August 17, 2020
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August 18, 2020
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November 2, 2022
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August 18, 2020
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April 30, 2022 (Final data collection date for primary outcome measure)
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Hierarchical composite endpoint [ Time Frame: Up to 30 days ] The primary endpoint of the trial will be a global rank score that ranks patient outcomes according to 5 factors: (1) time to death; (2) the number of days supported by invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO); (3) The inspired concentration of oxygen/percent oxygen saturation (FiO2/SpO2) ratio area under the curve; (4) For participants enrolled as outpatients who are subsequently hospitalized, the number of days out of the hospital during the 30 day-period following randomization; (5) For participants enrolled as outpatients who don't get hospitalized during the 30-day observation period, the modified Borg dyspnea scale
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Same as current
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- Number of days alive, out of the intensive care unit, free of mechanical ventilation/extracorporeal membrane oxygenation, or maximal available respiratory support in the 30 days following randomization [ Time Frame: Up to 30 days ]
- Seven-category ordinal scale [ Time Frame: At 15 days ]
A seven-category ordinal scale consisting of the following categories: 1, not hospitalized with resumption of normal activities; 2, not hospitalized, but unable to resume normal activities; 3, hospitalized, not requiring supplemental oxygen; 4, hospitalized, requiring supplemental oxygen; 5, hospitalized, requiring nasal high-flow oxygen therapy, noninvasive mechanical ventilation, or both; 6, hospitalized, requiring extracorporeal membrane oxygenation (ECMO), invasive mechanical ventilation, or both; and 7, death.
- Hierarchical composite endpoint [ Time Frame: Up to 30 days ]
A global rank score similar to the primary endpoint, but using a more comprehensive COVID-19 symptom scale instead of the dyspnea Borg scale
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Same as current
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Same as current
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FEnofibRate as a Metabolic INtervention for COVID-19
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FEnofibRate as a Metabolic INtervention for Coronavirus Disease 2019
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The severe acute respiratory syndrome coronavirus 2 (SARS-CoC-2), the virus responsible for coronavirus disease 2019 (COVID-19), is associated with a high incidence of acute respiratory distress syndrome (ARDS) and death. Aging, obesity, diabetes, hypertension and other risk factors associated with abnormal lipid and carbohydrate metabolism are risk factors for death in COVID-19. Recent studies suggest that COVID-19 progression is dependent on metabolic mechanisms. Moreover, gene expression analyses in cultured human bronchial cells infected with SARS-CoV-2 and lung tissue from patients with COVID-19, indicated a marked shift in cellular metabolism, with excessive intracellular lipid generation. In this cell culture system, fenofibrate (a widely available low-cost generic drug approved by the FDA and multiple other regulatory agencies around the world to treat dyslipemias) at concentrations that can be achieved clinically, markedly inhibited SARS-CoV-2 viral replication. Fenofibrate also has immunomodulatory effects that may be beneficial in the setting of COVID-19. The aim of this trial is to assess the clinical impact of fenofibrate (145 mg/d of Tricor or dose-equivalent preparations for 10 days, with dose adjustment in chronic kidney disease ([CKD]) to improve clinical outcomes in patients with COVID-19.
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Not Provided
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Interventional
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Phase 2
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Allocation: Randomized Intervention Model: Parallel Assignment Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) Primary Purpose: Treatment
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Covid19
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- Other: Fenofibrate/fenofibric acid
The randomized intervention will be fenofibrate (Tricor) at a dose of 145 mg/d or dose-equivalent preparation of fenofibrate or fenofibric acid, for 10 days. In all cases, appropriate dose reductions will be implemented for patients with chronic kidney disease as per the approved preparation label. The intended duration of randomized treatment will be for 10 days.
- Other: Placebo
The control intervention will be a placebo, for 10 days.
- Other: Usual care
All participants will otherwise receive usual medical care
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- Experimental: Fenofibrate + Usual Care
The randomized intervention will be Fenofibrate, in combination with usual care. Dosing: 145 mg of Tricor or a dose-equivalent preparation
Interventions:
- Other: Fenofibrate/fenofibric acid
- Other: Usual care
- Placebo Comparator: Placebo + Usual Care
The randomized intervention will a matching placebo, in combination with usual care.
Interventions:
- Other: Placebo
- Other: Usual care
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- Tahmaz M, Kumbasar B, Ergen K, Ure U, Karatemiz G, Kazancioglu R. Acute renal failure secondary to fenofibrate monotherapy-induced rhabdomyolysis. Ren Fail. 2007;29(7):927-30. doi: 10.1080/08860220701573640.
- Ghosh B, Sengupta S, Bhattacharjee B, Majumder A, Sarkar SB. Fenofibrate-induced myopathy. Neurol India. 2004 Jun;52(2):268-9.
- Zhou J, Li D, Cheng Q. Fenofibrate monotherapy-induced rhabdomyolysis in a patient with post-pancreatitis diabetes mellitus: A rare case report and a review of the literature. Medicine (Baltimore). 2020 May 22;99(21):e20390. doi: 10.1097/MD.0000000000020390.
- Keech A, Simes RJ, Barter P, Best J, Scott R, Taskinen MR, Forder P, Pillai A, Davis T, Glasziou P, Drury P, Kesaniemi YA, Sullivan D, Hunt D, Colman P, d'Emden M, Whiting M, Ehnholm C, Laakso M; FIELD study investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet. 2005 Nov 26;366(9500):1849-61. doi: 10.1016/S0140-6736(05)67667-2. Erratum In: Lancet. 2006 Oct 21;368(9545):1420. Lancet. 2006 Oct 21;368(9545):1415.
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- Davidson MH, Rooney MW, Drucker J, Eugene Griffin H, Oosman S, Beckert M; LCP-AtorFen Investigators. Efficacy and tolerability of atorvastatin/fenofibrate fixed-dose combination tablet compared with atorvastatin and fenofibrate monotherapies in patients with dyslipidemia: a 12-week, multicenter, double-blind, randomized, parallel-group study. Clin Ther. 2009 Dec;31(12):2824-38. doi: 10.1016/j.clinthera.2009.12.007.
- ACCORD Study Group; Ginsberg HN, Elam MB, Lovato LC, Crouse JR 3rd, Leiter LA, Linz P, Friedewald WT, Buse JB, Gerstein HC, Probstfield J, Grimm RH, Ismail-Beigi F, Bigger JT, Goff DC Jr, Cushman WC, Simons-Morton DG, Byington RP. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med. 2010 Apr 29;362(17):1563-74. doi: 10.1056/NEJMoa1001282. Epub 2010 Mar 14. Erratum In: N Engl J Med. 2010 May 6;362(18):1748.
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- Backman JT, Kyrklund C, Kivisto KT, Wang JS, Neuvonen PJ. Plasma concentrations of active simvastatin acid are increased by gemfibrozil. Clin Pharmacol Ther. 2000 Aug;68(2):122-9. doi: 10.1067/mcp.2000.108507.
- Kyrklund C, Backman JT, Neuvonen M, Neuvonen PJ. Gemfibrozil increases plasma pravastatin concentrations and reduces pravastatin renal clearance. Clin Pharmacol Ther. 2003 Jun;73(6):538-44. doi: 10.1016/S0009-9236(03)00052-3.
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- Guiomar V, Oliveira D, Correia C, Pereira E. Efficacy of Rituximab in Refractory Inflammatory Myopathy Associated With Coexistence of Behcet's Disease and Antiphospholipid Syndrome. Eur J Case Rep Intern Med. 2019 Nov 11;6(11):001294. doi: 10.12890/2019_001294. eCollection 2019.
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- Sugie M, Kuriki A, Arai D, Ichikawa H, Kawamura M. [A case report of acute neuromyopathy induced by concomitant use of colchicine and bezafibrate]. No To Shinkei. 2005 Sep;57(9):785-90. Japanese.
- Feher MD, Hepburn AL, Hogarth MB, Ball SG, Kaye SA. Fenofibrate enhances urate reduction in men treated with allopurinol for hyperuricaemia and gout. Rheumatology (Oxford). 2003 Feb;42(2):321-5. doi: 10.1093/rheumatology/keg103.
- Schlesinger N. Management of acute and chronic gouty arthritis: present state-of-the-art. Drugs. 2004;64(21):2399-416. doi: 10.2165/00003495-200464210-00003.
- Lee YH, Lee CH, Lee J. Effect of fenofibrate in combination with urate lowering agents in patients with gout. Korean J Intern Med. 2006 Jun;21(2):89-93. doi: 10.3904/kjim.2006.21.2.89.
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- Khanna PP. Gout: a patrician malady no more. Lancet Diabetes Endocrinol. 2018 Apr;6(4):263-264. doi: 10.1016/S2213-8587(18)30073-1. No abstract available.
- Waldman B, Ansquer JC, Sullivan DR, Jenkins AJ, McGill N, Buizen L, Davis TME, Best JD, Li L, Feher MD, Foucher C, Kesaniemi YA, Flack J, d'Emden MC, Scott RS, Hedley J, Gebski V, Keech AC; FIELD investigators. Effect of fenofibrate on uric acid and gout in type 2 diabetes: a post-hoc analysis of the randomised, controlled FIELD study. Lancet Diabetes Endocrinol. 2018 Apr;6(4):310-318. doi: 10.1016/S2213-8587(18)30029-9. Epub 2018 Feb 26.
- Ting R-D, Keech A. Fenofibrate and renal disease: clinical effects in diabetes. Clinical Lipidology. 2013;8(6):669-680
- McDonald KB, Garber BG, Perreault MM. Pancreatitis associated with simvastatin plus fenofibrate. Ann Pharmacother. 2002 Feb;36(2):275-9. doi: 10.1345/aph.1A180.
- Enger C, Gately R, Ming EE, Niemcryk SJ, Williams L, McAfee AT. Pharmacoepidemiology safety study of fibrate and statin concomitant therapy. Am J Cardiol. 2010 Dec 1;106(11):1594-601. doi: 10.1016/j.amjcard.2010.07.041. Epub 2010 Oct 14.
- Chirinos JA, Lopez-Jaramillo P, Giamarellos-Bourboulis EJ, Davila-Del-Carpio GH, Bizri AR, Andrade-Villanueva JF, Salman O, Cure-Cure C, Rosado-Santander NR, Cornejo Giraldo MP, Gonzalez-Hernandez LA, Moghnieh R, Angeliki R, Cruz Saldarriaga ME, Pariona M, Medina C, Dimitroulis I, Vlachopoulos C, Gutierrez C, Rodriguez-Mori JE, Gomez-Laiton E, Cotrina Pereyra R, Ravelo Hernandez JL, Arbanil H, Accini-Mendoza J, Perez-Mayorga M, Milionis C, Poulakou G, Sanchez G, Valdivia-Vega R, Villavicencio-Carranza M, Ayala-Garcia RJ, Castro-Callirgos CA, Alfaro Carrasco RM, Garrido Lecca Danos W, Sharkoski T, Greene K, Pourmussa B, Greczylo C, Ortega-Legaspi J, Jacoby D, Chittams J, Katsaounou P, Alexiou Z, Sympardi S, Sweitzer NK, Putt M, Cohen JB; FERMIN Investigators. A randomized clinical trial of lipid metabolism modulation with fenofibrate for acute coronavirus disease 2019. Nat Metab. 2022 Dec;4(12):1847-1857. doi: 10.1038/s42255-022-00698-3. Epub 2022 Nov 7.
- Chirinos J, Lopez-Jaramillo P, Giamarellos-Bourboulis E, Davila-Del-Carpio G, Bizri A, Andrade-Villanueva J, Salman O, Cure-Cure C, Rosado-Santander N, Giraldo MC, Gonzalez-Hernandez L, Moghnieh R, Angeliki R, Saldarriaga MC, Pariona M, Medina C, Dimitroulis I, Vlachopoulos C, Gutierrez C, Rodriguez-Mori J, Gomez-Laiton E, Pereyra R, Hernandez JR, Arbanil H, Accini-Mendoza J, Perez-Mayorga M, Milionis H, Poulakou G, Sanchez G, Valdivia-Vega R, Villavicencio-Carranza M, Ayala-Garcia R, Castro-Callirgos C, Carrasco RA, Danos WL, Sharkoski T, Greene K, Pourmussa B, Greczylo C, Chittams J, Katsaounou P, Alexiou Z, Sympardi S, Sweitzer N, Putt M, Cohen J. A Randomized Trial of Lipid Metabolism Modulation with Fenofibrate for Acute Coronavirus Disease 2019. Res Sq. 2022 Aug 10:rs.3.rs-1933913. doi: 10.21203/rs.3.rs-1933913/v1. Preprint.
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Completed
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701
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300
|
April 30, 2022
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April 30, 2022 (Final data collection date for primary outcome measure)
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Inclusion Criteria:
- A diagnosis of COVID-19, based on: (a) A compatible clinical presentation with a positive laboratory test for SARS-CoV-2, or (b) Considered by the primary team to be a Person Under Investigation undergoing testing for COVID-19 with a high clinical probability, in addition to compatible pulmonary infiltrates on chest x-ray (bilateral, intersticial or ground glass opacities) or chest CT.
- Able to provide informed consent.
- Fewer than 14 days since symptom onset.
Exclusion Criteria:
- Known pregnancy or breastfeeding
- Estimated glomerular filtration rate (eGFR) <30 mL/min/1.73m2 or undergoing dialysis (CKD stages 4-5).
- History of active liver disease, cholelithiasis, uncontrolled hypothyroidism, or rhabdomyolysis (suspected or confirmed). Patients with a history of hypothyroidism receiving a stable dose of thyroid replacement therapy for at least 6 weeks, with a documented normal TSH (primary hypothyroidism) or free thyroxine (secondary or tertiary hypothyroidism) level at least 6 weeks after the last dose change will be considered eligible for enrollment.
- Known hypersensitivity to fenofibrate or fenofibric acid.
- Ongoing treatment with fenofibrate, clofibrate, warfarin and other coumarin anticoagulants, glimepiride, cyclosporine, tacrolimus
- Use of statins other than simvastatin, pravastatin or atorvastatin ≤40 mg/d or rosuvastatin ≤20 mg/d
- Prisoners/incarcerated individuals
- Inability to read, write or no access to a smart phone, computer or tablet device
- Intubated patients.
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Sexes Eligible for Study: |
All |
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18 Years and older (Adult, Older Adult)
|
No
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Contact information is only displayed when the study is recruiting subjects
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United States
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|
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NCT04517396
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843729
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Yes
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Studies a U.S. FDA-regulated Drug Product: |
No |
Studies a U.S. FDA-regulated Device Product: |
No |
Product Manufactured in and Exported from the U.S.: |
No |
|
Plan to Share IPD: |
No |
Plan Description: |
Not making it available |
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Julio A. Chirinos, University of Pennsylvania
|
Same as current
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University of Pennsylvania
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Same as current
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- University of Arizona
- Universidad Católica de Santa María (National Sponsor in Perú)
- Hospital Nacional Adolfo Guevara Velasco, Peru
- Hospital Nacional Edgardo Rebagliati Martins
- Hospital Nacional Alberto Sabogal Sologuren, Peru
- Hospital Nacional Guillermo Almenara Irigoyen, Peru
- Hospital Nacional Carlos Alberto Seguin Escobedo - EsSalud
- Universidad de Santander, Bucaramanga, Colombia (National Sponsor in Colombia)
- National Center for Advancing Translational Sciences (NCATS)
- Hospitales Civiles de Guadalajara, Mexico
- Hospital 2 de Mayo. Lima, Peru
- Hospital de la Fuerza Aérea del Perú. Lima, Peru
- Hospital Militar Central "Coronel Luis Arias Schereiber"; Lima, Perú
- Hospital Victor Lazarte Echegaray. Lima, Peru
- Ioannina University General Hospital. Greece
- AHEPA Thessaloniki University General Hospital. Greece
- SOTIRIA Athens General University Hospital of Chest Diseases. Greece
- THRIASIO Eleusis General Hospital. Greece
- Alexandroupolis University General Hospital. Greece
- G. GENNIMATAS Athens General Hospital. Greece
- Colombia Centro 1: BIOMELAB S.A.S. Barranquilla, Colombia
- Fundación Oftalmológica de Santander. Santander, Colombia
- IPS Centro Científico Asistencial. Barranquilla, Colombia
- Fundación Cardiomet. Quindio, Colombia
- Clínica de Marly. Bogotá, Colombia
- Clinica Internacional. Lima, Peru
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Not Provided
|
University of Pennsylvania
|
March 2022
|