds to this receptor. The Type II cell is also the cell selectively attacked by the SARS-CoV-2 virus via the ACE2 surface receptor.

Nonclinical studies demonstrate that VIP is highly concentrated in the lung and specifically bound to the ATII cell, where it prevents NMDA-induced caspase-3 activation in the lung, inhibits IL6 and TNFa production, protects against HCl-induced pulmonary edema, and upregulates surfactant production, These and other effects have been observed in numerous animal model systems of lung injury in mice, rats, guinea pigs, sheep, swine, and dogs. In these models, Aviptadil restores barrier function at the endothelial/alveolar interface and thereby protects the lung and other organs from failure.

Aviptadil ihas a demonstrated 20 year history of safety in phase 2 trials for Sarcoid, Pulmonary Fibrosis, Bronchospasm, and a phase I trial in ARDS. In that phase I trial, 8 patients with severe ARDS on mechanical ventilation were treated with ascending doses of VIP. Seven of the 8 patients were successfully extubated and were alive at the five day timepoint. Six left the hospital and one died of an unrelated cardiac event.

Five phase 2 trials of aviptadil have been conducted under European regulatory authority. Numerous healthy volunteer studies have shown that i.v. infusion of Aviptadil is well tolerated with few adverse effects including alterations in blood pressure, heart rate, or ECG. In addition to published studies of human use, Aviptadil has been used on a compounded basis in certain ICUs for many years in the belief that it preserves life and restores function in pulmonary hypertension, ARDS, and Acute Lung Injury (ALI).

In this study, patients who are hospitalized for Critical COVID-19 infection with respiratory failure will be randomly allocated to Aviptadil administered by intravenous infusion in addition to maximal intensive care vs. maximal intensive care alone. Primary endpoints will be improvement in blood oxygenation and mortality.

Conditions
Conditions: Critical COVID-19 With Respiratory Failure
Acute Respiratory Distress Syndrome (ARDS)
Corona Virus Infection
Acute Lung Injury
Keywords: COVID-19
ARDS
Aviptadil
Acute Respiratory Distress Syndrome
Respiratory Failure
Study Design
Study Type: Interventional
Primary Purpose: Treatment
Study Phase: Phase 2
Interventional Study Model: Parallel Assignment
Multicenter trial, initially conducted at a single center with a safety/futility assessment following enrollment of 30 patients
Number of Arms: 2
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Allocation: Randomized
Enrollment: 144 [Anticipated]
Arms and Interventions
Arms Assigned Interventions
Experimental: Aviptadil IV in escalating doses + standard of care
Patients will be administered Aviptadil IV in escalating doses of 50 pmol, 100 pmol, 150 pmol/kg/hr
Drug: Aviptadil by intravenous infusion + standard of care
Aviptadil by intravenous infusion + standard of care (SOC). SOC is defined not to include extracorporeal mechanical oxygenation. Those requiring ECMO will be withdrawn from the study as treatment failures.
Experimental: Placebo + standard of care
Patients will first be treated with placebo infusion + maximal intensive care
Drug: Normal Saline Infusion + standard of care
Saline by intravenous infusion + standard of care (SOC). SOC is defined not to include extracorporeal mechanical oxygenation. Those requiring ECMO will be withdrawn from the study as treatment failures.
Outcome Measures
Primary Outcome Measures:
1. Mortality
Mortality

[Time Frame: 5 Days with followup through 30 days]
2. PaO2:FiO2 ratio
Index of Respiratory Distress

[Time Frame: 5 Days with followup through the end of telemetry monitoring]
Secondary Outcome Measures:
3. TNF alpha
TNF alpha levels as measured in hospital laboratory

[Time Frame: 5 Days]
4. Multi-system organ failure free days
Multi-system organ failure free days

[Time Frame: 5 days with followup through 30 days]
Eligibility
Minimum Age: 18 Years
Maximum Age: 100 Years
Sex: All
Gender Based:
Accepts Healthy Volunteers: No
Criteria:

Inclusion Criteria:

  • Critical COVID-19 with respiratory failure
  • Physician determination that patient is on maximal conventional medical therapy

Exclusion Criteria:

  1. Pregnancy (pregnant women may apply for open label treatment under compassionate care IND
  2. Age <18 years
  3. Mechanical ventilation for more than 7 days in primary cohort. Mechanical ventilation>21 days in the exploratory cohort
  4. Mean Arterial Pressure < 65 mm Hg with use of pressor per ICU protocol
  5. Irreversible condition (other than COVID-19) with projected fatal course
  6. ECMO
  7. Current or recent (within 30 d) enrollment in another investigational trial of anti-IL6 drug;
  8. Active diagnosis of Acquired immune deficiency syndrome;
  9. Transplant patients currently immunosuppressed;
  10. Chemotherapy-induced neutropenia (granulocyte count <1000/mm3);
  11. Cardiogenic shock; congestive heart failure - NYHA Class 3 or 4;
  12. Recent myocardial infarction - within last 6 months and troponin > 0.5
  13. Anuria (urine output < 50 ml/d) or other signs of multi-organ failure
  14. Severe liver disease with portal hypertension;
  15. Recent stroke or head trauma within last 12 months
  16. Increased intracranial pressure, or other serious neurologic disorder;
  17. Liquid Diarrhea more than 3x/day; defined as more than 3 non-bloody watery stools within a 24-hour period, requiring additional fluid and electrolyte supplementation
Contacts/Locations
Central Contact: Robert E Besthof, MIM
Telephone: +14842546134 Ext. 701
Email: rbesthof@neurorxpharma.com
Study Officials: Jonathan C Javitt, MD, MPH
Study Chair
NeuroRx, Inc.
Locations: United States, California
University of California - Irvine
[Recruiting]
Irvine, California, United States, 92697
Contact: Richard Lee, MD richaral@hs.uci.edu
Principal Investigator: Richard Lee, MD
United States, Florida
Miller School of Medicine / University of Miami Medical Center
[Recruiting]
Miami, Florida, United States, 33136
Contact: Dushyantha Jayaweera, MD DJayawee@med.miami.edu
Principal Investigator: Dushyanatha Jayaweera, MD
Sub-Investigator: Daniel H Kett, MD
Sub-Investigator: Daniel D Yeh, MD
United States, Kentucky
University of Louisville
[Recruiting]
Louisville, Kentucky, United States, 40202
Contact: Rainer Lenhardt, MD 502-562-3000 rainer.lenhardt@louisville.edu
Principal Investigator: Rainer Lenhardt, MD
United States, New York
Robert I Grossman School of Medicine / NYU Langone Medical Center
[Not yet recruiting]
New York, New York, United States, 10016
Principal Investigator: Daniel H Sterman, MD
United States, Pennsylvania
Thomas Jefferson University Hospital
[Not yet recruiting]
Philadelphia, Pennsylvania, United States, 19107
Contact: Ross Summer, MD
United States, Texas
Houston Methodist Hospital
[Recruiting]
Houston, Texas, United States, 77030
Contact: Jihad Georges Youssef, MD 713-441-3948 jgyoussef@houstonmethodist.org
Principal Investigator: Jihad Georges Youssef, MD
Israel
Rambam Health Care Campus
[Not yet recruiting]
Haifa, Israel, 3109601
Contact: Yaron Bar-Lavie, MD, FCCP 04-777-2601 y_barlavie@rambam.health.gov.il
Principal Investigator: Yaron Bar-Lavie, MD, FCCP
IPDSharing
Plan to Share IPD: Yes
NeuroRx will share study protocol and statistical analysis plan upon request by qualified researchers
Supporting Information:
Study Protocol
Statistical Analysis Plan (SAP)
Informed Consent Form (ICF)
Time Frame:
Currently available
Access Criteria:
URL:
References
Citations:
Links:
Available IPD/Information:

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