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Safety, Tolerability, and Efficacy of Anti-Spike (S) SARS-CoV-2 Monoclonal Antibodies for Hospitalized Adult Patients With COVID-19

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT04426695
Recruitment Status : Active, not recruiting
First Posted : June 11, 2020
Last Update Posted : May 12, 2021
Sponsor:
Information provided by (Responsible Party):
Regeneron Pharmaceuticals

Brief Summary:

The primary objectives are:

Phase 1/2 (Cohort 1)

  • To exclude futility of REGN10933+REGN10987 compared to placebo, as measured by death or mechanical ventilation
  • To evaluate the safety and tolerability of REGN10933+REGN10987 compared to placebo Phase 2 (Cohort 1A)
  • To evaluate the clinical efficacy of REGN10933+REGN10987 compared to placebo, as measured by death or mechanical ventilation
  • To evaluate the safety and tolerability of REGN10933+REGN10987 compared to placebo Phase 3 (Cohort 1 and Cohort 1A)
  • To evaluate the clinical efficacy of REGN10933+REGN10987 compared to placebo, as measured by death or mechanical ventilation

Condition or disease Intervention/treatment Phase
COVID-19 Drug: REGN10933+REGN10987 combination therapy Drug: Placebo Phase 1 Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 6900 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Phase 1/Phase 2/Phase 3
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Master Protocol Assessing the Safety, Tolerability, and Efficacy of Anti-Spike (S) SARS-CoV-2 Monoclonal Antibodies for the Treatment of Hospitalized Patients With COVID-19
Actual Study Start Date : June 10, 2020
Actual Primary Completion Date : May 7, 2021
Estimated Study Completion Date : June 4, 2021


Arm Intervention/treatment
Experimental: On Low-Flow Oxygen
Cohort 1 (C1): O2 saturation >93% on low-flow oxygen via nasal cannula, simple face mask, or other similar device
Drug: REGN10933+REGN10987 combination therapy
Administered intravenously (IV) single dose
Other Names:
  • REGN-COV2
  • casirivimab
  • imdevimab

Drug: Placebo
Placebo IV Single Dose

Experimental: With COVID-19 symptoms but not requiring supplemental O2
Cohort 1A (C1A): With COVID-19 symptoms but not requiring supplemental oxygen
Drug: REGN10933+REGN10987 combination therapy
Administered intravenously (IV) single dose
Other Names:
  • REGN-COV2
  • casirivimab
  • imdevimab

Drug: Placebo
Placebo IV Single Dose

Experimental: High O2 No Mechanical Ventilation
Cohort 2 (C2): On high-intensity oxygen (O2) therapy but not on mechanical ventilation
Drug: REGN10933+REGN10987 combination therapy
Administered intravenously (IV) single dose
Other Names:
  • REGN-COV2
  • casirivimab
  • imdevimab

Drug: Placebo
Placebo IV Single Dose

Experimental: On Mechanical Ventilation
Cohort 3 (C3): On mechanical ventilation
Drug: REGN10933+REGN10987 combination therapy
Administered intravenously (IV) single dose
Other Names:
  • REGN-COV2
  • casirivimab
  • imdevimab

Drug: Placebo
Placebo IV Single Dose




Primary Outcome Measures :
  1. Incidence of death or required mechanical ventilation [ Time Frame: Through day 169 ]

    Primary:

    Through Day 169: Phase 1/2: C1 (Futility) Through Day 57: Phase 2: C1A (Clinical Efficacy) Timeframe determined based on Phase 1/2 data: Phase 3, C1, C1A (Clinical Efficacy)

    Secondary (Clinical Efficacy):

    Through Day 169: Phase 1/2: C1 Through Day 57: Phase 2: C2 Timeframe determined based on Phase 1/2 data: Phase 3: C1, C1A


  2. Proportion of patients with treatment-emergent Serious Adverse Events (SAEs) [ Time Frame: Through Day 169 ]

    Primary:

    Through Day 169: Phase 1/2: C1 Through Day 57: Phase 2, C1A

    Secondary:

    Through Day 57: Phase 2: C2, C3


  3. Proportion of patients with infusion-related reactions [ Time Frame: Through Day 4 ]
    Primary: Phase 1/2: C1, Phase 2: C1A Secondary: Phase 2: C2, C3

  4. Proportion of patients with hypersensitivity reactions [ Time Frame: Through Day 29 ]
    Primary: Phase 1/2: C1, Phase 2: C1A Secondary: Phase 2: C2, C3


Secondary Outcome Measures :
  1. Time-weighted average change from baseline in viral load as measured by quantitative reverse transcription polymerase chain reaction (RT-qPCR) in nasopharyngeal (NP) swab samples [ Time Frame: Baseline to Day 7 ]
    Phase 1/2: C1, Phase 2: C1A, C2, C3, Phase 3: C1, C1A

  2. Time-weighted average change from baseline in viral load as measured by RT-qPCR in NP swab samples [ Time Frame: Baseline up to Day 11 ]
    Phase 1/2: C1, Phase 2: C1A, C2, C3, Phase 3: C1, C1A

  3. Time-weighted average change from baseline in viral load as measured by RT-qPCR in NP swab samples [ Time Frame: Baseline up to Day 29 ]
    Phase 1/2: C1, Phase 2: C1A, C2, C3, Phase 3: C1, C1A

  4. Change from baseline in viral load as measured by RT-qPCR in NP swabs [ Time Frame: Baseline up to Day 29 ]
    Phase 1/2: C1, Phase 2: C1A, C2, C3, Phase 3: C1, C1A

  5. Time to sustained negative RT-qPCR in NP swab samples [ Time Frame: Up To Day 29 ]

    Negative RT-qPCR with no subsequent positive

    Phase 1/2: C1, Phase 2; C1A, C2, C3, Phase 3: C1, C1A


  6. Incidence of deaths due to any cause [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 57: Phase 2: C1A, C2, C3


  7. Incidence of required mechanical ventilation [ Time Frame: Through Day 29 ]
    Through Day 29: Phase 1/2: C1, Phase 2: C1A, C2, Phase 3: C1, C1A

  8. Proportion of patients who died or went on mechanical ventilation [ Time Frame: By Day 29 ]
    Phase 1/2: C1, Phase 2: C1A, C2, Phase 3: C1, C1A

  9. Proportion of patients who died [ Time Frame: By Day 29 ]
    Phase 1/2: C1, Phase 2: C1A, C2, C3, Phase 3: C1, C1A

  10. Proportion of patients who went on mechanical ventilation [ Time Frame: By Day 29 ]
    Phase 1/2: C1, Phase 2: C1A, C2, Phase 3: C1, C1A

  11. Time to discharge [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  12. Serum concentration of REGN10933 over time [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  13. Serum concentration of REGN10987 over time [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  14. Assessment of pharmacokinetic (PK) parameter: maximum serum concentration observed (Cmax) of REGN10933 [ Time Frame: Through day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  15. Assessment of PK parameter: maximum serum concentration observed (Cmax) of REGN10987 [ Time Frame: Through day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  16. Assessment of PK parameter: Cmax-to-dose ratio (Cmax/dose) for REGN10933 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  17. Assessment of PK parameter: Cmax-to-dose ratio (Cmax/dose) for REGN10987 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  18. Assessment of PK parameter: Time to Cmax (tmax) for REGN10933 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  19. Assessment of PK parameter: Time to Cmax (tmax) for REGN10987 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  20. Assessment of PK parameter: Area Under the Curve (AUC) computed from time zero to the time of the last positive concentration (AUClast) for REGN10933 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  21. Assessment of PK parameter: AUC computed from time zero to the time of the last positive concentration (AUClast) for REGN10987 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  22. Assessment of PK parameter: AUC from time zero extrapolated to infinity (AUCinf) for REGN10933 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  23. Assessment of PK parameter: AUC from time zero extrapolated to infinity (AUCinf) for REGN10987 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  24. Assessment of PK parameter: AUCinf-to-dose ratio (AUCinf/dose) of REGN10933 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  25. Assessment of PK parameter: AUCinf-to-dose ratio (AUCinf/dose) of REGN10987 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  26. Assessment of PK parameter: Observed terminal half-life [t1/2] for REGN10933 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  27. Assessment of PK parameter: Observed terminal half-life [t1/2] of REGN10987 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  28. Assessment of PK parameter: Clearance (CL) for REGN10933 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  29. Assessment of PK parameter: Clearance (CL) of REGN10987 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  30. Assessment of PK parameter: Volume of distribution at steady state (Vss) of REGN10933 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  31. Assessment of PK parameter: Volume of distribution at steady state (Vss) of REGN10987 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  32. Assessment of PK parameter: Mean residence time (MRT) of REGN10933 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  33. Assessment of PK parameter: Mean residence time (MRT) of REGN10987 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  34. Incidence of anti-drug antibodies (ADA) to REGN10933 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3


  35. Incidence of anti-drug antibodies (ADA) to REGN10987 [ Time Frame: Through Day 169 ]

    Through Day 169: Phase 1/2: C1, Phase 3: C1, C1A

    Through Day 29: Phase 2: C1A, C2, C3




Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Key Inclusion Criteria:

  • Has SARS-CoV-2-positive antigen or molecular diagnostic test (by validated SARS-CoV-2 antigen, RT-PCR, or other molecular diagnostic assay, using an appropriate sample such as NP, nasal, oropharyngeal [OP], or saliva) ≤72 hours prior to randomization and no alternative explanation for current clinical condition. A historical record of positive result from test conducted ≤72 hours prior to randomization is acceptable.
  • Has symptoms consistent with COVID-19, as determined by investigator, with onset ≤10 days before randomization
  • Hospitalized for ≤72 hours with at least 1 of the following at randomization; patients meeting more than one criterion will be categorized in the most severely affected category:

    1. Cohort 1A: With COVID-19 symptoms but not requiring supplemental oxygen
    2. Cohort 1: Maintains O2 saturation >93% on low-flow oxygen as defined in the protocol
    3. Cohort 2: High-intensity oxygen therapy without mechanical ventilation as defined in the protocol
    4. Cohort 3: On mechanical ventilation

Key Exclusion Criteria:

  • Phase 1 Only: Patients maintaining O2 saturation >94% on room air
  • In the opinion of the investigator, unlikely to survive for >48 hours from screening
  • Receiving extracorporeal membrane oxygenation (ECMO)
  • Has new-onset stroke or seizure disorder during hospitalization
  • Initiated on renal replacement therapy due to COVID-19

NOTE: Other protocol defined inclusion / exclusion criteria apply


Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04426695


Locations
Show Show 121 study locations
Sponsors and Collaborators
Regeneron Pharmaceuticals
Investigators
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Study Director: Clinical Trial Management Regeneron Pharmaceuticals
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Responsible Party: Regeneron Pharmaceuticals
ClinicalTrials.gov Identifier: NCT04426695    
Other Study ID Numbers: R10933-10987-COV-2066
2020-002537-15 ( EudraCT Number )
First Posted: June 11, 2020    Key Record Dates
Last Update Posted: May 12, 2021
Last Verified: March 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: All Individual Patient Data (IPD) that underlie publicly available results will be considered for sharing
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Informed Consent Form (ICF)
Clinical Study Report (CSR)
Analytic Code
Time Frame: Individual anonymized participant data will be considered for sharing once the indication has been approved by a regulatory body, if there is legal authority to share the data and there is not a reasonable likelihood of participant re-identification
Access Criteria: Qualified researchers may request access to anonymized patient level data or aggregate study data when Regeneron has received marketing authorization from major health authorities (e.g., Food and Drug Administration (FDA), European Medicines Agency (EMA), Pharmaceuticals and Medical Devices Agency (PMDA), etc) for the product and indication, has the legal authority to share the data, and has made the study results publicly available (eg, scientific publication, scientific conference, clinical trial registry).
URL: https://vivli.org/

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Regeneron Pharmaceuticals:
Coronavirus disease 2019 (COVID-19)
Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2)
coronavirus
acute respiratory distress syndrome