Official Title
Industry Alliance Platform Trial to Assess the Efficacy and Safety of Multiple Candidate Agents for the Treatment of COVID-19 in Hospitalized Patients
Brief Summary

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.

Detailed Description

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.

Completed
COVID-19

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.

Eligibility Criteria

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).

Eligibility Gender
All
Eligibility Age
Minimum: 18 Years ~ Maximum: N/A
Countries
Argentina
Brazil
Chile
Mexico
Russian Federation
South Africa
Ukraine
United States
Locations

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

NCT Number
Keywords
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
MeSH Terms
COVID-19
Thalidomide
Apremilast
Antibodies, Monoclonal