Early inhibition of entry and replication of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a very promising therapeutic approach. Polyclonal neutralizing antibodies offers many advantages such as providing immediate immunity, consequently blunt an early pro-inflammatory pathogenic endogenous antibody response and lack of drug-drug interactions1-3. Because a suboptimal endogenous early antibody response with regard to SARS-CoV-2 replication in severe cases is observed, neutralising antibody treatment can be very interesting for patient with COVID-19 induced moderate pneumonia4,5. Convalescent plasma to treat infected patients is therefore an interesting therapeutic option currently under evaluation. However, the difficulties of collecting plasma and its safety aspects are not adapted to many patients. A new polyclonal humanized anti-SARS-CoV2 antibodies (XAV-19) is being developed by Xenothera, which can be administered as intravenous treatment. XAV-19 is a heterologous swine glyco-humanized polyclonal antibody (GH-pAb) raised against the spike protein of SARS-CoV-2, inhibiting infection of ACE-2 positive human cells with SARS-CoV-2. Pharmacokinetic and pharmacodynamic studies have been performed in preclinical models including primates and a First In Human study with another fully representative GH-pAb from Xenothera is ongoing in volunteer patients recipients of a kidney graft. These studies indicated that 5 consecutive administrations of GH-pAbs can be safely performed in humans. The objective of this 2-steps phase 2 randomized double-blind, placebo-controlled study is 1) to define the optimal and safety XAV-19 dose to administrate in patients with COVID-19 induced moderate pneumonia ; 2) to show the clinical benefit of selected dose of XAV-19 when administered to patients with COVID-19 induced moderate pneumonia.
For the first set of statistical analyses, to allow early reporting of primary and secondary
endpoints at D15, the blind will be partially broken once all patients have completed Day 29.
Except for statisticians, only the principal investigator and the scientific coordinator will
have access to the full data set for the analysis of the primary and secondary endpoints up
to day 29. The database will be partially locked (with all data up to day 29) as neither
monitors nor investigators will be informed of the unblinding until the final data for day 60
is completed and the final database is locked.
Drug: XAV-19
Phase 2a: Administration on Day 1 and day 5 for Group1 and 2, Administration on Day 1 for Group 3 Phase 2b: Administration on Day 1
Drug: Placebo
Phase 2a: Administration on Day 1 and day 5 for Group1 and 2, Administration on Day 1 for Group 3 Phase 2b: Administration on Day 1
Phase 2a:
Inclusion Criteria:
1. Willing and able to provide written informed consent prior to performing study
procedures
2. Male or female ≥ 18 years and ≤ 85 years
3. Hospitalized for COVID-19
4. Positive SARS-CoV-2 RT-PCR in any body specimen (nasopharynx, saliva, sputum) ≤ 10
days before enrolment
5. Evidence of pulmonary involvement (on lung examination [rales/crackles] and/or
chest-imaging [Chest X-ray or computed tomography])
6. Requiring O2 supplement ≤ 6L/min at screening
7. Requiring O2 supplementation with SpO2 ≥ 94% on O2 therapy at screening
8. First onset of COVID-19 symptoms ≤ 10 days, among fever and/or chills, headache,
myalgias, cough, shortness of breath, whichever as occurred fist
9. WOCBP must have a negative urinary pregnancy test the day of inclusion
10. All sexually active male subjects must agree to use an adequate method of
contraception throughout the study period and for 90 days after the last dose of study
drug and agree to no sperm donation until the end of the study, or for 90 days after
the last dose of XAV-19, whichever is longer
11. Patients with French social security
Exclusion Criteria:
1. Evidence of multiorgan failure (severe COVID-19)
2. Mechanically ventilated (including ECMO)
3. Receipt of immunoglobulins or any blood products in the past 30 days
4. Psychiatric or cognitive illness or recreational drug/alcohol use that in the opinion
of the investigator, would affect subject safety and/or compliance
5. End-stage renal disease (eGFR < 15 ml/min/1,73 m2)
6. Child-Pugh C stage liver cirrhosis
7. Decompensated cardiac insufficiency
8. History of active drug abuse
9. Known allergy, hypersensitivity, or intolerance to the study drug, or to any of its
components
10. Females of childbearing potential without contraceptive method, or with positive
pregnancy test, breastfeeding, or planning to become pregnant during the study period
11. Current documented and uncontrolled bacterial infection.
12. Prior severe (grade 3) allergic reactions to plasma transfusion
13. Patient participating in another interventional clinical trial
14. Life expectancy estimated to be less than 6 months
15. Patient under guardianship or trusteeship
Phase 2b:
Inclusion criteria:
1. Willing and able to provide written informed consent prior to performing study
procedures
2. Male or female ≥ 18 years
3. Hospitalized for COVID-19
4. Documentation of SARS-Cov-2 infection before enrolment, by positive SARS-CoV-2 RT-PCR
or antigen in any body specimen (nasopharynx, oropharynx, saliva, sputum,
bronchoalveolar lavage …) before enrolment
5. Evidence of pulmonary involvement (on lung examination [rales/crackles] and/or
chestimaging [Chest X-ray or computed tomography])
6. Requiring O2 supplement ≤ 6L/min at screening
7. Requiring O2 supplementation with SpO2 ≥ 92% on O2 therapy at screening (or ≥ 90
% if chronic obstructive pulmonary disease)
8. First onset of COVID-19 symptoms ≤ 14 days, among fever and/or chills, headache,
myalgias, cough, shortness of breath, whichever as occurred fist (other symptoms such
as asthenia not to be considered in this list)
9. WOCBP must have a negative urinary pregnancy test the day of inclusion
10. All sexually active male subjects must agree to use an adequate method of
contraception throughout the study period and for 90 days after the last dose of study
drug and agree to no sperm donation until the end of the study, or for 90 days after
the last dose of XAV-19, whichever is longer
11. Patients with French social security
Exclusion criteria:
1. Evidence of multiorgan failure (severe COVID-19)
2. Mechanically ventilated (including ECMO)
3. Receipt of immunoglobulins or any blood products in the past 30 days
4. Psychiatric or cognitive illness or recreational drug/alcohol use that in the opinion
of the investigator, would affect subject safety and/or compliance
5. End-stage renal disease (eGFR < 15 ml/min/1,73 m2)
6. Child-Pugh C stage liver cirrhosis
7. Decompensated cardiac insufficiency
8. Known allergy, hypersensitivity, or intolerance to the study drug, or to any of its
components
9. Females of childbearing potential without contraceptive method, or with positive
pregnancy test, breastfeeding, or planning to become pregnant during the study period
10. Current documented and uncontrolled bacterial infection.
11. Prior severe (grade 3) allergic reactions to plasma transfusion
12. Patient participating in another interventional clinical trial
13. Life expectancy estimated to be less than 6 months
14. Patient under guardianship or trusteeship
15. Patient already included
16. Prior hospitalisation in intensive care unit for the current covid-19 episode
CHU Amiens Picardie
Amiens, France
CHU Angers
Angers, France
Hôpital Privé d'Antony
Antony, France
CH Avignon
Avignon, France
CH de la Côte Basque
Bayonne, France
APHP - Hôpital Avicennes
Bobigny, France
CHU Caen
Caen, France
CH Métropole Savoie
Chambéry, France
CH Colmar
Colmar, France
CH Sud Francilien
Corbeil-Essonnes, France
CHD Vendée
La Roche-sur-Yon, France
CH de La Rochelle
La Rochelle, France
CH Le Mans
Le Mans, France
CHRU Lille
Lille, France
CHU Limoges
Limoges, France
Hospices Civils Lyon
Lyon, France
CH de Mont de Marzan
Mont-de-Marsan, France
GHR Mulhouse Sud-Alsace
Mulhouse, France
CHU Nantes
Nantes, France
CHU Nice
Nice, France
CHU Nîmes
Nîmes, France
CHR Orléans La Source
Orléans, France
APHP - Hôpital Tenon
Paris, France
Hôpital Saint Antoine
Paris, France
CH René Dubos
Pontoise, France
CH Cornouaille
Quimper, France
CHU Reims
Reims, France
CHU Saint Etienne
Saint-Priest-en-Jarez, France
CHU Strasbourg
Strasbourg, France
Hôpital FOCH
Suresnes, France
CHRU Nancy
Vandœuvre-lès-Nancy, France
CH Bretagne Atlantique
Vannes, France
CHU Martinique
Fort de France, Martinique
CHU La Réunion
Saint-Pierre, Réunion
Benjamin Gaborit, Principal Investigator
CHU Nantes