Efficacy and Safety of aerosolizedDornase Alfa Administration in Patients With COVID19 Induced ARDS (COVIDORNASE)

COVID-19 Clinical Trial

— COVIDORNASE  

Official title:

Efficacy and Safety of Dornase Alfa Aerosol in ARDS Secondary to SARS-CoV-2 Coronavirus Respiratory Infection - COVID-19

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT04355364
• Other study ID #: CGE_2020_9
• Status: Terminated
• Phase: Phase 3
• Start date: April 21, 2020
• Est. completion date: December 20, 2021

Study information

• Verified date: December 2021
• Source: Fondation Ophtalmologique Adolphe de Rothschild
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study plans to learn more about the effects of Dornase Alfa in COVID19 (coronavirus disease of 2019) patients, the medical condition caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Dornase Alfa is a FDA-approved drug for the treatment of cystic fibrosis, which facilitates mucus clearance by cutting apart neutrophil-derived extracellular double-stranded DNA. This study intends to define the impact of aerosolized intra-tracheal Dornase Alfa administration on the severity and progression of acute respiratory distress syndrome (ARDS) in COVID-19 patients. This drug might make lung mucus thinner and looser, promoting improved clearance of secretions and reduce extracellular double-stranded DNA-induced hyperinflammation in alveoli, preventing further damage to the lungs. The study will recruit mechanically ventilated patients hospitalized in ICU who have been diagnosed with COVID-19 and meet ARDS criteria. It is a prospective, randomized, controlled, multicentric, open-label clinical trial. The goal is to recruit 100 patients.

Description:

Acute Respiratory Distress Syndrome (ARDS) is the most severe form of COVID-19 with a mortality reaching 50%. To date, no specific therapy has been shown to be effective. During an acute viral respiratory infection, lungs are the site of an intense neutrophil recruitment. Recruited neutrophils generate NETs (extracellular neutrophil traps) in the alveoli and bronchioles. NETs have been shown to be involved in bronchoalveolar congestion and amplification of the inflammatory response during viral pneumonia responsible for ARDS. Deoxyribonuclease 1 (DNAse 1) is an enzyme capable of cutting apart extracellular DNA strands, the backbone of NETs. The administration of recombinant human DNAse 1 (dornase alfa) leads to the loosening of the broncho-alveolar mucus and to a reduction in the inflammatory response within the alveoli. By conducting a randomized, open-label, multicenter, controlled trial, our goal is to evaluate the efficacy and safety of aerosolized intra-tracheal dornase alfa administration in mechanically ventilated patients hospitalized for COVID19-related ARDS. This is a randomized, controlled, multicentric, open-label clinical trial to evaluate the efficacy and safety of dornase alfa administration aerosol, intensive care hospitalized patients with COVID19-related ARDS. The comparison of D7-D0 between the groups will be carried out using a linear regression fitted to the stratification factors.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 77
• Est. completion date: December 20, 2021
• Est. primary completion date: December 20, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

inclusion criteria

• Adult patient (age = 18 years old);
• Hospitalized in intensive care ;
• Severe COVID-19 pneumonia (positive diagnosis by RT-PCR or SARS-CoV-2 antigen test on nasopharyngeal or deep respiratory specimen and/or evocative thoracic scan: frosted glass opacities, consolidation, cross-linking, thickening of interlobular septa, peripheral nodules) with ARDS criteria according to Berlin criteria (PaO2/FiO2 = 300 and PEP = 5).
• With respiratory assistance (intubated or NIV or ONHD) for less than 8 days;
• With an expected duration of respiratory assistance > 48 hours;
• Carrier of an arterial catheter ;
• For which 4 PaO2/FiO2 values on arterial blood over the last 24 hours are available;

Exclusion Criteria:

• Known hypersensitivity to Dornase alfa or any of the excipients;
• Pregnant or breastfeeding status;
• Patient with legal protection.

Related Conditions & MeSH terms

• Acute Lung Injury
• Acute Respiratory Distress Syndrome
• COVID-19
• Respiratory Distress Syndrome
• Respiratory Distress Syndrome, Newborn

Intervention

Drug:
• Dornase Alfa Inhalation Solution [Pulmozyme]
Administered by nebulization, at a dose of 2500 IU twice daily, 12 hours apart, for 7 consecutive days

Procedure:
• standard procedure
Patients will receive the usual care in accordance with good practice.

Locations

Country	Name	City	State
France	Hôpital Fondation A. de Rotschhild	Paris

Sponsors (3)

Lead Sponsor	Collaborator
Fondation Ophtalmologique Adolphe de Rothschild	Centre Hospitalier Régional Metz-Thionville, University Hospital, Strasbourg, France

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Efficacy of intratracheal administration: occurrence of at least one grade improvement	The primary endpoint is the occurrence of at least one grade improvement between D0 (inclusion) and D7 in the ARDS scale severity (Berlin criteria). For instance from severe to moderate or from moderate to mild	Day 7