At present there is no approved drug treatment for Covid-19. In this study we plan to investigate if an experimental drug called IMU-838 (vidofludimus calcium) can improve your symptoms, prevent worsening that would initiate further treatments such as ventilation, and can lower your virus number if given in addition to your doctor's choice of standard therapy. We will also test if IMU-838 has any side effects and measure the level of IMU 838 in your blood. Experimental drug means that it is not yet authorized for marketing in your country. To date approximately 600 individuals have received IMU-838 (or a drug similar to IMU-838 that contains the same active substance as IMU-838) in research studies.
The trial consists of a Phase 2 proof-of-concept phase (Part 1) with the option to extend
enrollment (without interruption) to Phase 3 (Expansion Phase, Part 2).
This trial is a multicenter, double-blind, placebo-controlled, randomized, parallel-group
trial to evaluate the safety and efficacy of IMU-838 as addition to investigator's choice of
SoC treatment in patients with COVID-19. Eligible patients will be centrally randomized 1:1
to twice-daily (BID) oral 22.5 mg IMU-838 (45 mg/day + SoC) or placebo (+ SoC). Randomization
will be stratified by age (< or >=65 years) and antiviral therapy (no antivirals,
Hydroxychloroquine and Chloroquine, all other antivirals).
Adaptive sequential trial design and overall trial design
The trial uses an adaptive sequential design. An IDMC will review unblinded data and provide
the Sponsor with recommendations regarding modifications of sample size and trial conduct.
A 1st interim analysis (IA1) will be performed after approximately 200 patients have
completed the trial (either as scheduled or prematurely), while enrollment continues. If no
activity of IMU 838 is observed by the IDMC in this IA, further patient enrollment will be
stopped, and a final analysis of Part 1 will be performed (FA1). It is expected that the
final analysis of Part 1 will include approximately 230 patients. If the IA1 results indicate
activity of IMU-838 in COVID-19, the trial may be extended to Part 2 with a revised sample
size derived by the IDMC based on IA1 results and with possible other trial adjustments. If
the trial is extended into Part 2, a 2nd IA (IA2) is planned after approximately two-thirds
of patients (based on the overall global sample size [Part 1 and Part 2 combined]) have been
enrolled to potentially adjust sample size and other trial features if needed. The final
analysis of the trial (FA2) will then be done after all patients have completed Part 2.
In addition, an early interim safety analysis will be performed and evaluated by the IDMC
after 30 patients have been enrolled to assess unblinded safety data. Further safety analyses
can be initiated at any time by the IDMC or Sponsor when new safety signals are identified
within this or other trials of IMU-838.
Screening
Patients can be screened for a maximum of 2 days (from Day -2 to Day 0) and eligible patients
will be randomized on Day 0 and treated with IMP + SoC for 14 days. It is encouraged to
screen potential participants immediately at the day of hospitalization (including informed
consent, assessment of inclusion/exclusion criteria, screening laboratory tests all done
locally, assessment of clinical and blood gas criteria) and randomize patients on the same
day (Day 0). To assess eligibility criteria, existing local laboratory values obtained within
48 hours of randomization can also be used, except for testing of positive status of
SARS-CoV-2 infection where a 4-day window is allowed.
IMP administration should start as quickly as possible after randomization and first IMP
intended to be given in the evening of the screening day (Day 0).
Blinded Treatment period (Day 0 to Day 13) and Day 14 (end-of-treatment)
The first dose of IMP (2 tablets) should always be given on Day 0 (allowed range for first
dose: 12:00 noon on Day 0 to 02:00 a.m.). All further IMP doses are 1 tablet each in the
morning and evening. Information about the status and patient care are continuously obtained
and documented once or twice daily.
After the last IMP dose in the evening of Day 13, the end-of-treatment assessments will be
done on Day 14. Blood sampling for IMU-838 trough values must be performed in the morning
around the time the morning dose was usually taken by the respective patient. Patients may
then continue to receive SoC without any further restrictions on concomitant medications as
during the 14-day BT period .
Day 28 Visit (EoS)
The patient should return for the final trial visit on Day 28 (EoS). If IMP is prematurely
discontinued for any reason, the EoS visit should always be conducted on Day 28 and no
earlier EoS should be performed. If patients withdraw from IMP prematurely, they should be
encouraged to allow the EoS visit as part of the follow-up. If the patient dies during the
trial, the investigator should indicate that this visit was not performed. However, even if
no EoS visit was performed, information about patient status should be reported on the EoS
page in the case report form. If the patient refuses any EoS visit or the patient is lost to
follow-up, it is permissive in this trial that the investigator contacts the patient, the
family of the patient or the referring physician by phone or email to obtain status of life
information, or is able to search in registers or publicly available information for such
status of life information.
Drug: IMU-838
Tablets will be taken BID with a glass of water (if possible); one tablet each in the morning (15 to 50 min before a meal if applicable), and in the evening (2 hours after any meal if applicable).
If the patient is intubated for ventilation, IMP is to be given via a gastric tube. The tablet has no coating and a homogeneous content and can be crushed into smaller pieces (if necessary) for dosing via gastric tube.
Other Name: vidofludimus calcium
Other: Placebo
Matching placebo, twice-daily administration BID as described for the test product, identical number of tablets as given for IMU-838
Inclusion Criteria:
1. Male or female patients at least 18 years old (may be extended to include also
children 12 years or older after the 1st interim analysis)
2. Admitted to the hospital or other medical in-patient treatment facility for treatment
of COVID-19 The hospitalization needs to be for medical reasons (treatment of COVID-19
disease) and cannot be for social reasons or due to housing insecurity.
For US sites only: If the investigator would commonly hospitalize the patient but for
healthcare resource reasons decides to treat the patient in a specially designed
out-patient setting, then such patients are also allowed to enter the trial (please
note that in this case the patient would be counted as clinical status category 3).
The investigator then must assure that the patient has at least a twice daily
assessment by qualified trial personnel and all laboratory assessments can be
adequately performed as per protocol. The Sponsor reserves the right to discontinue
this option via administrative letter if such assurances cannot be met by any site.
3. SARS-CoV-2 infection confirmed by reverse transcriptase polymerase chain reaction
(RT-PCR) test in a nasopharyngeal, oropharyngeal or respiratory sample at ≤4 days
before randomization
4. Moderate COVID-19 disease defined as fulfilling clinical status category 3 or 4 on the
WHO 9-point ordinal scale [21]:
- Category 3: Hospitalized (see note above for US only), virus-positive, no oxygen
therapy with the following conditions:
- The hospitalization needs to be for medical reasons (treatment of COVID-19
disease) and cannot be for social reasons or due to housing insecurity
- Category 4: Hospitalized, virus-positive, oxygen by mask or nasal prongs
(excluding high-flow oxygen therapy) with the following conditions:
- Peripheral capillary oxyhemoglobin saturation (SpO2) >92% at maximum of 6 liters
oxygen flow per minute
- Stable respiratory rate ≤30 breaths/min at maximum of 6 liters oxygen flow per
minute
5. Presence of at least 1 symptom characteristic for COVID-19 disease i.e., fever, cough
or respiratory distress
6. Willingness and ability to comply with the protocol
7. Written informed consent given prior to any trial-related procedure
8. For women of childbearing potential: Application of a highly effective method of birth
control (failure rate less than 1% per year when used consistently and correctly)
together with a barrier method between trial consent and 30 days after the last intake
of the IMP.
Highly effective forms of birth control are those with a failure rate less than 1% per
year and include:
- oral, intravaginal, or transdermal combined (estrogen and progestogen containing)
hormonal contraceptives associated with inhibition of ovulation
- oral, injectable, or implantable progestogen-only hormonal contraceptives
associated with inhibition of ovulation
- intrauterine device or intrauterine hormone-releasing system
- bilateral tubal occlusion
- vasectomized partner (i.e., the patient's male partner underwent effective
surgical sterilization before the female patient entered the clinical trial and
is the sole sexual partner of the female patient during the clinical trial)
- sexual abstinence (acceptable only if it is the patient's usual form of birth
control/lifestyle choice; periodic abstinence [e.g., calendar, ovulation,
symptothermal, postovulation methods] and withdrawal are no acceptable methods of
contraception)
Barrier methods of contraception include:
- Condom
- Occlusive cap (diaphragm or cervical/vault caps) with spermicidal
gel/film/cream/suppository
9. Male patients must agree not to father a child or to donate sperm starting at
Screening, throughout the clinical trial and for 30 days after the last intake of the
IMP. Male patients must also
- abstain from sexual intercourse with a female partner (acceptable only if it is
the patient's usual form of birth control/lifestyle choice), or
- use adequate barrier contraception during treatment with the IMP and until at
least 30 days after the last intake of the IMP, and
- if they have a female partner of childbearing potential, the partner should use a
highly effective contraceptive method as outlined in inclusion criterion 8
- if they have a pregnant partner, they must use condoms while taking the IMP to
avoid exposure of the fetus to the IMP
Exclusion Criteria:
Underlying disease-related exclusion criteria
1. Involvement in the trial is not in the patient's best interest according to the
investigator's decision, including the presence of any condition that would, in the
assessment of the investigator, not allow the protocol to be followed safely Note: The
investigator should particularly consider exclusion of patients at increased risk for
serious or fatal AEs in case of worsening of the pulmonary perfusion. This includes,
but is not limited to, pre-existing pulmonary hypertension, severe chronic respiratory
disease, severely increased risk for thromboembolic complications and moderate to
severe left ventricular ejection fraction (LVEF) dysfunction. In addition, other known
risk factors of highest risk of mortality in COVID-19 patients should be considered.
2. Presence of respiratory failure, shock, and/or combined failure of other organs that
requires ICU monitoring in the near foreseeable future
3. Critical patients whose expected survival time <48-72 hours
4. Presence of the following laboratory values at screening:
- White blood cell count (WBC) <1.0 x 109/L
- Platelet count <100,000/mm³ (<100 x 109/L)
- Total bilirubin>2 x ULN
- Alanine aminotransferase (ALT) or gamma glutamyl transferase (GGT) >5 x ULN
5. Participation in any other interventional clinical trial
6. Hospitalization primarily for other reasons than COVID-19 (including primarily for
concomitant conditions during ongoing SARS-CoV-2 infection)
7. Anticipated transport to a different hospital or institution, in particular when such
transport is anticipated for pending ECMO or RRT treatment
8. Clinical suspicion of a bacterial superinfection at Screening IMP-related exclusion
criteria
9. Patients who cannot take drugs orally
10. Allergic or hypersensitive to the IMP or any of the ingredients
11. Use of the following concomitant medications is prohibited from Screening to end of
treatment with IMP in this trial (up to Day 14) if not indicated otherwise in this
protocol:
- Concurrent use of any mycophenolate mofetil or of methotrexate exceeding 17.5 mg
weekly
- Any medication known to significantly increase urinary elimination of uric acid,
in particular lesinurad (Zurampic™) as well as uricosuric drugs such as
probenecid
- Current treatments for any malignancy, in particular irinotecan, paclitaxel,
tretinoin, bosutinib, sorafenib, enasidenib, erlotinib, regorafenib, pazopanib
and nilotinib
- Any drug significantly restricting water diuresis, in particular vasopressin and
vasopressin analogs
- Use of rosuvastatin at daily doses higher than 10 mg
- Arbidol and Colchicine
- Any use of other DHODH inhibitors, including teriflunomide (Aubagio™) or
leflunomide (Arava™)
- Chloroquine and Hydroxychloroquine during the entire trial unless taken for
indicated use before entering the trial
12. Use of any investigational product within 8 weeks or 5x the respective half-life
before the date of informed consent, whichever is longer, and throughout the duration
of the trial General exclusion criteria
13. Patients who have a "do not intubate" or "do not resuscitate" order (unless the
patient waives in writing this order and will allow intubation for the duration of the
trial period)
14. Patients with end-stage liver disease (Child Pugh C score)
15. History or presence of serious or acute heart disease such as uncontrolled cardiac
dysrhythmia or arrhythmia, uncontrolled angina pectoris, cardiomyopathy, or
uncontrolled congestive heart failure (New York Heart Association [NYHA] class 3 or 4)
Note: NYHA class 3: Cardiac disease resulting in marked limitation of physical
activity. Patients are comfortable at rest. Less than ordinary activity causes
fatigue, palpitation, dyspnea, or anginal pain. NYHA class 4: Cardiac disease
resulting in inability to carry on any physical activity without discomfort. Symptoms
of heart failure or the anginal syndrome may be present even at rest. If any physical
activity is undertaken, discomfort is increased.
16. Legal incapacity, limited legal capacity, or any other condition that makes the
patient unable to provide consent for the trial
17. Pregnant or breastfeeding
18. An employee of an investigator or Sponsor or an immediate relative of an investigator
or Sponsor
19. Patients institutionalized due to judicial order
Military Medical Academy, Clinic of Infectious Diseases
Sofia, Bulgaria
UMHATEM N.I.Pirogov, Clinic of internal diseases
Sofia, Bulgaria
University Hospital Frankfurt, Infectious Diseases
Frankfurt, Germany
Clinic of the Hannover Medical School, Pneumology Clinic
Hannover, Germany