Non-inferiority Trial on Treatments in Early COVID-19

COVID-19 Clinical Trial

Official title:

Adaptive, Randomized, Non-inferiority Trial on the Use of Monoclonal Antibodies or Antivirals in Outpatients With Mild or Moderate COVID-19

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05321394
• Other study ID #: MANTICO 2
• Secondary ID: 2021-002612-31
• Status: Completed
• Phase: Phase 3
• Start date: March 7, 2022
• Est. completion date: October 29, 2023

Study information

• Verified date: November 2023
• Source: Azienda Ospedaliera Universitaria Integrata Verona
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The study aims at assessing the non-inferiority of tixagevimab plus cilgavimab and nirmatrelvir plus ritornavir vs. sotrovimab (reference standard due to the wider evidence gathered on its efficacy) on COVID-19 progression in a real-life setting of outpatients aged at least 50 years at an early stage of the disease. The progression of COVID-19 disease (hospitalization, need for supplementary oxygen therapy at home, death) within 14 days of randomisation is the composite outcome variable on which the calculation of the sample size is based. Based on available data regarding the reduction in the number of hospitalisations and medical visits with the use of sotrovimab at an early-stage of COVID-19, a disease progression of 1% has been estimated in the reference arm. 3% delta margin was considered clinically relevant, taking into account both the estimates of disease progression in the study population in absence of early treatment (7%, based on national data) and the efficacy of the reference standard. Therefore, 1095 participants will be randomly assigned in an equal ratio between the reference standard and each of the other two experimental arms (1:1:1). Randomization will be computer-generated in permuted blocks with a stratification based on site.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 536
• Est. completion date: October 29, 2023
• Est. primary completion date: October 29, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 50 Years and older

Eligibility

Inclusion Criteria:

• Age = 50 years

• Informed consent by the subject or legally authorized representative

• Laboratory-confirmed SARS-CoV-2 infection, as determined by PCR or other commercial or public health assay in any specimen, no more than 4 days prior to the study drug administration

• Peripheral oxygen saturation = 94% on room air and not requiring supplemental oxygen

• Onset of symptom is no more than 4 days prior to the study drug administration. Onset time of symptom is defined as the time when the patient experienced the presence of at least one of the following (but not limited to) SARS-CoV-2 infection-associated symptom (FDA, September 2020): nasal obstruction or congestion, cough, fever > 37.3 °C, sore throat, body pain or muscle pain, headache, loss of taste or smell, nausea or vomiting, diarrhoea

Exclusion Criteria:

• Previously or currently hospitalized or requiring hospitalization

• Respiratory distress with respiratory rate = 25 breaths/min

• Heart rate = 125 beats per minute

• Peripheral oxygen saturation = 93% on room air at sea level

• Known allergies to any of the components used in the formulation of the interventions

• Severe renal impairment (eGFR <30 mL/min)

• Severe hepatic impairment (Child-Pugh Class C)

• Co-administration with drugs highly dependent on CYP3A for clearance and for which elevated concentrations are associated with serious and/or life-threatening reactions

• Co-administration with potent CYP3A inducers

• Hemodynamic instability requiring use of pressors within 24 hours of randomization

• Suspected or proven serious, active bacterial, fungal, viral, or other infection (besides COVID-19) that could potentially lead to hospitalization in within 30 days

• Any co-morbidity requiring surgery within 7 days or that is considered life-threatening within 90 days

• History of a positive SARS-CoV-2 test prior to the one serving as eligibility for this study

• Other investigational intervention for SARS-CoV-2 prophylaxis within 30 days before dosing

• Previous treatment with a SARS-CoV-2 specific monoclonal antibody

• History of convalescent COVID-19 plasma treatment

• Participation, within the last 30 days, in a clinical study involving an investigational intervention

• Pregnancy or breast feeding

• Investigator site personnel directly affiliated with this study

• Sexually active women of childbearing potential or sexually active men who are unwilling to practice effective contraception prior to the initial dose/start of the first treatment, during the study, and for at least 6 months after the last dose

• Inability to participate to the study follow-up

Related Conditions & MeSH terms

• COVID-19

Intervention

Drug:
• Sotrovimab
Single intravenous infusion of sotrovimab 500 mg (500 mg/8 mL), administered in 100 mL prefilled 0.9% sodium chloride injection infusion solution over 1/2 hour.
• Tixagevimab Cilgavimab
2 subsequent injections: tixagevimab 300mg/3mL (100mg/mL) cilgavimab 300mg/3mL (100mg/mL)
• Nirmatrelvir Ritonavir
300 mg nirmatrelvir (two 150 mg tablets) with 100 mg ritonavir (one 100 mg tablet) with all three tablets taken together twice daily for 5 days

Locations

Country	Name	City	State
Italy	RCCS Policlinico di S. Orsola	Bologna
Italy	PO SS Trinità di Cagliari	Cagliari
Italy	Azienda Ospedaliera Cannizzaro	Catania
Italy	Azienda Ospedaliera Universitaria Policlinico Vittorio Emanuele	Catania
Italy	PO Garibaldi Nesima	Catania
Italy	Azienda Socio-Sanitaria Territoriale di Cremona	Cremona
Italy	Ospedale S. Maria Annunziata	Firenze
Italy	Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico	Milano
Italy	Azienda Ospedaliera dei Colli, presidio ospedaliero Cotugno	Napoli
Italy	Azienda Ospedaliera di Padova	Padova
Italy	AOU Policlinico	Palermo
Italy	Azienda Ospedaliera S. Maria della Misericordia	Perugia
Italy	Università degli Studi di Pescara	Pescara
Italy	Fondazione Policlinico Universitario A. Gemelli	Roma
Italy	Ospedale San Paolo ASL 2 Savonese	Savona
Italy	AOU Città della Salute e Scienza, Presidio Molinette	Torino
Italy	Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI)	Trieste
Italy	Azienda Sanitaria Universitaria Friuli Centrale	Udine
Italy	Azienda Ospedaliera di Verona	Verona

Sponsors (3)

Lead Sponsor	Collaborator
Azienda Ospedaliera Universitaria Integrata Verona	Agenzia Italiana del Farmaco, Azienda Sanitaria-Universitaria Integrata di Udine

Country where clinical trial is conducted

Italy, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	COVID-19 progression	(1) hospitalization or (2) need of supplemental oxygen therapy at home or (3) death within 14 days of randomisation	14 days
Secondary	Visits to the Emergency Room	Number of visits to the Emergency Room without subsequent hospitalization within 28 days of randomization	28 days
Secondary	Duration of supplemental oxygen therapy	Days of supplemental oxygen therapy within 90 days of randomization	90 days
Secondary	Duration of hospitalization	Days of any hospitalization within 90 days of randomization	90 days
Secondary	Non-invasive ventilation	Rate of patients undergoing non-invasive ventilation within 28 days of randomization	28 days
Secondary	Duration of non-invasive ventilation	Days of non-invasive ventilation within 90 days of randomization	90 days
Secondary	Mechanical ventilation	Rate of patients undergoing mechanical ventilation within 28 of randomization	28 days
Secondary	Duration of mechanical ventilation	Days of mechanical ventilation within 90 days of randomization	90 days
Secondary	28-day mortality	Death rate at 28 days of randomization	28 days
Secondary	90-day mortality	Death rate at 90 days of randomization	90 days
Secondary	Duration of symptoms	Days of symptoms within 90 days of randomization	90 days