Safety and Efficacy of Dapansutrile for Treatment of Moderate COVID-19 Symptoms and Evidence of Early Cytokine Release Syndrome

Inclusion Criteria:

1. Male and female subjects ≥ 18 years of age;

2. SARS-CoV-2-positive, confirmed by Food and Drug Administration (FDA)- or European
Medicines Agency (EMA)-authorized COVID-19 test ≤ 7 days prior to randomization;

3. Less than or equal to 7 days from first symptom onset to randomization;

4. Subjects with moderate COVID-19 consistent with the definition of "moderate" as set
forth by the February 2021 FDA Guidance for Industry: COVID-19: Developing Drugs and
Biological Products for Treatment or

Prevention (FDA, 2021) who at the Screening/Baseline/Day 1 Visit:

1. have felt feverish within the past 24 hours,

2. have an SpO2 > 93% on room air at sea level when sitting, and

3. meet at least one of the following criteria: i). Respiratory rate: ≥ 20
breaths/minute, when the subject is sitting, ii). SpO2: ≤ 96% on room air at sea
level, when the subject is sitting, iii). Shortness of breath: with exertion, not
requiring oxygen, or vi). Heart rate: ≥ 90 beats/minute, when the subject is
sitting;

5. If all the criteria in Inclusion 4c are met, subject must possess at least one of the
following high-risk conditions known to have an underlying increased level of cytokine
production; otherwise, at least two of these high-risk conditions must be met:

1. 70 years or more of age,

2. Obesity (BMI ≥ 30 kg/m2),

3. Diabetes (type 1 or 2),

4. Uncontrolled hypertension, defined as diastolic > 100 mm Hg and/or systolic > 150
mm Hg without any current anti-hypertensive medications. At the time of screening
if the subject is on anti- hypertensive medication(s) and diastolic or systolic
rates are elevated, subject may be enrolled after consultation with the Medical
Monitor,

5. Known respiratory disease (including asthma or chronic obstructive pulmonary
disease [COPD]),

6. Known heart failure (note: subjects with New York Heart Association Class IV
congestive heart failure cannot be enrolled per Exclusion Criterion 4), or

7. Known coronary disease;

6. Plasma CRP level must be collected at Screening/Baseline/Day 1 Visit;

7. Acceptable overall medical condition to be safely enrolled in and complete the study
(with specific regard to cardiovascular, renal, and hepatic conditions) in the opinion
of the Investigator;

8. Ability to provide written, informed consent prior to initiation of any study- related
procedures, and ability in the opinion of the Investigator to understand and comply
with all the requirements of the study, which includes abstaining from the use of
prohibited medications.

9. Subject must present with at least moderate symptomatology, based on having symptoms
in the prior 24 hours that were uncomfortable and interfered with daily activities or
required treatment other than study drug and having at least one of the following
symptoms: cough; fatigue; myalgia; diarrhea; vomiting; nausea; headache; sore throat;
nasal congestion; rhinorrhea; loss of taste; loss of smell; fainting; or chills,
shivering, and/or sweating.

Exclusion Criteria:

1. Women of childbearing potential, or men whose sexual partner(s) is a woman of
childbearing potential, who:

1. Are or intend to become pregnant (including use of fertility drugs) during the
study;

2. Are nursing (female subjects only);

3. Are not using an acceptable, highly effective method of contraception until all
follow-up procedures are complete.

2. Evidence of pre-existing or new-onset organ failure;

3. Evidence of moderate concurrent nervous system, renal, endocrine, or gastrointestinal
disease, unrelated to COVID-19 as determined by the Investigator;

4. Evidence of cardiovascular disease with significant arrhythmia, congestive heart
failure (New York Heart Association Class IV), unstable angina, cor pulmonale, or
symptomatic pericardial effusion, not related to COVID-19 as determined by the
Investigator;

5. Required use of vasoactive drug support;

6. History of myocardial infarction in the 6 months prior to the Screening/Baseline/Day 1
Visit;

7. Evidence of current liver disease, not related to COVID-19 as determined by the
investigator;

8. History or evidence of active tuberculosis (TB) infection at Screening/Baseline/Day 1
Visit or one of the risk factors for tuberculosis such as but not limited or exclusive
to:

1. History of any of the following: residence in a congregate setting (e.g., jail or
prison, homeless shelter, or chronic care facility), substance abuse (e.g.,
injection or non-injection), health-care workers with unprotected exposure to
subjects who are at high risk of TB or subjects with TB disease before the
identification and correct airborne precautions of the subject or

2. Close contact (i.e., share the same air space in a household or other enclosed
environment for a prolonged period (days or weeks, not minutes or hours)) with a
person with active pulmonary TB disease within the last 12 months.

9. History of or currently active primary or secondary immunodeficiency;

10. Past or present requirement for oxygen (e.g., nasal cannula, proning, mechanical
ventilation and/or supplemental oxygen).

11. Use of any prohibited concomitant medications/therapies over the defined or planned
use of any concomitant medications/therapies during the

Treatment Period, including specifically:

1. use of ibuprofen or diclofenac

2. use of colchicine

3. use of systemic steroids within 30 days of randomization

4. use of janus kinase (JAK) inhibitors

5. use of off-label agents (e.g., hydroxychloroquine, remdesivir, dexamethasone) and
biologic and oral anti-cytokine agents (e.g., current treatment with adalimumab,
infliximab, etanercept, golimumab, certolizumab pegol, tocilizumab, sarilumab,
anakinra, canakinumab, rilonacept, baricitinib, tofacitinib, or upadacitinib);

Note: During the treatment period a patient may meet the criteria for a treatment
approved by the FDA specifically for COVID-19 (e.g. remdesivir). In this situation the
investigator and medical monitor should confer and take the most appropriate decision
for the patient. If possible, the preference would be for the patient to complete the
14 days of dosing before adding on the 2nd treatment. If that is not possible the
preference would be for the patient to continue their 14 days on dapansutrile and
complete all study related visits.

12. Known history of renal impairment (e.g., calculated glomerular filtration rate [GFR] <
45 mL/min);

13. Evidence of malignant disease, or malignancies diagnosed within the previous 5 years
(except for local basal or squamous cell carcinoma of the skin or carcinoma in situ of
the cervix uteri that has been excised and cured);

14. History of infection or known active infection with human immunodeficiency virus
(HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV);

15. Any other concomitant medical or psychiatric conditions, diseases, or prior surgeries
that, in the opinion of the Investigator, would impair the subject from safely
participating in the trial and/or completing protocol requirements;

16. Individuals who have been in a chronic care facility in the past 30 days;

17. Individuals who are incarcerated;

18. Participation in any clinical trial and/or use of any investigational product within
the immediate 30-day period prior to the Screening/Baseline//Day 1 Visit; or receipt
prior to Screening/Baseline/Day 1 Visit or intending to receive during the trial a
COVID-19 vaccination.