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suPAR-Guided Anakinra Treatment for Management of Severe Respiratory Failure by COVID-19 (SAVE-MORE)

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: NCT04680949
Recruitment Status : Completed
First Posted : December 23, 2020
Last Update Posted : September 6, 2022
Sponsor:
Information provided by (Responsible Party):
Hellenic Institute for the Study of Sepsis

Study Description
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Brief Summary:
The SAVE-MORE is a pivotal, confirmatory, phase III randomized clinical trial (RCT) aiming to evaluate the efficacy and safety of early start of anakinra guided by suPAR in patients with LRTI by SARS-CoV-2 in improving the clinical state of COVID-19 over 28 days as measured by the ordinal scale of the 11-point World Health Organization (WHO) clinical progression scale (CPS).

Condition or disease Intervention/treatment Phase
Covid19 Drug: Anakinra Drug: Placebo Phase 3

Detailed Description:

Since March 2020 when the COVID-19 pandemic started in Europe, the Hellenic Institute for the Study of Sepsis has launched in Greece the SAVE clinical trial (suPAR-guided Anakinra treatment for Validation of the risk and Early management of severe respiratory failure by COVID-19) (EudraCT number 2020-001466-11; approval 38/20 of the National Ethics Committee of Greece, approval IS 028/20 of the National Organization for Medicine of Greece, ClinicalTrials.gov identifier, NCT04357366). The concept of the SAVE trial was that early recognition of the risk for the progression of patients with lower respiratory tract infection (LRTI) by the new coronavirus SARS-CoV-2 into severe respiratory failure (SRF) may guide anakinra therapy to prevent SRF. The tool that was used for the diagnosis of risk for SRF is the biomarker suPAR (soluble urokinase plasminogen activator receptor) at measurable concentrations in the blood ≥6 ng/ml. The trial was designed to be open-label non-randomized and the idea was το the start of treatment well before any sign of respiratory failure emerges. Patients hospitalized at tertiary hospitals during the same time period as the SAVE trial was ongoing and who were receiving the same standard-of-care (SOC) treatment were studied as comparators. An interim analysis was submitted to the National Organization for Medicines; number 108002/23.10/2020. In this interim analysis, 130 patients receiving anakinra treatment and SOC were analysed and they were compared to 130 patients receiving SOC. The 130 SOC parallel comparators were selected by propensity score matching to be fully matched to the anakinra-treated patients for age, comorbidities, severity scores on the day of hospital admission, i.e. APACHE II score, Pneumonia Severity Index (PSI), Sequential Organ Failure Assessment (SOFA) and WHO severity, and for the intake of azithromycin, hydroxychloroquine and dexamethasone. SRF was defined as any respiratory ratio (pO2/FiO2) less than 150 mmHg necessitating mechanical ventilation or non-invasive ventilation (NIV). The results of this analysis may be summarized as follows:

  • The incidence of SRF was significantly decreased from 59.2% in the parallel standard-of-care (SOC) comparators (n= 130) to 22.3% among the 130 anakinra-treated patients; hazard ratio, 0.30; 95% confidence intervals 0.20-0.46; P: 4.6 x 10-8.
  • 30-day mortality was decreased from 22.3% in the SOC comparators to 11.5% among anakinra-treated patients; hazard ratio 0.49; 95% confidence intervals 0.25-0.97%; P: 0.041.
  • Duration of stay at the intensive care unit was shortened with anakinra treatment compared to the SOC comparators for the patients who eventually developed SRF
  • The median cost of hospitalization was significantly reduced from €2.398,40 among SOC comparators to €1.291,40 among anakinra-treated patients
  • No safety concerns were raised.
Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 606 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: The SAVE-MORE is a pivotal, confirmatory, phase III randomized clinical trial (RCT) aiming to evaluate the efficacy and safety of early start of anakinra guided by suPAR in patients with LRTI by SARS-CoV-2 in improving the clinical state of COVID-19 over 28 days as measured by the ordinal scale of the 11-point WHO clinical progression scale (CPS).
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking Description: double-blind trial
Primary Purpose: Treatment
Official Title: suPAR-Guided Anakinra Treatment for Validation of the Risk and Early Management of Severe Respiratory Failure by COVID-19: The SAVE-MORE Double-blind, Randomized, Phase III Confirmatory Trial
Actual Study Start Date : December 23, 2020
Actual Primary Completion Date : March 31, 2021
Actual Study Completion Date : February 6, 2022

Resource links provided by the National Library of Medicine

Drug Information available for: Anakinra

Arms and Interventions
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Arm Intervention/treatment
Placebo Comparator: Placebo
Patients receiving standard-of-care (SOC) and placebo. Placebo is injected subcutaneously once daily for 10 days
 Drug: Placebo
Standard-of-care and placebo. Placebo is injected subcutaneously once daily for 10 days
Experimental: Anakinra
Patients receiving SOC and anakinra. Anakinra is injected subcutaneously as 100 mg once daily for 10 days
 Drug: Anakinra
Standard-of-care and anakinra. Anakinra is injected subcutaneously as 100 mg once daily for 10 days
Other Name: Kineret


Outcome Measures
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Primary Outcome Measures :
  1. Comparison of the distribution of frequencies of each score of a 5-scale patient state evaluated from the 11-point WHO Clinical Progression ordinal Scale (CPS) between the two arms of treatment [ Time Frame: 28 days ]
    Comparison of the distribution of frequencies of each score of the 5-scale patient state evaluated from the 11-point WHO Clinical Progression ordinal Scale (CPS) between the two arms of treatment by Day 28. This will be expressed as the distribution of the frequencies of each score of the scale in each arm of treatment by Day 28. The scale ranges from 0 (best outcome-asymptomatic) to 11 (worst outcome-death).


Secondary Outcome Measures :
  1. Absolute change of the measure of the 11-point of WHO Clinical Progression ordinal Scale (CPS) [ Time Frame: 28 days ]
    Comparison of the absolute change of the measure of the 11-point of WHO Clinical Progression ordinal Scale (CPS) between the two arms of treatment. The scale ranges from 0 (best outcome-asymptomatic) to 11 (worst outcome-death).

  2. Relative change of the measure of the 11-point of WHO Clinical Progression ordinal Scale (CPS) [ Time Frame: 28 days ]
    Comparison of the relative change (%) of the measure of the 11-point of WHO Clinical Progression ordinal Scale (CPS) between the two arms of treatment. The scale ranges from 0 (best outcome-asymptomatic) to 11 (worst outcome-death).

  3. Absolute change of the measure of the 11-point of WHO Clinical Progression ordinal Scale (CPS) [ Time Frame: 14 days ]
    Comparison of the absolute change of the measure of the 11-point of WHO Clinical Progression nordinal Scale (CPS) between the two arms of treatment. The scale ranges from 0 (best outcome-asymptomatic) to 11 (worst outcome-death).

  4. Relative change of the measure of the 11-point of WHO Clinical Progression ordinal Scale (CPS) [ Time Frame: 14 days ]
    Comparison of the relative (%) change of the measure of the 11-point of WHO Clinical Progression ordinal Scale (CPS) between the two arms of treatment. The scale ranges from 0 (best outcome-asymptomatic) to 11 (worst outcome-death).

  5. Absolute change of the SOFA score [ Time Frame: 14 days ]
    Comparison of the absolute change of the SOFA score (in points) between the two arms of treatment

  6. Relative change of the SOFA score [ Time Frame: 14 days ]
    Comparison of the relative (%) change of the SOFA score (in points) between the two arms of treatment

  7. Absolute change of the SOFA score [ Time Frame: 7 days ]
    Comparison of the absolute change of the SOFA score between the two arms of treatment

  8. Relative change of the SOFA score [ Time Frame: 7 days ]
    Comparison of the relative (%) change of the SOFA score between the two arms of treatment

  9. Time until hospital discharge [ Time Frame: 90 days ]
    Comparison of the time until hospital discharge between the two arms of treatment

  10. Time until discharge from the intensive care unit [ Time Frame: 90 days ]
    Comparison of the time until discharge from the intensive care unit between the two arms of treatment

  11. Comparison of the rate of serious and non-serious adverse events between the two arms of treatment [ Time Frame: 90 days ]
    Comparison of the rate of serious and non-serious adverse events between the two arms of treatment

  12. Comparison of the rate of serious and non-serious adverse events between the two arms of treatment [ Time Frame: 60 days ]
    Comparison of the rate of serious and non-serious adverse events between the two arms of treatment

  13. Relative changes of circulating concentrations of suPAR (μg/liter), D-dimers (μg/liter), ferritin (μg/liter), and Interleukin-6 (μg/liter) by Day 7 from baseline Day 1 [ Time Frame: 7 days ]
    Comparison of the relative changes of circulating concentrations of suPAR (μg/liter),D-dimers (μg/liter), ferritin (μg/liter), and Interleukin-6 (μg/liter) between the two arms of treatment

  14. Relative changes of circulating concentrations of C-reactive protein (mg/liter) by Day 7 from baseline Day 1 [ Time Frame: 7 days ]
    Comparison of the relative changes of circulating concentrations of C-reactive protein (mg/liter) between the two arms of treatment

  15. Relative changes of circulating concentrations of suPAR (μg/liter),D-dimers (μg/liter), ferritin (μg/liter), and Interleukin-6 (μg/liter) by Day 4 from baseline Day 1 [ Time Frame: 4 days ]
    Comparison of the relative changes of circulating concentrations of suPAR (μg/liter),D-dimers (μg/liter), ferritin (μg/liter), and Interleukin-6 (μg/liter) between the two arms of treatment

  16. Relative changes of circulating concentrations of C-reactive protein (mg/liter) by Day 4 from baseline Day 1 [ Time Frame: 4 days ]
    Comparison of the relative changes of circulating concentrations of C-reactive protein (mg/liter) between the two arms of treatment

  17. Absolute change of the viral load by Day 7 from baseline Day 1 [ Time Frame: 7 days ]
    Comparison of the absolute change of the viral load (in copies) between the two arms of treatment

  18. Relative change of the viral load by Day 7 from baseline Day 1 [ Time Frame: 7 days ]
    Comparison of the relative (%) change of the viral load between the two arms of treatment

  19. Absolute change of the viral load by Day 4 from baseline Day 1 [ Time Frame: 4 days ]
    Comparison of the absolute change of the viral load (in copies) between the two arms of treatment

  20. relative change of the viral load by Day 4 from baseline Day 1 [ Time Frame: 4 days ]
    Comparison of the relative change (%) of the viral load between the two arms of treatment

  21. Transcriptomic analysis [ Time Frame: 7 days ]
    Expression of messenger Ribonucleic Acid (mRNA) will be compared between the two arms of treatment

  22. Proteomic analysis [ Time Frame: 7 days ]
    Protein composition will be compared between the two arms of treatment


Other Outcome Measures:
  1. Cost of hospitalization [ Time Frame: 90 days ]
    Comparison of the cost of hospitalization between the two arms of treatment

  2. Comparison of the distribution of frequencies of each score of a 5-scale patient state [ Time Frame: 60 days ]
    Comparison of the distribution of frequencies of each score of the 5-scale patient state evaluated from the 11-point WHO Clinical Progression ordinal Scale (CPS) between the two arms of treatment by Day 28. This will be expressed as the distribution of the frequencies of each score of the scale in each arm of treatment by Day 60. The scale ranges from 0 (best outcome outpatients) to 5 (worst outcome-death)

  3. Comparison of the distribution of frequencies of each score of a 5-scale patient state [ Time Frame: 90 days ]
    Comparison of the distribution of frequencies of each score of the 5-scale patient state evaluated from the 11-point WHO Clinical Progression ordinal Scale (CPS) between the two arms of treatment by Day 28. This will be expressed as the distribution of the frequencies of each score of the scale in each arm of treatment by Day 90. The scale ranges from ) (best outcome-outpatients) to 5 (worst outcome-death)


Eligibility Criteria
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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

Inclusion Criteria:

  1. Age equal to or above 18 years
  2. Male or female gender
  3. In case of women, unwillingness to remain pregnant during the study period.
  4. Written informed consent provided by the patient. For subjects without decision-making capacity, informed consent must be obtained from a legally designated representative following the national legislation in the Member State where the trial is planned.
  5. Confirmed infection by SARS-CoV-2 virus
  6. Findings in chest-X-ray or in chest computed tomography compatible with lower respiratory tract infection
  7. Need for hospitalization for COVID-19. The need for hospitalization is defined by the attending physician taking into consideration clinical presentation, requirement for supportive care, potential risk factors for severe disease, and conditions at home, including the presence of vulnerable persons in the household.
  8. Plasma suPAR ≥6ng/ml

Exclusion Criteria:

  • Age below 18 years
  • Denial for written informed consent
  • Any stage IV malignancy
  • Any do not resuscitate decision
  • Αny pO2/FiO2 (partial oxygen pressure to fraction of inspired oxygen) ratio less than 150 mmHg irrespective if the patient is under mechanical ventilation (MV) / non-invasive ventilation (NIV) / extracorporeal membrane oxygenation (ECMO) or not
  • Patient under MV or NIV or ECMO
  • Any primary immunodeficiency
  • Less than 1,500 neutrophils/mm3
  • Plasma suPAR less than 6 ng/ml
  • Known hypersensitivity to anakinra
  • Oral or IV intake of corticosteroids at a daily dose equal or greater than 0.4 mg/kg prednisone for a period greater than the last 15 days.
  • Any anti-cytokine biological treatment the last one month
  • Severe hepatic failure defined as Child-Pugh stage of 3
  • End-stage renal failure necessitating hemofiltration or peritoneal hemodialysis
  • Pregnancy or lactation. Women of child-bearing potential will be screened by a urine pregnancy test before inclusion in the study
  • Participation in any other interventional trial
Contacts and Locations
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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): NCT04680949


Locations
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Sponsors and Collaborators
Hellenic Institute for the Study of Sepsis
Investigators
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Study Chair: Evangelos Giamarellos-Bourboulis, MD, PhD Hellenic Institute for the Study of Sepsis
More Information
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Responsible Party: Hellenic Institute for the Study of Sepsis
ClinicalTrials.gov Identifier: NCT04680949    
Other Study ID Numbers: SAVE-MORE
First Posted: December 23, 2020    Key Record Dates
Last Update Posted: September 6, 2022
Last Verified: September 2022

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Hellenic Institute for the Study of Sepsis:
SARS-CoV 2
anakinra
Additional relevant MeSH terms:
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COVID-19
Respiratory Insufficiency
Pneumonia, Viral
Pneumonia
Respiratory Tract Infections
Infections
Virus Diseases
Coronavirus Infections
 Coronaviridae Infections
Nidovirales Infections
RNA Virus Infections
Lung Diseases
Respiratory Tract Diseases
Respiration Disorders
Interleukin 1 Receptor Antagonist Protein
Antirheumatic Agents