The primary objective of this study is to evaluate the time to confirmed clinical recovery in participants hospitalized with COVID-19. Candidate agents will be evaluated frequently for efficacy and safety, with candidate agents being added to and/or removed from the study on an ongoing basis, depending on the results of their evaluation.
This adaptive, randomized, placebo-controlled platform study is designed to rapidly assess
multiple candidate agents as treatments for COVID-19 in hospitalized patients. Candidate
agents will be evaluated frequently (through ongoing monitoring) for futility and safety,
with candidate agents being added to and/or removed from the study on an ongoing basis,
depending on the results of their evaluation.
For inclusion, participants will need to be hospitalized with a clinical status of Grade 2 to
Grade 5, as defined by the following Clinical Severity Status 8-Point Ordinal Scale:
1. Death
2. Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation
(ECMO)
3. Hospitalized, on noninvasive ventilation or high-flow oxygen devices
4. Hospitalized, requiring supplemental oxygen
5. Hospitalized, not requiring supplemental oxygen, requiring ongoing medical care
(COVID-19 related or otherwise)
6. Hospitalized, not requiring supplemental oxygen, no longer requires ongoing medical care
7. Not hospitalized, limitation on activities and/or requiring home oxygen
8. Not hospitalized, no limitations on activities
Participants will be randomized equally to either the candidate agent plus standard of care
(SoC) or placebo plus SoC in a double-blind fashion. Participants who are randomized to
placebo plus SoC will subsequently be randomized equally to a matching placebo corresponding
to an available agent whose sub-protocol the patient qualified for (ie, a 2-stage
randomization). Each participant in the placebo plus SoC group will only receive one type of
placebo. Randomization will be stratified by baseline clinical severity of 2 on the 8-point
ordinal scale (yes/no) and remdesivir use at baseline (yes/no).
The study will evaluate each candidate agent separately as an add-on to the SoC to assess
safety and efficacy. The comparator group for a candidate agent will include participants
randomized to the placebo arm of any sub-protocol according to the following conditions:
- Apremilast sub-protocol: participants who were enrolled concurrently to apremilast and
who would have been eligible for the apremilast sub-protocol.
- Lanadelumab sub-protocol: at a site where at least one participant was randomized to
either lanadelumab active or placebo arms.
- Zilucoplan sub-protocol: at a site where at least one participant was randomized to
either the zilucoplan active or placebo arms.
Drug: Standard of care
Standard of care (SoC) treatment for COVID-19 infection in line with institutional practice. The SoC may change as new information becomes available about treating COVID-19.
Drug: Apremilast
Apremilast administered orally as a tablet.
Other Name: Otezla
Drug: Apremilast placebo
Matching apremilast placebo administered orally as a tablet.
Drug: Lanadelumab
Lanadelumab administered as an intravenous (IV) infusion.
Other Name: Array
Drug: Lanadelumab placebo
Matching lanadelumab placebo (normal saline) administered as an intravenous (IV) infusion.
Drug: Zilucoplan
Zilucoplan administered as a subcutaneous (sc) injection in the abdomen, thigh, or upper arm.
Drug: Zilucoplan placebo
Matching zilucoplan placebo administered as a subcutaneous (sc) injection in the abdomen, thigh, or upper arm.
Inclusion Criteria:
- Adults (≥18 years of age) with active severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) infection confirmed by laboratory tests and/or point of care tests (eg,
commercial or public health assay, which is approved for emergency use). If no
diagnostic test results are available that have been obtained during the previous 72
hours, then a test should be performed as part of the screening assessment.
- A score of Grade 2 (hospitalized, on invasive mechanical ventilation or ECMO), Grade 3
(hospitalized, on noninvasive ventilation or high-flow oxygen devices), Grade 4
(hospitalized, requiring supplemental oxygen), or Grade 5 (hospitalized, not requiring
supplemental oxygen, requiring ongoing medical care [COVID-19 related or otherwise]),
as defined by an 8 point ordinal scale.
- Male participants:
- A male participant must agree to use contraception during the treatment period
and for at least 6 weeks after the last dose of study treatment and refrain from
donating sperm during this period.
- Female participants:
- A female participant is eligible to participate if she is not pregnant, not
breastfeeding, and at least 1 of the following conditions applies:
- Not a woman of childbearing potential (WOCBP). OR
- A WOCBP who agrees to follow the contraceptive guidance during the treatment
period and for at least 6 weeks after the last dose of study treatment.
- Ability to provide informed consent signed by the study participant or legally
authorized representative.
- Ability and willingness to participate in telephone/telemedicine follow-up visits if
needed.
- Zilucoplan only: Antibiotic prophylaxis: all participants must be willing to take
antibiotic prophylaxis concomitantly, starting with the first dose of zilucoplan or
placebo.
Exclusion Criteria:
- Participant has any condition for which, in the opinion of the Investigator,
participation would not be in the best interest of the participant (eg, compromise
their well-being) or that could prevent, limit, or confound the protocol-specified
assessments (eg, participants unable to swallow study medication tablets).
- Stage 4 severe chronic kidney disease or requiring dialysis.
- Screening 12-lead electrocardiogram (ECG) with a measurable QTc interval according to
Fridericia correction (QTcF) ≥ 500 ms.
- Anticipated transfer to another hospital that is not a study center within 72 hours.
- Participants who are currently pregnant or who are not willing to discontinue
breastfeeding.
- Participants participating in another clinical study of an investigational medicinal
product or other unapproved (or investigational) treatment for COVID-19.
- Active tuberculosis or a history of incompletely treated tuberculosis.
- Active, uncontrolled systemic bacterial or fungal infection(s).
- Apremilast only: Current treatment with apremilast, or another agent of similar
mechanism of action, for any indication within 1 week prior to first dose of
investigational product.
- Apremilast only: Concurrent use at screening or randomization of cytochrome P450
(CYP)3A inducers (eg, rifampin, phenobarbital, carbamazepine) within 1 week prior to
first dose of investigational product.
- Apremilast only: Known hypersensitivity to apremilast or any excipients in
formulation.
- Lanadelumab only: Known or suspected hypersensitivity to lanadelumab or any of its
excipients.
- Lanadelumab only: Previous (within 3 months prior to baseline) or current use of
immunomodulators (eg, methotrexate, azathioprine, 6-mercaptopurine, tumor necrosis
factor [TNF] α inhibitor, Janus kinase [JAK] inhibitor, alpha-integrin inhibitor).
- Lanadelumab only: Known or suspected venous thromboembolism.
- Lanadelumab only: Previous (within 3 months [or 5 half-lives, whichever is greater] of
screening) or current use of plasma kallikrein (pKal) inhibitor or bradykinin receptor
blocker.
- Zilucoplan only: Participants with unresolved or suspected infection with Neisseria
meningitidis or a past history of N. meningitidis (eg, in a complement-deficient
patient).
Pinnacle Research Group LLC
Anniston, Alabama, United States
Good Samaritan Hospital
Bakersfield, California, United States
Sharp Chula Vista Medical Center
Chula Vista, California, United States
El Centro Regional Medical Center
El Centro, California, United States
University of California Irvine Medical Center
Orange, California, United States
Riverside Community Hospital
Riverside, California, United States
National Institute of Clinical Research
S. El Monte, California, United States
University of California Davis Health System
Sacramento, California, United States
UF Health Shands Hospital
Gainesville, Florida, United States
Memorial Hospital Jacksonville
Jacksonville, Florida, United States
Grady Health System
Atlanta, Georgia, United States
Great Lakes Clinical Trials
Chicago, Illinois, United States
The University of Iowa
Iowa City, Iowa, United States
Harper University Hospital
Detroit, Michigan, United States
Sinai Grace Hospital
Detroit, Michigan, United States
Detroit Receiving Hospital
Royal Oak, Michigan, United States
University of Tennessee Health Sciences Center
Memphis, Tennessee, United States
Medical City Ft. Worth
Fort Worth, Texas, United States
University of Texas Health Science Center at Houston
Houston, Texas, United States
Texoma Medical Center
Sherman, Texas, United States
MultiCare Health System Institute for Research and Innovation
Tacoma, Washington, United States
Hospital San Juan de Dios
Ramos Mejia, Buenos Aires, Argentina
Hospital General de Agudos Dr. J. M. Ramos Mejia
Ciudad Autonoma Buenos Aires, Argentina
Hospital General de Agudos Dr. Ignacio Pirovano
Ciudad Autonoma Buenos Aires, Argentina
Clinica Adventista Belgrano
Ciudad Autonoma Buenos Aires, Argentina
Hospital Italiano de Rosario
Rosario, Argentina
Chronos Pesquisa Clinica
Brasília, Distrito Federal, Brazil
HC-UFG - Hospital das Clínicas da Universidade Federal de Goiás
Goiânia, Goiás, Brazil
Santa Casa de Misericórdia de Belo Horizonte
Belo Horizonte, Minas Gerais, Brazil
Hospital de Clínicas de Porto Alegre
Porto Alegre, Rio Grande Do Sul, Brazil
UNESP - Faculdade de Medicina da Universidade Estadual Paulista - Campus Botucatu
Botucatu, Sao Paulo, Brazil
Praxis Pesquisa Médica
Santo André, Sao Paulo, Brazil
Hospital Base Osorno
Osorno, Chile
Hospital General de Tijuana
Tijuana, Baja California Norte, Mexico
Hospital Civil de Guadalajara Dr. Juan I. Menchaca
Guadalajara, Jalisco, Mexico
Universidad Autonoma de Nuevo Leon, Hospital Universitario Dr. Jose Eleuterio Gonzalez
Monterrey, Nuevo León, Mexico
Hospital Civil de Culiacan
Culiacán, Sinaloa, Mexico
TSBIH "Krasnoyarsk Interdistrict Clinical Hospital of Emergency Medical Care n.a. N.S. Karpovich
Krasnoyarsk, Russian Federation
SBIH of Moscow "Infectious Clinical Hospital # 1 of Department of Healthcare of Moscow"
Moscow, Russian Federation
SPb SBIH "Alexandrovskaya City Hospital"
Saint Petersburg, Russian Federation
St-George Hospital
Saint Petersburg, Russian Federation
SPb SBIH "Nikolaevskaya Hospital"
Saint Petersburg, Russian Federation
SPb SBIH "City Pokrovskaya Hospital"
Saint Petersburg, Russian Federation
SPb SBIH "City Hospital # 40 of Kurortnyi region"
Sestroretsk, Russian Federation
Nelson Mandela Academic Clinical Research Unit (NeMACRU)
Mthatha, Eastern Cape, South Africa
Johese Clinical Research: Unitas
Centurion, Gauteng, South Africa
MERC SiReN
Johannesburg, Gauteng, South Africa
Drs Sarvan and Moodley
Durban, KwaZulu-Natal, South Africa
Tread Research
Cape Town, Western Cape, South Africa
Tiervlei Trial Centre
Cape Town, Western Cape, South Africa
2 Military Hospital Internal Medicine
Cape Town, Western Cape, South Africa
Dr JM Engelbrecht Trial Site
Somerset West, Western Cape, South Africa
Clinical Projects Research SA (PTY) LTD
Worcester, Western Cape, South Africa
Communal Noncommercial Profit "Clinical City Hospital 16 of Dnipro Regional Council"
Dnipro, Ukraine
CNE of Kharkov RC Reg Cl Infectious Hospital
Kharkiv, Ukraine
Communal Non-Commercial Medical Enterprise "O.T.Bohayevskyi Kremenchuk City Hospital #1"
Kremenchuk, Ukraine
City Clinical infectious Hospital
Odesa, Ukraine
Municipal Non-Profit Enterprise Central City Hospital Of Rivne City Council
Rivne, Ukraine
CCH #1 Vinnytsia M.I.Pyrogov NMU Ch of Infectious Diseases
Vinnytsia, Ukraine