Coronavirus Disease 2019Phase 4CLARITYNCT04394117
Controlled evaLuation of Angiotensin Receptor Blockers for COVID-19 respIraTorY Disease
A Phase 4 study testing Angiotensin Receptor Blockers in people with Coronavirus Disease 2019 and COVID-19, run by The George Institute at 22 sites in 2 countries.
Trial summary
The Controlled evaLuation of Angiotensin Receptor Blockers for COVID-19 respIraTorY disease (CLARITY) study is a pragmatic prospective, open-label, randomised controlled trial. CLARITY aims to examine the effectiveness of angiotensin II receptor blockers (ARBs) on improving the outcomes of people who tested positive… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Coronavirus Disease 2019, COVID-19
- What is being tested?
- Angiotensin Receptor Blockers
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 787 participants
- Where
- 22 sitesin 2 countries
- Study dates
- 19 Jun 2020to 17 Jan 2022
- Phase
- Phase 4
- 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 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Potential participants must satisfy all of the following:
- Laboratory-confirmed* diagnosis of Severe Acute Respiratory Syndrome-Coronavirus-2 infection within 10 days prior to randomisation
- Age ≥ 18 years
- a) Systolic Blood Pressure (SBP) ≥ 120 mmHg OR b) SBP ≥ 115 mmHg and currently treated with a non-Renin Angiotensin Aldosterone System inhibitor Blood Pressure (BP) lowering agent that can be ceased
- Participant and treating clinician are willing and able to perform trial procedures.
- Either Intended for hospital admission for management of COVID-19, or (In Australia Only) Intended for management at home with one or more of the following criteria:
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- Age≥60 years
- Body Mass Index ≥30kg/m2 (derived from the patient's self-report of their height and weight where these are not measured directly)
- Diagnosis of diabetes defined as HbA1c ≥7% and/or the consumption of glucose lowering medication
- History of cardiovascular disease
- History of chronic respiratory illness
- Currently treated with immunosuppression
Who cannot join
- Currently treated with an angiotensin-converting enzyme inhibitor, Angiotensin Receptor Blocker or aldosterone antagonist, aliskiren, or angiotensin receptor-neprilysin inhibitors (ARNi)
- Serum potassium > 5.2 mmol/L or no potassium testing within the last 3 months
- For those intended for hospital admission, an estimated Glomerular Filtration Rate (eGFR) <30ml/min/1.73m2 or no eGFR testing within the last 3 months, or For those intended for management at home (Australia only), an eGFR <45ml/min/1.73m2 or no eGFR testing within the last 3 months
- Known symptomatic postural hypotension
- Known biliary obstruction, known severe hepatic impairment (Child-Pugh-Turcotte score 10-15) - see Table below
- Intolerance of ARB
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- Pregnancy or risk of pregnancy, defined as;
- (In Australia only) Women younger than 51 years who have not had a negative pregnancy test during the past 3 days and/or who do not agree to use adequate contraception
- (In India Only) Women who are pregnant
- Women who are currently breastfeeding
- Individuals who are not able to take medications by mouth at enrolment, or who are not expected to be able to take medications by mouth during the first 48 hours after randomisation
Trial locations and contacts
22 sites in 2 countries.
22 sites in 2 countries
Australia15 sites
Royal Prince Alfred Hospital
Camperdown, New South Wales, 2050
Canterbury Hospital
Campsie, New South Wales, 2194
The Sutherland Hospital
Caringbah, New South Wales, 2229
Concord Hospital
Concord, New South Wales, 2139
Northern Health
Epping, Victoria, 3076
Austin Health
Heidelberg, Victoria, 3084
St George Hospital
Kogarah, New South Wales, 2217
Liverpool Hospital
Liverpool, New South Wales, 2170
Alfred Health
Melbourne, Victoria, 3004
John Hunter Hospital
New Lambton Heights, New South Wales, 2305
Prince of Wales Hospital
Randwick, New South Wales, 2031
Western Health
St Albans, Victoria, 3021
Royal North Shore Hospital
St Leonards, New South Wales, 2065
Westmead Hospital
Westmead, New South Wales, 2145
Wollongong Hospital
Wollongong, New South Wales, 2500
India7 sites
Government Medical College & Hospital
Chandigarh
Post Graduate Institute of Medical Education & Research
Chandigarh
Lok Nayak Jai Prakash
Delhi
Kasturba Medical College
Manipal
Christian Hospital
Nowrangapur
Jivenrekha Hospital
Pune
All India Institute of Medical Science
Raipur
About this study
The Controlled evaLuation of Angiotensin Receptor Blockers for COVID-19 respIraTorY disease (CLARITY) study is a pragmatic prospective, open-label, randomised controlled trial. CLARITY aims to examine the effectiveness of angiotensin II receptor blockers (ARBs) on improving the outcomes of people who tested positive for COVID-19 disease.
- Conditions
- Coronavirus Disease 2019, COVID-19
- Being tested
- Angiotensin Receptor Blockers, Placebo
- Keywords
- Angiotensin Receptor Blocker (ARB), Angiotensin Converting Enzyme 2 (ACE2), Coronavirus Disease 2019 (COVID-19), Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-Cov-2)
- Medical subject headings
- COVID-19
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Angiotensin Receptor BlockersDrug
Also called Candesartan, Eprosartan, Irbesartan, Losartan
Angiotensin Receptor Blockers (ARBs) have been in clinical use for more than 30 years for their cardiac and renal protective effects. ARBs mechanism of action is through selective inhibition of angiotensin-II (Ang-II) by competitive antagonism of the angiotensin receptor. ARBs displace ang-II from the angiotensin I receptor and produce their protective effects by reducing the downstream effects of ang-II induced vasoconstriction, aldosterone release, catecholamine release, arginine vasopressin release, water intake, and hypertrophic response The virus causing COVID-19, SARS-CoV-2, binds to the extracellular portion of Angiotensin-Converting-Enzyme-2 (ACE2) expressed on type II alveolar cells in the lungs which is followed by internalization of ACE2 before downregulating membrane ACE2 expression. Both these components appear to require angiotensin receptor Type 1 (AT1R), and ARBs, which block the actions of AT1R, would reduce the severity of COVID-19 and reduce the duration of symptoms
PlaceboOther
Placebo
| Study group | Role | What they receive |
|---|---|---|
| Standard Care + Angiotensin Receptor Blocker (ARB) | Active comparator | Participants will receive an Angiotensin Receptor Blocker on top of the standard care provided by their institution. Receives: Drug: Angiotensin Receptor Blockers |
| Standard Care + Placebo | Placebo comparator | Participants will receive a placebo on top of the standard care provided by their institution. Receives: Other: Placebo |
What is being measured
The primary outcome is the main question the study is designed to answer.
7-Point National Institute of Health Clinical Health Score
To determine whether the addition of the intervention, compared to standard care, changes the clinical health score of a participant on the following scale;
- Not hospitalized, no limitations on activities.
- Not hospitalized, limitation on activities;
- Hospitalized, not requiring supplemental oxygen;
- Hospitalized, requiring supplemental oxygen;
- Hospitalized, on non-invasive ventilation or high flow oxygen devices;
- Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO);
- Death;
Measured: 14 Days
Secondary outcomes (14)
7-Point National Institute of Health Clinical Health Score
To determine whether the addition of the intervention, compared to standard care, changes the clinical health score of a participant on the following scale;
- Not hospitalized, no limitations on activities.
- Not hospitalized, limitation on activities;
- Hospitalized, not requiring supplemental oxygen;
- Hospitalized, requiring supplemental oxygen;
- Hospitalized, on non-invasive ventilation or high flow oxygen devices;
- Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO);
- Death;
Measured: 28 Days
Mortality
To determine whether the addition of the intervention, compared to standard care, changes the risk of all cause mortality
Measured: 28 Days
Mortality
To determine whether the addition of the intervention, compared to standard care, changes the risk of all cause mortality
Measured: 90 Days
Intensive Care Unit Admission
To determine whether the addition of the intervention, compared to standard care, changes the count of all cause Intensive Care Unit admission
Measured: 28 Days
Intensive Care Unit Admission
To determine whether the addition of the intervention, compared to standard care, changes the count of all cause Intensive Care Unit admission
Measured: 90 Days
Intensive Care Unit Number of Days
To determine whether the addition of the intervention, compared to standard care, changes the number of days total, of intensive care unit admission
Measured: 90 Days
Respiratory Failure
To determine whether the addition of the intervention, compared to standard care, changes the incidence of respiratory failure
Measured: 28 Days
Dialysis Requirement
To determine whether the addition of the intervention, compared to standard care, changes the requirements for dialysis
Measured: 28 Days
Hospitalisation Days
To determine whether the addition of the intervention, compared to standard care, changes the number of hospitalisation days
Measured: 28 Days
Hospitalisation Days
To determine whether the addition of the intervention, compared to standard care, changes the number of hospitalisation days
Measured: 90 Days
Ventilator-Free Days
To determine whether the addition of the intervention, compared to standard care, changes need for ventilation
Measured: 28 Days
Dialysis Days
To determine whether the addition of the intervention, compared to standard care, changes need for dialysis
Measured: 28 Days
Acute Kidney Injury
To determine whether the addition of the intervention, compared to standard care, changes risk of acute kidney injury, based on the Kidney Disease: Improving Global Outcomes definition
Measured: 28 Days
Hypotension Requiring Vasopressors
To determine whether the addition of the intervention, compared to standard care, changes risk of hypotension requiring vasopressors
Measured: 28 Days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted19 May 2020
- Study start19 Jun 2020
- Primary completion14 Nov 2021
- Study completion17 Jan 2022
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for Coronavirus Disease 2019Studies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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 4
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- CLARITY is a randomised control trial of two parallel groups; 1. Standard Care + Angiotensin Receptor Blocker (ARB) 2. Standard Care Participants will be randomised in a 1:1 ratio. Randomisation will be stratified according to country and whether the participant is planned for hospital admission or home-based care.
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 787 participants (actual)
Sponsor and investigators
- Lead sponsor
- The George Institute
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Meg Jardine, Study chair, University of Sydney
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04394117
- Sponsor's protocol ID
- 11052020
- Acronym
- CLARITY
- Status last verified
- Mar 2022
- First submitted
- 18 May 2020
- Last updated
- 17 Mar 2022
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: Trial data will be disseminated in the form of a publication to a relevant clinical journal and presentation at appropriate scientific conferences. Individual participant data that underlie the results reported, after de-identification (text, tables, figures, and appendices), may be shared with Investigators whose proposed use of the data has been approved by an independent review committee ("learned intermediary") identified for this purpose.
Publications
Jardine MJ, Kotwal SS, Bassi A, Hockham C, Jones M, Wilcox A, Pollock C, Burrell LM, McGree J, Rathore V, Jenkins CR, Gupta L, Ritchie A, Bangi A, D'Cruz S, McLachlan AJ, Finfer S, Cummins MM, Snelling T, Jha V; CLARITY trial investigators. Angiotensin receptor blockers for the treatment of covid-19: pragmatic, adaptive, multicentre, phase 3, randomised controlled trial. BMJ. 2022 Nov 16;379:e072175. doi: 10.1136/bmj-2022-072175.
PubMed 36384746McGree JM, Hockham C, Kotwal S, Wilcox A, Bassi A, Pollock C, Burrell LM, Snelling T, Jha V, Jardine M, Jones M; CLARITY Trial Steering Committee. Controlled evaLuation of Angiotensin Receptor Blockers for COVID-19 respIraTorY disease (CLARITY): statistical analysis plan for a randomised controlled Bayesian adaptive sample size trial. Trials. 2022 Apr 27;23(1):361. doi: 10.1186/s13063-022-06167-2.
PubMed 35477480Hockham C, Kotwal S, Wilcox A, Bassi A, McGree J, Pollock C, Burrell LM, Bathla N, Kunigari M, Rathore V, John M, Lin E, Jenkins C, Ritchie A, McLachlan A, Snelling T, Jones M, Jha V, Jardine M; CLARITY Investigators. Protocol for the Controlled evaLuation of Angiotensin Receptor blockers for COVID-19 respIraTorY disease (CLARITY): a randomised controlled trial. Trials. 2021 Aug 28;22(1):573. doi: 10.1186/s13063-021-05521-0.
PubMed 34454580
Study at a glance
From the registry record, last updated by the sponsor on 17 Mar 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Controlled evaLuation of Angiotensin Receptor Blockers for COVID-19 respIraTorY Disease
- ClinicalTrials.gov ID
- NCT04394117
- Acronym / sponsor ID
- CLARITY / 11052020
- Conditions
- Coronavirus Disease 2019, COVID-19
- Keywords
- Angiotensin Receptor Blocker (ARB), Angiotensin Converting Enzyme 2 (ACE2), Coronavirus Disease 2019 (COVID-19), Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-Cov-2)
- Phase
- Phase 4
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 787 participants (actual)
- Lead sponsor
- The George InstituteUniversity, hospital or other
- Study start
- 19 Jun 2020 (actual)
- Primary completion
- 14 Nov 2021 (actual)
- Study completion
- 17 Jan 2022 (actual)
- First posted
- 19 May 2020 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The Controlled evaLuation of Angiotensin Receptor Blockers for COVID-19 respIraTorY disease (CLARITY) study is a pragmatic prospective, open-label, randomised controlled trial. CLARITY aims to examine the effectiveness of angiotensin II receptor blockers (ARBs) on improving the outcomes of people who tested positive for COVID-19 disease.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
- Model description
- CLARITY is a randomised control trial of two parallel groups; 1. Standard Care + Angiotensin Receptor Blocker (ARB) 2. Standard Care Participants will be randomised in a 1:1 ratio. Randomisation will be stratified according to country and whether the participant is planned for hospital admission or home-based care.
| Arm | Type | Receives |
|---|---|---|
| Standard Care + Angiotensin Receptor Blocker (ARB) | Active comparator | Drug: Angiotensin Receptor BlockersParticipants will receive an Angiotensin Receptor Blocker on top of the standard care provided by their institution. |
| Standard Care + Placebo | Placebo comparator | Other: PlaceboParticipants will receive a placebo on top of the standard care provided by their institution. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (12 listed)
- Laboratory-confirmed* diagnosis of Severe Acute Respiratory Syndrome-Coronavirus-2 infection within 10 days prior to randomisation
- Age ≥ 18 years
- a) Systolic Blood Pressure (SBP) ≥ 120 mmHg OR b) SBP ≥ 115 mmHg and currently treated with a non-Renin Angiotensin Aldosterone System inhibitor Blood Pressure (BP) lowering agent that can be ceased
- Participant and treating clinician are willing and able to perform trial procedures.
- Either Intended for hospital admission for management of COVID-19, or (In Australia Only) Intended for management at home with one or more of the following criteria:
Key exclusion criteria (11 listed)
- Currently treated with an angiotensin-converting enzyme inhibitor, Angiotensin Receptor Blocker or aldosterone antagonist, aliskiren, or angiotensin receptor-neprilysin inhibitors (ARNi)
- Serum potassium > 5.2 mmol/L or no potassium testing within the last 3 months
- For those intended for hospital admission, an estimated Glomerular Filtration Rate (eGFR) <30ml/min/1.73m2 or no eGFR testing within the last 3 months, or For those intended for management at home (Australia only), an eGFR <45ml/min/1.73m2 or no eGFR testing within the last 3 months
- Known symptomatic postural hypotension
- Known biliary obstruction, known severe hepatic impairment (Child-Pugh-Turcotte score 10-15) - see Table below
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Angiotensin Receptor BlockersAlso: Candesartan, Eprosartan, Irbesartan, LosartanAngiotensin Receptor Blockers (ARBs) have been in clinical use for more than 30 years for their cardiac and renal protective effects. ARBs mechanism of action is through selective inhibition of angiotensin-II (Ang-II) by competitive antagonism of the angiotensin receptor. ARBs displace ang-II from the angiotensin I receptor and produce their protective effects by reducing the downstream effects of ang-II induced vasoconstriction, aldosterone release, catecholamine release, arginine vasopressin release, water intake, and hypertrophic response The virus causing COVID-19, SARS-CoV-2, binds to the extracellular portion of Angiotensin-Converting-Enzyme-2 (ACE2) expressed on type II alveolar cells in the lungs which is followed by internalization of ACE2 before downregulating membrane ACE2 expression. Both these components appear to require angiotensin receptor Type 1 (AT1R), and ARBs, which block the actions of AT1R, would reduce the severity of COVID-19 and reduce the duration of symptoms | Drug | Standard Care + Angiotensin Receptor Blocker (ARB) |
| PlaceboPlacebo | Other | Standard Care + Placebo |
Primary outcome
7-Point National Institute of Health Clinical Health Score
Time frame: 14 Days
To determine whether the addition of the intervention, compared to standard care, changes the clinical health score of a participant on the following scale; 1. Not hospitalized, no limitations on activities. 2. Not hospitalized, limitation on activities; 3. Hospitalized, not requiring supplemental oxygen; 4. Hospitalized, requiring supplemental oxygen; 5. Hospitalized, on non-invasive ventilation or high flow oxygen devices; 6. Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO); 7. Death;
14 secondary outcomes
7-Point National Institute of Health Clinical Health Score
Time frame: 28 Days
Mortality
Time frame: 28 Days
Mortality
Time frame: 90 Days
Intensive Care Unit Admission
Time frame: 28 Days
Intensive Care Unit Admission
Time frame: 90 Days
Intensive Care Unit Number of Days
Time frame: 90 Days
Respiratory Failure
Time frame: 28 Days
Dialysis Requirement
Time frame: 28 Days
Hospitalisation Days
Time frame: 28 Days
Hospitalisation Days
Time frame: 90 Days
Ventilator-Free Days
Time frame: 28 Days
Dialysis Days
Time frame: 28 Days
Acute Kidney Injury
Time frame: 28 Days
Hypotension Requiring Vasopressors
Time frame: 28 Days
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 17 Mar 2022.
- Derived from this study: PubMed 36384746Jardine MJ, Kotwal SS, Bassi A, Hockham C, Jones M, Wilcox A, Pollock C, Burrell LM, McGree J, Rathore V, Jenkins CR, Gupta L, Ritchie A, Bangi A, D'Cruz S, McLachlan AJ, Finfer S, Cummins MM, Snelling T, Jha V; CLARITY trial investigators. Angiotensin receptor blockers for the treatment of covid-19: pragmatic, adaptive, multicentre, phase 3, randomised controlled trial. BMJ. 2022 Nov 16;379:e072175. doi: 10.1136/bmj-2022-072175.
- Derived from this study: PubMed 35477480McGree JM, Hockham C, Kotwal S, Wilcox A, Bassi A, Pollock C, Burrell LM, Snelling T, Jha V, Jardine M, Jones M; CLARITY Trial Steering Committee. Controlled evaLuation of Angiotensin Receptor Blockers for COVID-19 respIraTorY disease (CLARITY): statistical analysis plan for a randomised controlled Bayesian adaptive sample size trial. Trials. 2022 Apr 27;23(1):361. doi: 10.1186/s13063-022-06167-2.
- Derived from this study: PubMed 34454580Hockham C, Kotwal S, Wilcox A, Bassi A, McGree J, Pollock C, Burrell LM, Bathla N, Kunigari M, Rathore V, John M, Lin E, Jenkins C, Ritchie A, McLachlan A, Snelling T, Jones M, Jha V, Jardine M; CLARITY Investigators. Protocol for the Controlled evaLuation of Angiotensin Receptor blockers for COVID-19 respIraTorY disease (CLARITY): a randomised controlled trial. Trials. 2021 Aug 28;22(1):573. doi: 10.1186/s13063-021-05521-0.
- Individual participant dataSharing planned: Yes. Trial data will be disseminated in the form of a publication to a relevant clinical journal and presentation at appropriate scientific conferences. Individual participant data that underlie the results reported, after de-identification (text, tables, figures, and appendices), may be shared with Investigators whose proposed use of the data has been approved by an independent review committee ("learned intermediary") identified for this purpose.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Meg Jardine study chair
University of Sydney
22 sites in 2 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 4 study testing Angiotensin Receptor Blockers in people with Coronavirus Disease 2019 and COVID-19, run by The George Institute at 22 sites in 2 countries.
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 12 inclusion and 11 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: finished, as of the sponsor's last update on 17 Mar 2022. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 22 sites in Australia, India. 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. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
7-Point National Institute of Health Clinical Health Score (time frame: 14 Days). 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 NCT04394117, which also lists 3 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 17 Mar 2022.