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Pneumonia, ViralNCT04380818

Low Dose Anti-inflammatory Radiotherapy for the Treatment of Pneumonia by COVID-19

A study testing Low-dose radiotherapy, Hydroxychloroquine Sulfate and Ritonavir/lopinavir in people with Pneumonia, Viral, run by Grupo de Investigación Clínica en Oncología Radioterapia at 3 sites in Spain.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Low radiation doses produce anti-inflammatory effects, which may be useful in the treatment of respiratory complications of COVID-19. This type of treatment is non-invasive and therefore, a priori, it can be used in all types of patients. Read more about this study

Who is it for?
Ages 18 to 99 years
Conditions the study is for
Pneumonia, Viral
What is being tested?
Low-dose radiotherapy, Hydroxychloroquine Sulfate and Ritonavir/lopinavir
Could I receive a placebo?
No, everyone receives an active treatment
How many people
106 participants
Where
3 sitesSpain
Study dates
5 Jun 2020to 1 Nov 2021
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 99 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age >=18 years old
  • Moderate to severe COVID-19 pneumonia with fewer than 8 days of symptom onset and currently receiving standard medication for COVID-19 at appropriate doses
  • PAFIO2 of less than 300 mmHg or SaFI02 <315 mmHg
  • Patients who are not candidates for admission to the Intensive Care Unit due to age, concomitant diseases or general condition.
  • One of the following conditions:
  • or IL6 greater than 40
Show all 10Show fewer
  • or PCR> 100mg / l
  • D-dimer greater than 1500ng / ml
  • Suspected cytokine release syndrome
  • Have read the information sheet and signed the informed consent

Who cannot join

  • Age <18 years
  • Failure to meet the inclusion criteria
  • Leukopenia <1000
  • Pregnancy
  • Not understanding or refusing the purpose of the study

Trial locations and contacts

3 sites in 1 country.

ANGEL MONTERO, Md, PhD contact

+34667767601

angel.monteroluis@gmail.com

Spain3 sites, 3 recruiting
  • Hospital Del Mar

    Barcelona, 08003

    MANEL ALGARA, MD, PhD, MAlgara@parcdesalutmar.cat

    Not yet recruiting
  • Hospital Universitario Madrid Sanchinarro

    Madrid, 28050

    Angel Montero, MD, PhD, +34915629949, amontero@hmhospitales.com

    Recruiting
  • Hospital Sant Joan de Reus

    Reus, Tarragona, 43204

    MERITXELL ARENAS, MD, PhD, meritxell.arenas@gmail.com

    Not yet recruiting

Other trials in Spain

About this study

Official title: Low Dose Anti-inflammatory Radiotherapy for the Treatment of Pneumonia by COVID-19: Multi-central Prospective Study

Low radiation doses produce anti-inflammatory effects, which may be useful in the treatment of respiratory complications of COVID-19. This type of treatment is non-invasive and therefore, a priori, it can be used in all types of patients.

Main objective: To evaluate the efficacy of low-dose lung irradiation as an adjunctive treatment in interstitial pneumonia in patients with COVID-19 by improving the PAFI O2 by 20% measured 48h after treatment with respect to the pre baseline measurement. -irradiation.

Read the detailed description

Study design: This is a prospective multicenter study in 2 phases:

  1. Exploratory phase. It will include 10 patients, to assess the feasibility and efficacy of low-dose lung irradiation. If a minimum efficiency of 30% is not achieved, the study will not be continued.
  2. Comparative phase in two groups, a control group, which will only receive pharmacological treatment, and an experimental one. It will include 96 patients, the allocation will be 1: 2, that is, 32 in the control arm and 64 in the experimental arm, which will receive low-dose lung irradiation.
Being tested
Low-dose radiotherapy, Hydroxychloroquine Sulfate, Ritonavir/lopinavir, Tocilizumab Injection [Actemra], Azithromycin
Keywords
COVID 19, RADIATION, Anti-inflammatory effects
Medical subject headings
Pneumonia, Viral, COVID-19

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Low-dose radiotherapyRadiation

    Bilateral low-dose lung irradiation: 0.5 Gy in a single fraction. Optionally, additional 0.5 Gy fraction 48h later

  • Hydroxychloroquine SulfateDrug

    Also called Dolquine

    200 mg/12h for 5 days

  • Ritonavir/lopinavirDrug

    Also called Kaletra

    400/100 mg/12h for 7-10 days

  • Tocilizumab Injection [Actemra]Drug

    Also called Actemra

    600 mg/day for 1-2 doses

  • AzithromycinDrug

    500 mg/24h for 3 days

  • CorticosteroidDrug

    Corticosteroids (methylprednisolone/dexamethasone/prednisone)

  • Low molecular weight heparinDrug

    low molecular weight heparin (LMWH) in prophylaxis of venous thromboembolism

  • Oxygen supplyDevice

    Oxygen

Study groups in NCT04380818
Study groupRoleWhat they receive
Control groupActive comparatora control group only receive pharmacological treatment
Receives: Drug: Hydroxychloroquine Sulfate; Drug: Ritonavir/lopinavir; Drug: Tocilizumab Injection [Actemra]; Drug: Azithromycin; Drug: Corticosteroid; Drug: Low molecular weight heparin; Device: Oxygen supply
Experimental groupExperimentalan experimental group will receive low-dose lung irradiation
Receives: Radiation: Low-dose radiotherapy; Drug: Hydroxychloroquine Sulfate; Drug: Ritonavir/lopinavir; Drug: Tocilizumab Injection [Actemra]; Drug: Azithromycin; Drug: Corticosteroid; Drug: Low molecular weight heparin; Device: Oxygen supply

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Efficacy of low-dose pulmonary irradiation assessed by change in PAFI O2 by 20%

    To evaluate the efficacy of low-dose pulmonary irradiation as an adjunctive treatment in interstitial pneumonia in patients with COVID-19 by improving the PAFI O2 by 20% measured 48h after treatment with respect to baseline pre-irradiation measurement. .

    In cases of impossibility the SaFiO2 will be determined

    Measured: Day 2 after interventional radiotherapy

Secondary outcomes (9)
  1. Number of participants with treatment-related adverse events as assessed by CTCAE v5.0

    Lung toxicity measured according to CTCAEv5

    Measured: Day 30 and day 90 after interventional radiotherapy

  2. Change of the radiological image

    Chest CT

    Measured: Days 7 and day 30 after interventional radiotherapy

  3. Overall mortality

    Death of any cause

    Measured: Day 15 and Day 30 after interventional radiotherapy

  4. Measure of pro-inflammatory interleukins

    Interleukins IL-6, IL-10, IL-1, IL-2, IL-8 (pg/ml)

    Measured: Days 1, day 4 and day 7 after interventional radiotherapy

  5. Measure of trasforming growth factor (TGF-b)

    TGF-β (ng/ml)

    Measured: Days 1, day 4 and day 7 after interventional radiotherapy

  6. Measure of tumor necrosis factor alpha (TNF-a)

    TNF-α (pg/ml)

    Measured: Days 1, day 4 and day 7 after interventional radiotherapy

  7. Determining overexpression of pro-inflammatory selectin

    Overexpression of L-, E-, and P-selectin

    Measured: Days 1, day 4 and day 7 after interventional radiotherapy

  8. Determining cell adhesion molecules (CAMs)

    Overexpression of ICAM-1, VCAM

    Measured: Days 1, day 4 and day 7 after interventional radiotherapy

  9. Measure of marker of oxidative stress PON-1

    PON-1(paraoxonase and arylesterase activity) (IU/ml)

    Measured: Days 1, day 4 and day 7 after interventional radiotherapy

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 May 2020
  2. Study start5 Jun 2020
  3. Primary completion4 Sep 2021 (estimated)
  4. Study completion1 Nov 2021 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
106 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04380818
Sponsor's protocol ID
IPACOVID
Status last verified
Jul 2021
First submitted
4 May 2020
Last updated
30 Jul 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Individual epidemiological and clinical data will be shared after recruitment is complete.

Publications

  • Conti P, Ronconi G, Caraffa A, Gallenga CE, Ross R, Frydas I, Kritas SK. Induction of pro-inflammatory cytokines (IL-1 and IL-6) and lung inflammation by Coronavirus-19 (COVI-19 or SARS-CoV-2): anti-inflammatory strategies. J Biol Regul Homeost Agents. 2020 March-April,;34(2):327-331. doi: 10.23812/CONTI-E.

    PubMed 32171193
  • Rodel F, Frey B, Manda K, Hildebrandt G, Hehlgans S, Keilholz L, Seegenschmiedt MH, Gaipl US, Rodel C. Immunomodulatory properties and molecular effects in inflammatory diseases of low-dose x-irradiation. Front Oncol. 2012 Sep 25;2:120. doi: 10.3389/fonc.2012.00120. eCollection 2012.

    PubMed 23057008
  • Arenas M, Sabater S, Hernandez V, Rovirosa A, Lara PC, Biete A, Panes J. Anti-inflammatory effects of low-dose radiotherapy. Indications, dose, and radiobiological mechanisms involved. Strahlenther Onkol. 2012 Nov;188(11):975-81. doi: 10.1007/s00066-012-0170-8. Epub 2012 Aug 22.

    PubMed 22907572
  • Arenas M, Gil F, Gironella M, Hernandez V, Biete A, Pique JM, Panes J. Time course of anti-inflammatory effect of low-dose radiotherapy: correlation with TGF-beta(1) expression. Radiother Oncol. 2008 Mar;86(3):399-406. doi: 10.1016/j.radonc.2007.10.032. Epub 2007 Nov 26.

    PubMed 18031855
  • Lodermann B, Wunderlich R, Frey S, Schorn C, Stangl S, Rodel F, Keilholz L, Fietkau R, Gaipl US, Frey B. Low dose ionising radiation leads to a NF-kappaB dependent decreased secretion of active IL-1beta by activated macrophages with a discontinuous dose-dependency. Int J Radiat Biol. 2012 Oct;88(10):727-34. doi: 10.3109/09553002.2012.689464. Epub 2012 May 22.

    PubMed 22545750
  • Calabrese EJ, Dhawan G. How radiotherapy was historically used to treat pneumonia: could it be useful today? Yale J Biol Med. 2013 Dec 13;86(4):555-70.

    PubMed 24348219
  • Calabrese EJ, Dhawan G, Kapoor R, Kozumbo WJ. Radiotherapy treatment of human inflammatory diseases and conditions: Optimal dose. Hum Exp Toxicol. 2019 Aug;38(8):888-898. doi: 10.1177/0960327119846925. Epub 2019 May 6.

    PubMed 31060383
  • Kirkby C, Mackenzie M. Is low dose radiation therapy a potential treatment for COVID-19 pneumonia? Radiother Oncol. 2020 Jun;147:221. doi: 10.1016/j.radonc.2020.04.004. Epub 2020 Apr 6. No abstract available.

    PubMed 32342871
  • Jean-Marc Cosset, Éric Deutsch, Louis Bazire, Jean-Jacques Mazeron, Cyrus Chargari, Irradiation pulmonaire à faible dose pour l'orage de cytokines du covid-19: pourquoi pas?, Cancer/Radiothérapie, 2020, , ISSN 1278-3218, https://doi.org/10.1016/j.canrad.2020.04.003.

  • Dhawan G, Kapoor R, Dhawan R, Singh R, Monga B, Giordano J, Calabrese EJ. Low dose radiation therapy as a potential life saving treatment for COVID-19-induced acute respiratory distress syndrome (ARDS). Radiother Oncol. 2020 Jun;147:212-216. doi: 10.1016/j.radonc.2020.05.002. Epub 2020 May 8.

    PubMed 32437820
  • Algara M, Arenas M, Marin J, Vallverdu I, Fernandez-Leton P, Villar J, Fabrer G, Rubio C, Montero A. Low dose anti-inflammatory radiotherapy for the treatment of pneumonia by covid-19: A proposal for a multi-centric prospective trial. Clin Transl Radiat Oncol. 2020 Jun 15;24:29-33. doi: 10.1016/j.ctro.2020.06.005. eCollection 2020 Sep.

    PubMed 32613089

Questions about this trial

What is this clinical trial studying?

A study testing Low-dose radiotherapy, Hydroxychloroquine Sulfate and Ritonavir/lopinavir in people with Pneumonia, Viral, run by Grupo de Investigación Clínica en Oncología Radioterapia at 3 sites in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 30 Jul 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact ANGEL MONTERO, Md, PhD (+34667767601, angel.monteroluis@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Efficacy of low-dose pulmonary irradiation assessed by change in PAFI O2 by 20% (time frame: Day 2 after interventional radiotherapy). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04380818, which also lists 11 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Jul 2021.

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