The world is currently experiencing a coronavirus (CoV-2) pandemic. A new (SARS)-CoV infection epidemic began in Wuhan, Hubei, China, in late 2019; originally called 2019- nCoV the virus is now known as SARSCoV- 2 and the disease it causes COVID-19. Previous CoV epidemics included severe acute respiratory syndrome (SARS)-CoV, which started in China in 2003 and Middle East respiratory syndrome (MERS)-CoV in the Middle East, which started in 2012. The mortality rates were >10% for SARS and >35% for MERS. The direct cause of death is generally due to ensuing severe atypical pneumonia and ensuing acute respiratory distress syndrome (ARDS). Pneumonia also is generally the cause of death for people who develop influenza, although the mortality rate is lower (1%-3% for the influenza A H5N1 pandemic of 1918-1919 in the United States). Risk factors for a poor outcome of SARS-CoV-2 infection have so far been found to include older age and co-morbidities including chronic cardiovascular and respiratory conditions and current smoking status. In May 2020, the FDA authorized the emergency use of remdesivir for treatment of COVID-19 disease based on topline date of two clinical trials, even though an underpowered clinical trial did not find significant improvement in COVID- 19 patients treated with remdesivir. Nevertheless, remdesivir is the first and so far, only approved treatment for COVID-19. Additionally further trials and clinical observations have not found a significant benefit of other antiviral drugs. Although the results of several studies are still pending, there is still a desperate need for an effective, safe treatment for COVID-19. Aviptadil, which is a synthetic form of Human Vasoactive Intestinal Polypeptide (VIP), might be beneficial in patients at risk of developing ARDS. Nonclinical studies demonstrate that VIP is highly concentrated in the lung, where it reduces inflammation.
About 20% of individuals with Corona Virus disease (COVID-19) experience more severe disease
characterized by significant respiratory symptoms including acute respiratory distress
syndrome (ARDS). ARDS is a known lethal complication due to its low blood oxygenation levels
and may result in organ failure. Until now, there are no specific vaccines or therapeutic
drugs targeting SARS-CoV-2, alternative therapeutic interventions are needed to prevent and
ameliorate respiratory conditions associated with COVID-19 to effectively reduce mortality
and prevent ICU admissions. Aviptadil, which is a synthetic form of Human Vasoactive
Intestinal Polypeptide (VIP), might be beneficial in patients at risk of developing ARDS.
Nonclinical studies demonstrate that VIP is highly concentrated in the lung, where it
prevents N-methyl-D-aspartate (NMDA)-induced caspase-3 activation, inhibits IL-6 and TNFa
production and protects against HCl-induced pulmonary edema. Further, in animal model systems
of lung injury in mice, rats, guinea pigs, sheep, swine and dogs, Aviptadil was shown to
restore barrier function at the endothelial/alveolar interface and to protect the lung and
other organs from failure. In Europe, Aviptadil is approved for human use and has been shown
to be safe in phase II trials for sarcoidosis, pulmonary fibrosis, bronchospasm, erectile
dysfunction as well as in a phase I trial in ARDS in the past two decades. In the US, VIP has
been given FDA Orphan Drug Designation for the treatment of ARDS and was admitted to the FDA
Corona Virus Technology Accelerator Program. In a phase I trial of Aviptadil performed by
Sami Said in the early 2000s, eight patients with severe ARDS on mechanical ventilation were
treated with ascending doses of intravenous VIP. Seven patients (88%) were successfully
extubated and were alive at the five day time point. Six (75%) left the hospital and one
(13%) died of an unrelated cardiac event. A phase II clinical trial using intravenous
Aviptadil in patients with COVID-19 infection and ARDS has begun. Further, a phase II/III
clinical trial will study the effect of inhaled Aviptadil for the treatment of non-acute lung
injury in COVID- 19 and begins in June 2020. In Europe, two phase II trials of Aviptadil have
been conducted. Further, studies with healthy volunteers have shown that inhaled Aviptadil is
well tolerated with few adverse effects.
Drug: Aviptadil 67μg
Participants will receive standard care plus a dose of 67μg nebulized Aviptadil three times a day for ten days.
Drug: Placebo 0.9% NaCl solution
Patiens will receive Standard care plus 0.9% NaCl solution three times a day for ten days
Inclusion Criteria:
- COVID-19 infection diagnosed
- Risk factors for the development of an ARDS according to an adapted EALI (early acute
lung injury score) ≥ 2 Points (with at least one point from the EALI score)
EALI Score:
- 2-6l O2 supplementation to achieve a SaO2>90%: 1 point
- >6l O2 supplementation to achieve a SaO2>90%: 2 points
- Respiratory rate ≥ 30/min: 1 point
- Immunosuppression: 1 Point
Modification (for adapting for risk factors for ARDS in SARS-CoV-2 affected patients
- Arterial hypertension: 1 point
- Diabetes: 1 point
- Fever > 39°C: 1 point
- Age > 18 years
- Ability to adequate compliance with the inhalation manoeuvre
- Ability to sign the informed consent
Exclusion Criteria:
- Known or highly suspected bacterial infection (antibiotic treatment to avoid bacterial
superinfection may be allowed)
- PCT ≥ 1μg/l
- Mechanical ventilation
- Inability to conduct inhalation therapy
- Hemodynamic instability with requirement of vasopressor therapy
- Severe comorbidities interfering with the safe participation at the trial according to
the treating physician
- Pregnancy
- Systemic immunosuppression
Cantonal Hospital Baselland Liestal
Liestal, BL, Switzerland
Cantonal Hospital St.Gallen
St.Gallen, Switzerland
Jörg D Leuppi, Professor
+41 61 925 2181
joerg.leuppi@ksbl.ch
Kristin Abig
+41 925 37 54
kristin.abig@ksbl.ch
Jörg D Leuppi, Professor, Principal Investigator
Cantonal Hosptal, Baselland