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AzTrials

COVID-19Phase 3NCT04401579

Adaptive COVID-19 Treatment Trial 2 (ACTT-2)

A Phase 3 study testing Remdesivir and Baricitinib in people with COVID-19, run by National Institute of Allergy and Infectious Diseases (NIAID) at 71 sites in 8 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

ACTT-2 will evaluate the combination of baricitinib and remdesivir compared to remdesivir alone. Subjects will be assessed daily while hospitalized. If the subjects are discharged from the hospital, they will have a study visit at Days 15, 22, and 29. Read more about this study

Who is it for?
Ages 18 to 99 years
Conditions the study is for
COVID-19
What is being tested?
Remdesivir and Baricitinib
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
1,033 participants
Where
71 sitesin 8 countries
Study dates
8 May 2020to 31 Jul 2020
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

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

  • Admitted to a hospital with symptoms suggestive of COVID-19.
  • Subject (or legally authorized representative) provides informed consent prior to initiation of any study procedures.
  • Subject (or legally authorized representative) understands and agrees to comply with planned study procedures.
  • Male or non-pregnant female adult > / = 18 years of age at time of enrollment.
  • Has laboratory-confirmed SARS-CoV-2 infection as determined by polymerase chain reaction (PCR) or other commercial or public health assay in any specimen, as documented by either of the following:
  • PCR positive in sample collected < 72 hours prior to randomization; OR
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  • PCR positive in sample collected >/= 72 hours prior to randomization, documented inability to obtain a repeat sample (e.g. due to lack of testing supplies, limited testing capacity, results taking >24 hours, etc.) AND progressive disease suggestive of ongoing SARS-CoV-2 infection.
  • Illness of any duration, and at least one of the following:
  • Radiographic infiltrates by imaging (chest x-ray, CT scan, etc.), OR
  • SpO2 < / = 94% on room air, OR
  • Requiring supplemental oxygen, OR
  • Requiring mechanical ventilation or extracorporeal membrane oxygenation (ECMO).
  • Women of childbearing potential must agree to either abstinence or use at least one primary form of contraception not including hormonal contraception from the time of screening through Day 29.
  • Agrees to not participate in another clinical trial for the treatment of COVID-19 through Day 29.

Who cannot join

  • Alanine Transaminase (ALT) or Aspartate Transaminase (AST) > 5 times the upper limit of normal.
  • Estimated glomerular filtration rate (eGFR) < 30 ml/min or patient is receiving hemodialysis or hemofiltration at time of screening.
  • Neutropenia (absolute neutrophil count <1000 cells/microliter) (<1.0 x 103/microliter or <1.0 GI/L).
  • Lymphopenia (absolute lymphocyte count <200 cells/microliter) (<0.20 x 103/microliter or <0.20 GI/L)
  • Pregnancy or breast feeding.
  • Anticipated discharge from the hospital or transfer to another hospital which is not a study site within 72 hours.
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  • Allergy to any study medication.
  • Received three or more doses of remdesivir, including the loading dose, outside of the study under the EUA (or similar mechanism) for COVID-19.
  • Received convalescent plasma or intravenous immunoglobulin [IVIg]) for COVID-19, the current illness for which they are being enrolled.
  • Received small molecule tyrosine kinase inhibitors (e.g. baricitinib, imatibib, genfinitib), in the 1 week prior to screening
  • Received monoclonal antibodies targeting cytokines (e.g., TNF inhibitors, anti-interleukin-1 [IL-1], anti-IL-6 [tocilizumab or sarilumab]), or T-cells (e.g., abatacept) in the 4 weeks prior to screening.
  • Received monoclonal antibodies targeting B-cell (e.g., rituximab, and including any targeting multiple cell lines including B-cells) in the 3 months prior to screening.
  • Received other immunosuppressants in the 4 weeks prior to screening and in the judgement of the investigator, the risk of immunosuppression with baricitinib is larger than the risk of COVID-19.
  • Received >/= 20 mg/day of prednisone or equivalent for >/=14 consecutive days in the 4 weeks prior to screening.
  • Use of probenecid that cannot be discontinued at study enrollment.
  • Have diagnosis of current active tuberculosis (TB) or, if known, latent TB treated for less than 4 weeks with appropriate anti-tuberculosis therapy per local guidelines (by history only, no screening required).
  • Suspected serious, active bacterial, fungal, viral, or other infection (besides COVID-19) that in the opinion of the investigator could constitute a risk when taking investigational product.
  • Have received any live vaccine (that is, live attenuated) within 4 weeks before screening, or intend to receive a live vaccine (or live attenuated) during the study. Note: Use of non-live (inactivated) vaccinations is allowed for all subjects.
  • Have a history of VTE (deep vein thrombosis [DVT] or pulmonary embolism [PE]) within 12 weeks prior to screening or have a history of recurrent (>1) VTE (DVT/PE).
  • Immunocompromised patients, patients with a chronic medical condition, or those taking a medication that cannot be discontinued at enrollment, who, in the judgment of PI, are at increased risk for serious infections or other safety concerns given the study products.

Trial locations and contacts

71 sites in 8 countries.

71 sites in 8 countries

United States53 sites
  • University of New Mexico Clinical and Translational Science Center

    Albuquerque, New Mexico, 87106

  • Eastern Colorado Health Care System

    Aurora, Colorado, 80045

  • University of Maryland School of Medicine - Center for Vaccine Development - Baltimore

    Baltimore, Maryland, 21201

  • Johns Hopkins Hospital - Medicine - Infectious Diseases

    Baltimore, Maryland, 21287-0005

  • Walter Reed National Military Medical Center

    Bethesda, Maryland, 20889

  • National Institutes of Health - Clinical Center, National Institute of Allergy and Infectious Diseases Laboratory Of Immunoregulation, Clinical Research Section

    Bethesda, Maryland, 20892-1504

  • University of Alabama at Birmingham School of Medicine - Infectious Disease

    Birmingham, Alabama, 35233

  • Massachusetts General Hospital - Infectious Diseases

    Boston, Massachusetts, 02114-2621

  • University of Virginia - Acute Care Surgery

    Charlottesville, Virginia, 22908-0816

  • Northwestern Hospital - Infectious Disease

    Chicago, Illinois, 60611-2908

  • University of Illinois at Chicago College of Medicine - Division of Infectious Diseases

    Chicago, Illinois, 60612

  • Baylor Scott & White Health - Baylor University Medical Center - North Texas Infectious Disease Consultants

    Dallas, Texas, 75246

  • University of Texas Southwestern Medical Center - Internal Medicine - Infectious Diseases

    Dallas, Texas, 75390-8884

  • Emory Vaccine Center - The Hope Clinic

    Decatur, Georgia, 30030-1705

  • Atlanta VA Medical Center - Infectious Diseases Clinic

    Decatur, Georgia, 30033

  • Denver Health Division of Hospital Medicine - Main Campus

    Denver, Colorado, 80204

  • Duke Human Vaccine Institute - Duke Vaccine and Trials Unit

    Durham, North Carolina, 27704

  • Womack Army Medical Center - Pulmonary and Respiratory Services

    Fort Bragg, North Carolina, 28310

  • Brooke Army Medical Center

    Fort Sam Houston, Texas, 78234

  • University of Florida Health - Shands Hospital - Division of Infectious Diseases and Global Medicine

    Gainesville, Florida, 32610

  • University of Texas Medical Branch - Division of Infectious Disease

    Galveston, Texas, 77555-0435

  • Penn State Health Milton S. Hershey Medical Center - Division of Infectious Diseases

    Hershey, Pennsylvania, 17033

  • Baylor College of Medicine - Molecular Virology and Microbiology

    Houston, Texas, 77030-3411

  • Indiana University School of Medicine - Infectious Diseases

    Indianapolis, Indiana, 46202

  • Ochsner Medical Center - Kenner - Department of Infectious Diseases

    Kenner, Louisiana, 70065

  • EvergreenHealth Infectious Disease Service

    Kirkland, Washington, 98034

  • University of California San Diego Health - Jacobs Medical Center

    La Jolla, California, 29037

  • University of California Los Angeles Medical Center - Westwood Clinic

    Los Angeles, California, 90095

  • University of Miami Miller School of Medicine - Infectious Diseases

    Miami, Florida, 33136

  • University of Minnesota Medical Center, Fairview - Infectious Diseases and International Medicine

    Minneapolis, Minnesota, 55455-0341

  • Vanderbilt University Medical Center - Infectious Diseases

    Nashville, Tennessee, 37232-0011

  • Southeast Louisiana Veterans Health Care System (SLVHCS) - Section of Infectious Diseases

    New Orleans, Louisiana, 70119

  • New York University School of Medicine - Langone Medical Center - Microbiology - Parasitology

    New York, New York, 10016

  • University of Nebraska Medical Center - Infectious Diseases

    Omaha, Nebraska, 68198-5400

  • University of California Irvine Medical Center - Infectious Disease

    Orange, California, 92868-3298

  • VA Palo Alto Health Care System - Infectious Diseases

    Palo Alto, California, 94304-1207

  • Stanford University - Stanford Hospital and Clinics - Pediatrics - Infectious Diseases

    Palo Alto, California, 94304-1503

  • University of Pennsylvania Perelman School of Medicine - Penn Institute for Immunology

    Philadelphia, Pennsylvania, 19104-4863

  • Kaiser Permanente Northwest - Center for Health Research

    Portland, Oregon, 97227

  • Naval Medical Center Portsmouth - Infectious Disease Division

    Portsmouth, Virginia, 23708

  • University of Rochester Medical Center - Vaccine Research Unit

    Rochester, New York, 14642-0001

  • University of California Davis Medical Center - Internal Medicine - Infectious Disease

    Sacramento, California, 95817-1460

  • University of Utah - Infectious Diseases

    Salt Lake City, Utah, 84132

  • University of Texas Health Science Center at San Antonio - Infectious Diseases

    San Antonio, Texas, 78229-3901

  • Naval Medical Center San Diego - Infectious Disease Clinic

    San Diego, California, 92314

  • University of California San Francisco - Zuckerberg San Francisco General Hospital - Division of Human Immunodeficiency Virus, Infectious Disease, and Global Medicine

    San Francisco, California, 94110-2859

  • Providence Sacred Heart Medical Center

    Spokane, Washington, 99204

  • Saint Louis University - Center for Vaccine Development

    St Louis, Missouri, 63104-1015

  • Madigan Army Medical Center - Infectious Disease Clinic

    Tacoma, Washington, 98431

  • Montefiore Medical Center - Infectious Diseases

    The Bronx, New York, 10467-2401

  • Georgetown University Medical Center - Division of Infectious Diseases

    Washington D.C., District of Columbia, 20007

  • Cedars Sinai Medical Center

    West Hollywood, California, 90048-1804

  • University of Massachusetts Medical School - Infectious Diseases and Immunology

    Worcester, Massachusetts, 01655-0002

Other trials in United States

United Kingdom5 sites
  • Royal Sussex County Hospital - Department of Intensive Care Medicine

    Brighton

  • Saint Thomas' Hospital - Directorate of Infection

    City of London

  • St. James's University Hospital - Infectious Diseases

    Leeds

  • Royal Victoria Infirmary - Department of Infectious Diseases

    Newcastle upon Tyne

  • John Radcliffe Hospital

    Oxford

Other trials in United Kingdom

Singapore4 sites
  • National University Health System - Division of Infectious Diseases

    Singapore, 119228

  • National Centre for Infectious Diseases (NCID)

    Singapore, 308442

  • Changi General Hospital - Clinical Trials and Research Unit (CTRU)

    Singapore, 529889

  • Ng Teng Fong General Hospital - Infectious Disease Service

    Singapore, 609606

Other trials in Singapore

Spain3 sites
  • Hospital Clinic Barcelona, Servicio de Salud Internacional

    Barcelona, Catalonia, 08036

  • Hospital Germans Trias i Pujol - Servei Malalties Infeccioses

    Barcelona, Catalonia, 08916

  • Hospital Clinico San Carlos - Enfermedades Infecciosas

    Madrid, 28040

Other trials in Spain

Mexico2 sites
  • Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán - Departamento de Infectologia

    Mexico City, 14080

  • Instituto Nacional de Enfermedades Respiratorias (INER) - Ismael Cosío Villegas

    Mexico City, 14080

Other trials in Mexico

South Korea2 sites
  • Seoul National University Bundang Hospital - Division of Infectious Diseases

    Bundang-gu Seongnam-si, 13620

  • Seoul National University Hospital

    Seoul, 03080

Other trials in South Korea

Denmark1 site
  • University of Copenhagen - Centre of Excellence for Health, Immunity and Infections (CHIP) - Department of Infectious Diseases

    Copenhagen, 2100

Other trials in Denmark

Japan1 site
  • National Center for Global Health and Medicine Hospital - Disease Control and Prevention Center

    Tokyo, 162-8655

Other trials in Japan

About this study

Official title: A Multicenter, Adaptive, Randomized Blinded Controlled Trial of the Safety and Efficacy of Investigational Therapeutics for the Treatment of COVID-19 in Hospitalized Adults (ACTT-2)

ACTT-2 will evaluate the combination of baricitinib and remdesivir compared to remdesivir alone. Subjects will be assessed daily while hospitalized. If the subjects are discharged from the hospital, they will have a study visit at Days 15, 22, and 29. For discharged subjects, it is preferred that the Day 15 and 29 visits are in person to obtain safety laboratory tests and oropharyngeal (OP) swab and blood (serum only) samples for secondary research as well as clinical outcome data. However, infection control or other restrictions may limit the ability of the subject to return to the clinic. In this case, these visits may be conducted by phone, and only clinical data will be obtained. The Day 22 visit does not have laboratory tests or collection of samples and is conducted by phone. The primary outcome is time to recovery by Day 29.

Read the detailed description

This study is an adaptive randomized double-blind placebo-controlled trial to evaluate the safety and efficacy of novel therapeutic agents in hospitalized adults diagnosed with COVID-19. The study is a multicenter trial that will be conducted in up to approximately 100 sites globally. The study will compare different investigational therapeutic agents to a control arm. New arms can be introduced according to scientific and public health needs. There will be interim monitoring to allow early stopping for futility, efficacy, or safety. If one therapy proves to be efficacious, then this treatment may become the control arm for comparison(s) with new experimental treatment(s). Any such change would be accompanied by an updated sample size. This adaptive platform is used to rapidly evaluate different therapeutics in a population of those hospitalized with moderate to severe COVID-19. The platform will provide a common framework sharing a similar population, design, endpoints, and safety oversight. New stages with new therapeutics can be introduced. One independent Data and Safety Monitoring Board (DSMB) will actively monitor interim data in all stages to make recommendations about early study closure or changes to study arms.

ACTT-2 will evaluate the combination of baricitinib and remdesivir compared to remdesivir alone. Subjects will be assessed daily while hospitalized. If the subjects are discharged from the hospital, they will have a study visit at Days 15, 22, and 29. For discharged subjects, it is preferred that the Day 15 and 29 visits are in person to obtain safety laboratory tests and oropharyngeal (OP) swab and blood (serum only) samples for secondary research as well as clinical outcome data. However, infection control or other restrictions may limit the ability of the subject to return to the clinic. In this case, these visits may be conducted by phone, and only clinical data will be obtained. The Day 22 visit does not have laboratory tests or collection of samples and is conducted by phone.

All subjects will undergo a series of efficacy, safety, and laboratory assessments. Safety laboratory tests and blood (serum and plasma) research samples and oropharyngeal (OP) swabs will be obtained on Days 1 (prior to infusion) and Days 3, 5, 8, and 11 (while hospitalized). OP swabs and blood (serum only) plus safety laboratory tests will be collected on Day 15 and 29 (if the subject attends an in-person visit or are still hospitalized).

The primary outcome is time to recovery by Day 29. A key secondary outcome evaluates treatment-related improvements in the 8-point ordinal scale at Day 15. Each stage may prioritize different secondary endpoints for the purpose of multiple comparison analyses.

Contacts:

20-0006 Central Contact

Telephone: 1 (301) 7617948

Email: DMIDClinicalTrials@niaid.nih.gov

Conditions
COVID-19
Being tested
Placebo, Remdesivir, Baricitinib
Keywords
Adaptive, COVID-19, Efficacy, Multicenter, novel coronavirus, Safety
Medical subject headings
COVID-19

What participants receive

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

  • PlaceboOther

    The matching Baricitinib placebo contains lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, and magnesium stearate. The coating for the placebo tablet is identical to that of the corresponding active tablet.

  • RemdesivirDrug

    Drug Remdesivir is a single diastereomer monophosphoramidate prodrug designed for the intracellular delivery of a modified adenine nucleoside analog GS-441524. In addition to the active ingredient, the lyophilized formulation of Remdesivir contains the following inactive ingredients: water for injection, sulfobutylether beta-cyclodextrin sodium (SBECD), and hydrochloric acid and/or sodium hydroxide.

  • BaricitinibDrug

    Baricitinib is a Janus kinase (JAK) inhibitor with the chemical name [1-(ethylsulfonyl)-3-(4-(7Hpyrrolo(2,3-d)pyrimidin-4-yl)-1H-pyrazol-1-yl)azetidin-3-yl]acetonitrile Each tablet contains 2 mg of baricitinib and the following inactive ingredients: croscarmellose sodium, magnesium stearate, mannitol, microcrystalline cellulose, ferric oxide, lecithin (soya), polyethylene glycol, polyvinyl alcohol, talc and titanium dioxide.

Study groups in NCT04401579
Study groupRoleWhat they receive
Remdesivir plus BaricitinibExperimental200 mg of Remdesivir administered intravenously on Day 1, followed by a 100 mg once-daily maintenance dose of Remdesivir while hospitalized for up to a 10-day total course and 4 mg (2 tablets of 2 mg) of Baricitinib administered orally daily for the duration of the hospitalization up to a 14-day total course.
Receives: Drug: Remdesivir; Drug: Baricitinib
Remdesivir plus PlaceboPlacebo comparator200 mg of Remdesivir administered intravenously on Day 1, followed by a 100 mg once-daily maintenance dose of Remdesivir while hospitalized for up to a 10-day total course and 4 mg (2 tablets of 2 mg) of Baricitinib Placebo administered orally daily for the duration of the hospitalization up to a 14-day total course.
Receives: Other: Placebo; Drug: Remdesivir

What is being measured

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

  1. Time to Recovery

    Day of recovery is defined as the first day on which the subject satisfies one of the following three categories from the ordinal scale: 1) Not hospitalized, no limitations on activities; 2) Not hospitalized, limitation on activities and/or requiring home oxygen; 3) Hospitalized, not requiring supplemental oxygen and no longer requires ongoing medical care.

    Measured: Day 1 through Day 29

  2. Time to Recovery by Race

    Day of recovery is defined as the first day on which the subject satisfies one of the following three categories from the ordinal scale: 1) Not hospitalized, no limitations on activities; 2) Not hospitalized, limitation on activities and/or requiring home oxygen; 3) Hospitalized, not requiring supplemental oxygen and no longer requires ongoing medical care.

    Measured: Day 1 through Day 29

  3. Time to Recovery by Ethnicity

    Day of recovery is defined as the first day on which the subject satisfies one of the following three categories from the ordinal scale: 1) Not hospitalized, no limitations on activities; 2) Not hospitalized, limitation on activities and/or requiring home oxygen; 3) Hospitalized, not requiring supplemental oxygen and no longer requires ongoing medical care.

    Measured: Day 1 through Day 29

  4. Time to Recovery by Sex

    Day of recovery is defined as the first day on which the subject satisfies one of the following three categories from the ordinal scale: 1) Not hospitalized, no limitations on activities; 2) Not hospitalized, limitation on activities and/or requiring home oxygen; 3) Hospitalized, not requiring supplemental oxygen and no longer requires ongoing medical care.

    Measured: Day 1 through Day 29

Secondary outcomes (41)
  1. Change From Baseline in Alanine Transaminase (ALT)

    Blood to evaluate ALT was collected at Days 1, 3, 5, 8, and 11 while participants were inpatient, and at Days 15 and 29, with the Day 1 assessment serving as baseline. Participants who had been discharged had blood collected if infection control measures allowed for in-person visits after discharge.

    Measured: Days 1, 3, 5, 8, 11, 15 and 29

  2. Change From Baseline in Aspartate Transaminase (AST)

    Blood to evaluate AST was collected at Days 1, 3, 5, 8, and 11 while participants were inpatient, and at Days 15 and 29, with the Day 1 assessment serving as baseline. Participants who had been discharged had blood collected if infection control measures allowed for in-person visits after discharge.

    Measured: Days 1, 3, 5, 8, 11, 15 and 29

  3. Change From Baseline in Creatinine

    Blood to evaluate serum creatinine was collected at Days 1, 3, 5, 8, and 11 while participants were inpatient, and at Days 15 and 29, with the Day 1 assessment serving as baseline. Participants who had been discharged had blood collected if infection control measures allowed for in-person visits after discharge.

    Measured: Days 1, 3, 5, 8, 11, 15 and 29

  4. Change From Baseline in Glucose

    Blood to evaluate serum glucose was collected at Days 1, 3, 5, 8, and 11 while participants were inpatient, and at Days 15 and 29, with the Day 1 assessment serving as baseline. Participants who had been discharged had blood collected if infection control measures allowed for in-person visits after discharge.

    Measured: Days 1, 3, 5, 8, 11, 15 and 29

  5. Change From Baseline in Hemoglobin

    Blood to evaluate hemoglobin was collected at Days 1, 3, 5, 8, and 11 while participants were inpatient, and at Days 15 and 29, with the Day 1 assessment serving as baseline. Participants who had been discharged had blood collected if infection control measures allowed for in-person visits after discharge.

    Measured: Days 1, 3, 5, 8, 11, 15 and 29

  6. Change From Baseline in Platelets

    Blood to evaluate platelets was collected at Days 1, 3, 5, 8, and 11 while participants were inpatient, and at Days 15 and 29, with the Day 1 assessment serving as baseline. Participants who had been discharged had blood collected if infection control measures allowed for in-person visits after discharge.

    Measured: Days 1, 3, 5, 8, 11, 15 and 29

  7. Change From Baseline in Prothrombin International Normalized Ratio (INR)

    Blood to evaluate INR was collected at Days 1, 3, 5, 8, and 11 while participants were inpatient, and at Days 15 and 29, with the Day 1 assessment serving as baseline. Participants who had been discharged had blood collected if infection control measures allowed for in-person visits after discharge.

    Measured: Days 1, 3, 5, 8, 11, 15 and 29

  8. Change From Baseline in Total Bilirubin

    Blood to evaluate total bilirubin was collected at Days 1, 3, 5, 8, and 11 while participants were inpatient, and at Days 15 and 29, with the Day 1 assessment serving as baseline. Participants who had been discharged had blood collected if infection control measures allowed for in-person visits after discharge.

    Measured: Days 1, 3, 5, 8, 11, 15 and 29

  9. Change From Baseline in White Blood Cell Count (WBC)

    Blood to evaluate WBC was collected at Days 1, 3, 5, 8, and 11 while participants were inpatient, and at Days 15 and 29, with the Day 1 assessment serving as baseline. Participants who had been discharged had blood collected if infection control measures allowed for in-person visits after discharge.

    Measured: Days 1, 3, 5, 8, 11, 15 and 29

  10. Change From Baseline in Neutrophils

    BBlood to evaluate neutrophils was collected at Days 1, 3, 5, 8, and 11 while participants were inpatient, and at Days 15 and 29, with the Day 1 assessment serving as baseline. Participants who had been discharged had blood collected if infection control measures allowed for in-person visits after discharge.

    Measured: Days 1, 3, 5, 8, 11, 15 and 29

  11. Change From Baseline in Lymphocytes

    Blood to evaluate lymphocytes was collected at Days 1, 3, 5, 8, and 11 while participants were inpatient, and at Days 15 and 29, with the Day 1 assessment serving as baseline. Participants who had been discharged had blood collected if infection control measures allowed for in-person visits after discharge.

    Measured: Days 1, 3, 5, 8, 11, 15 and 29

  12. Change From Baseline in Monocytes

    Blood to evaluate monocytes was collected at Days 1, 3, 5, 8, and 11 while participants were inpatient, and at Days 15 and 29, with the Day 1 assessment serving as baseline. Participants who had been discharged had blood collected if infection control measures allowed for in-person visits after discharge.

    Measured: Days 1, 3, 5, 8, 11, 15 and 29

  13. Change From Baseline in Basophils

    Blood to evaluate basophils was collected at Days 1, 3, 5, 8, and 11 while participants were inpatient, and at Days 15 and 29, with the Day 1 assessment serving as baseline. Participants who had been discharged had blood collected if infection control measures allowed for in-person visits after discharge.

    Measured: Days 1, 3, 5, 8, 11, 15 and 29

  14. Change From Baseline in Eosinophils

    Blood to evaluate eosinophils was collected at Days 1, 3, 5, 8, and 11 while participants were inpatient, and at Days 15 and 29, with the Day 1 assessment serving as baseline. Participants who had been discharged had blood collected if infection control measures allowed for in-person visits after discharge.

    Measured: Days 1, 3, 5, 8, 11, 15 and 29

  15. Change in National Early Warning Score (NEWS) From Baseline

    The NEW score has demonstrated an ability to discriminate patients at risk of poor outcomes. This score is based on 7 clinical parameters (respiration rate, oxygen saturation, any supplemental oxygen, temperature, systolic blood pressure, heart rate, level of consciousness). The NEW Score is being used as an efficacy measure. The minimum score is 0, representing the better outcome, and the maximum value is 19, representing the worse outcome.

    Measured: Days 1, 3, 5, 8, 11, 15, 22, and 29

  16. Percentage of Participants Reporting Grade 3 and 4 Clinical and/or Laboratory Adverse Events (AEs)

    Grade 3 AEs are defined as events that interrupt usual activities of daily living, or significantly affects clinical status, or may require intensive therapeutic intervention. Severe events are usually incapacitating. Grade 4 AEs are defined as events that are potentially life threatening.

    Measured: Day 1 through Day 29

  17. Percentage of Participants Reporting Serious Adverse Events (SAEs)

    An SAE is defined as an AE or suspected adverse reaction is considered serious if, in the view of either the investigator or the sponsor, it results in death, a life-threatening AE, inpatient hospitalization or prolongation of existing hospitalization, a persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions, or a congenital anomaly/birth defect.

    Measured: Day 1 through Day 29

  18. Duration of Hospitalization

    Duration of hospitalization was determined two ways. The first includes imputations for participants who died. The second method is restricted to participants who did not die.

    Measured: Day 1 through Day 29

  19. Duration of New Non-invasive Ventilation or High Flow Oxygen Use

    Duration of new non-invasive ventilation or high flow oxygen use was measured in days among participants who were not on non-invasive ventilation or high-flow oxygen use at baseline, determined two ways. The first includes imputations for participants who died. The second method is restricted to participants who did not die

    Measured: Day 1 through Day 29

  20. Duration of New Oxygen Use

    Duration of new oxygen use was measured in days among participants who were not on oxygen at baseline, determined two ways. The first includes imputations for participants who died. The second method is restricted to participants who did not die

    Measured: Day 1 through Day 29

  21. Duration of New Ventilator or Extracorporeal Membrane Oxygenation (ECMO) Use

    Duration of new ventilator or ECMO use was measured in days among participants who were not on a ventilator or ECMO at baseline, determined two ways. The first includes imputations for participants who died. The second method is restricted to participants who did not die

    Measured: Day 1 through Day 29

  22. Duration of Oxygen Use

    Duration of oxygen use was measured in days among participants who were on oxygen in based, calculated in two ways. The first includes imputations for participants who died. The second method is restricted to participants who did not die.

    Measured: Day 1 through Day 29

  23. Percentage of Participants Discontinued or Temporarily Suspended From Investigational Therapeutics

    Participants may have been discontinued from investigational therapeutics due to discharge or death. The halting or slowing of the infusion for any reason was collected, as was missed doses in the series of 10 doses of Remdesivir, or in the 14 doses of Baricitinib/placebo.

    Measured: Day 1 through Day 14

  24. Percentage of Participants Requiring New Ventilator or Extracorporeal Membrane Oxygenation (ECMO) Use

    The percentage of participants requiring new ventilator or ECMO use was determined as the percentage not on a ventilator or ECMO at baseline

    Measured: Day 1 through Day 29

  25. Percentage of Participants Requiring New Oxygen Use

    The percentage of participants requiring new oxygen use was determined as the percentage of participants not requiring oxygen at baseline

    Measured: Day 1 through Day 29

  26. Mean Change in the Ordinal Scale

    The ordinal scale is an assessment of the clinical status at the first assessment of a given study day. The scale is as follows: 8) Death; 7) Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO); 6) Hospitalized, on non-invasive ventilation or high flow oxygen devices; 5) Hospitalized, requiring supplemental oxygen; 4) Hospitalized, not requiring supplemental oxygen - requiring ongoing medical care (COVID-19 related or otherwise); 3) Hospitalized, not requiring supplemental oxygen - no longer requires ongoing medical care; 2) Not hospitalized, limitation on activities and/or requiring home oxygen; 1) Not hospitalized, no limitations on activities. A positive change indicates a worsening and a negative change is an improvement.

    Measured: Day 1, 3, 5, 8, 11, 15, 22, and 29

  27. Percentage of Participants at Each Clinical Status Using Ordinal Scale at Day 15

    The ordinal scale is an assessment of the clinical status at the first assessment of a given study day. The scale is as follows: 8) Death; 7) Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO); 6) Hospitalized, on non-invasive ventilation or high flow oxygen devices; 5) Hospitalized, requiring supplemental oxygen; 4) Hospitalized, not requiring supplemental oxygen - requiring ongoing medical care (COVID-19 related or otherwise); 3) Hospitalized, not requiring supplemental oxygen - no longer requires ongoing medical care; 2) Not hospitalized, limitation on activities and/or requiring home oxygen; 1) Not hospitalized, no limitations on activities. Data was imputed using last observation carried forward or worst possible score based on hospitalization status (2 if not hospitalized, 7 if hospitalized) when there was a change in hospitalization status since last score. Deaths were imputed as an 8.

    Measured: Day 15

  28. Percentage of Participants at Each Clinical Status Using Ordinal Scale at Day 1

    The ordinal scale is an assessment of the clinical status at the first assessment of a given study day. The scale is as follows: 8) Death; 7) Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO); 6) Hospitalized, on non-invasive ventilation or high flow oxygen devices; 5) Hospitalized, requiring supplemental oxygen; 4) Hospitalized, not requiring supplemental oxygen - requiring ongoing medical care (COVID-19 related or otherwise); 3) Hospitalized, not requiring supplemental oxygen - no longer requires ongoing medical care; 2) Not hospitalized, limitation on activities and/or requiring home oxygen; 1) Not hospitalized, no limitations on activities.

    Measured: Day 1

  29. Percentage of Participants at Each Clinical Status Using Ordinal Scale at Day 3

    The ordinal scale is an assessment of the clinical status at the first assessment of a given study day. The scale is as follows: 8) Death; 7) Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO); 6) Hospitalized, on non-invasive ventilation or high flow oxygen devices; 5) Hospitalized, requiring supplemental oxygen; 4) Hospitalized, not requiring supplemental oxygen - requiring ongoing medical care (COVID-19 related or otherwise); 3) Hospitalized, not requiring supplemental oxygen - no longer requires ongoing medical care; 2) Not hospitalized, limitation on activities and/or requiring home oxygen; 1) Not hospitalized, no limitations on activities.

    Measured: Day 3

  30. Percentage of Participants at Each Clinical Status Using Ordinal Scale at Day 5

    The ordinal scale is an assessment of the clinical status at the first assessment of a given study day. The scale is as follows: 8) Death; 7) Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO); 6) Hospitalized, on non-invasive ventilation or high flow oxygen devices; 5) Hospitalized, requiring supplemental oxygen; 4) Hospitalized, not requiring supplemental oxygen - requiring ongoing medical care (COVID-19 related or otherwise); 3) Hospitalized, not requiring supplemental oxygen - no longer requires ongoing medical care; 2) Not hospitalized, limitation on activities and/or requiring home oxygen; 1) Not hospitalized, no limitations on activities.

    Measured: Day 5

  31. Percentage of Participants at Each Clinical Status Using Ordinal Scale at Day 8

    The ordinal scale is an assessment of the clinical status at the first assessment of a given study day. The scale is as follows: 8) Death; 7) Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO); 6) Hospitalized, on non-invasive ventilation or high flow oxygen devices; 5) Hospitalized, requiring supplemental oxygen; 4) Hospitalized, not requiring supplemental oxygen - requiring ongoing medical care (COVID-19 related or otherwise); 3) Hospitalized, not requiring supplemental oxygen - no longer requires ongoing medical care; 2) Not hospitalized, limitation on activities and/or requiring home oxygen; 1) Not hospitalized, no limitations on activities.

    Measured: Day 8

  32. Percentage of Participants at Each Clinical Status Using Ordinal Scale at Day 11

    The ordinal scale is an assessment of the clinical status at the first assessment of a given study day. The scale is as follows: 8) Death; 7) Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO); 6) Hospitalized, on non-invasive ventilation or high flow oxygen devices; 5) Hospitalized, requiring supplemental oxygen; 4) Hospitalized, not requiring supplemental oxygen - requiring ongoing medical care (COVID-19 related or otherwise); 3) Hospitalized, not requiring supplemental oxygen - no longer requires ongoing medical care; 2) Not hospitalized, limitation on activities and/or requiring home oxygen; 1) Not hospitalized, no limitations on activities.

    Measured: Day 11

  33. Percentage of Participants at Each Clinical Status Using Ordinal Scale at Day 22

    The ordinal scale is an assessment of the clinical status at the first assessment of a given study day. The scale is as follows: 8) Death; 7) Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO); 6) Hospitalized, on non-invasive ventilation or high flow oxygen devices; 5) Hospitalized, requiring supplemental oxygen; 4) Hospitalized, not requiring supplemental oxygen - requiring ongoing medical care (COVID-19 related or otherwise); 3) Hospitalized, not requiring supplemental oxygen - no longer requires ongoing medical care; 2) Not hospitalized, limitation on activities and/or requiring home oxygen; 1) Not hospitalized, no limitations on activities.

    Measured: Day 22

  34. Percentage of Participants at Each Clinical Status Using Ordinal Scale at Day 29

    The ordinal scale is an assessment of the clinical status at the first assessment of a given study day. The scale is as follows: 8) Death; 7) Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO); 6) Hospitalized, on non-invasive ventilation or high flow oxygen devices; 5) Hospitalized, requiring supplemental oxygen; 4) Hospitalized, not requiring supplemental oxygen - requiring ongoing medical care (COVID-19 related or otherwise); 3) Hospitalized, not requiring supplemental oxygen - no longer requires ongoing medical care; 2) Not hospitalized, limitation on activities and/or requiring home oxygen; 1) Not hospitalized, no limitations on activities.

    Measured: Day 29

  35. 14-day Participant Mortality

    The mortality rate was determined as the proportion of participants who died by study Day 15. The proportions reported are Kaplan-Meier estimates.

    Measured: Day 1 through Day 15

  36. 28-day Participant Mortality

    The mortality rate was determined as the proportion of participants who died by study Day 29. The proportions reported are Kaplan-Meier estimates.

    Measured: Day 1 through Day 29

  37. Time to an Improvement of One Category Using an Ordinal Scale

    The ordinal scale is an assessment of the clinical status at the first assessment of a given study day. The scale is as follows: 8) Death; 7) Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO); 6) Hospitalized, on non-invasive ventilation or high flow oxygen devices; 5) Hospitalized, requiring supplemental oxygen; 4) Hospitalized, not requiring supplemental oxygen - requiring ongoing medical care (COVID-19 related or otherwise); 3) Hospitalized, not requiring supplemental oxygen - no longer requires ongoing medical care; 2) Not hospitalized, limitation on activities and/or requiring home oxygen; 1) Not hospitalized, no limitations on activities. Time to improvement by at least one category was determined for each participant

    Measured: Day 1 through Day 29

  38. Time to an Improvement of Two Categories Using an Ordinal Scale

    The ordinal scale is an assessment of the clinical status at the first assessment of a given study day. The scale is as follows: 1) Death; 2) Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO); 3) Hospitalized, on non-invasive 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. Time to improvement by at least two categories was determined for each participant

    Measured: Day 1 through Day 29

  39. Time to Discharge or to a NEWS of 2 or Less and Maintained for 24 Hours, Whichever Occurs First

    The NEW score has demonstrated an ability to discriminate patients at risk of poor outcomes. This score is based on 7 clinical parameters (respiration rate, oxygen saturation, any supplemental oxygen, temperature, systolic blood pressure, heart rate, level of consciousness). The NEW Score is being used as an efficacy measure. The minimum score is 0, representing the better outcome, and the maximum value is 19, representing the worse outcome. The time to discharge or a NEWS of less than or equal to 2 was determined for each participant.

    Measured: Day 1 through Day 29

  40. Change From Baseline in C-reactive Protein (CRP)

    Blood to evaluate CRP was collected at Days 1, 3, 5, 8, and 11 while participants were inpatient, and at Days 15 and 29, with the Day 1 assessment serving as baseline. Participants who had been discharged had blood collected if infection control measures allowed for in-person visits after discharge.

    Measured: Days 1, 3, 5, 8, 11, 15 and 29

  41. Change From Baseline in D-dimer Concentration

    Blood to evaluate d-dimer concentration was collected at Days 1, 3, 5, 8, and 11 while participants were inpatient, and at Days 15 and 29, with the Day 1 assessment serving as baseline. Participants who had been discharged had blood collected if infection control measures allowed for in-person visits after discharge.

    Measured: Days 1, 3, 5, 8, 11, 15 and 29

Timeline

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

  1. First posted26 May 2020
  2. Study start8 May 2020
  3. Primary completion31 Jul 2020
  4. Study completion31 Jul 2020

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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
1,033 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04401579
Sponsor's protocol ID
20-0006 ACTT-2
Status last verified
Apr 2020
First submitted
22 May 2020
Last updated
14 Mar 2022
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Lin DY, Wang J, Gu Y, Zeng D. Evaluating treatment efficacy in hospitalized COVID-19 patients, with applications to Adaptive COVID-19 Treatment Trials. Clin Trials. 2024 Aug;21(4):500-506. doi: 10.1177/17407745241238443. Epub 2024 Apr 15.

    PubMed 38618926
  • Paules CI, Wang J, Tomashek KM, Bonnett T, Singh K, Marconi VC, Davey RT Jr, Lye DC, Dodd LE, Yang OO, Benson CA, Deye GA, Doernberg SB, Hynes NA, Grossberg R, Wolfe CR, Nayak SU, Short WR, Voell J, Potter GE, Rapaka RR. A Risk Profile Using Simple Hematologic Parameters to Assess Benefits From Baricitinib in Patients Hospitalized With COVID-19: A Post Hoc Analysis of the Adaptive COVID-19 Treatment Trial-2. Ann Intern Med. 2024 Mar;177(3):343-352. doi: 10.7326/M23-2593. Epub 2024 Feb 27.

    PubMed 38408357
  • Potter GE, Bonnett T, Rubenstein K, Lindholm DA, Rapaka RR, Doernberg SB, Lye DC, Mularski RA, Hynes NA, Kline S, Paules CI, Wolfe CR, Frank MG, Rouphael NG, Deye GA, Sweeney DA, Colombo RE, Davey RT Jr, Mehta AK, Whitaker JA, Castro JG, Amin AN, Colombo CJ, Levine CB, Jain MK, Maves RC, Marconi VC, Grossberg R, Hozayen S, Burgess TH, Atmar RL, Ganesan A, Gomez CA, Benson CA, Lopez de Castilla D, Ahuja N, George SL, Nayak SU, Cohen SH, Lalani T, Short WR, Erdmann N, Tomashek KM, Tebas P. Temporal Improvements in COVID-19 Outcomes for Hospitalized Adults: A Post Hoc Observational Study of Remdesivir Group Participants in the Adaptive COVID-19 Treatment Trial. Ann Intern Med. 2022 Dec;175(12):1716-1727. doi: 10.7326/M22-2116. Epub 2022 Nov 29.

    PubMed 36442063
  • Kramer A, Prinz C, Fichtner F, Fischer AL, Thieme V, Grundeis F, Spagl M, Seeber C, Piechotta V, Metzendorf MI, Golinski M, Moerer O, Stephani C, Mikolajewska A, Kluge S, Stegemann M, Laudi S, Skoetz N. Janus kinase inhibitors for the treatment of COVID-19. Cochrane Database Syst Rev. 2022 Jun 13;6(6):CD015209. doi: 10.1002/14651858.CD015209.

    PubMed 35695334
  • Kreuzberger N, Hirsch C, Chai KL, Tomlinson E, Khosravi Z, Popp M, Neidhardt M, Piechotta V, Salomon S, Valk SJ, Monsef I, Schmaderer C, Wood EM, So-Osman C, Roberts DJ, McQuilten Z, Estcourt LJ, Skoetz N. SARS-CoV-2-neutralising monoclonal antibodies for treatment of COVID-19. Cochrane Database Syst Rev. 2021 Sep 2;9(9):CD013825. doi: 10.1002/14651858.CD013825.pub2.

    PubMed 34473343
  • Kalil AC, Patterson TF, Mehta AK, Tomashek KM, Wolfe CR, Ghazaryan V, Marconi VC, Ruiz-Palacios GM, Hsieh L, Kline S, Tapson V, Iovine NM, Jain MK, Sweeney DA, El Sahly HM, Branche AR, Regalado Pineda J, Lye DC, Sandkovsky U, Luetkemeyer AF, Cohen SH, Finberg RW, Jackson PEH, Taiwo B, Paules CI, Arguinchona H, Erdmann N, Ahuja N, Frank M, Oh MD, Kim ES, Tan SY, Mularski RA, Nielsen H, Ponce PO, Taylor BS, Larson L, Rouphael NG, Saklawi Y, Cantos VD, Ko ER, Engemann JJ, Amin AN, Watanabe M, Billings J, Elie MC, Davey RT, Burgess TH, Ferreira J, Green M, Makowski M, Cardoso A, de Bono S, Bonnett T, Proschan M, Deye GA, Dempsey W, Nayak SU, Dodd LE, Beigel JH; ACTT-2 Study Group Members. Baricitinib plus Remdesivir for Hospitalized Adults with Covid-19. N Engl J Med. 2021 Mar 4;384(9):795-807. doi: 10.1056/NEJMoa2031994. Epub 2020 Dec 11.

    PubMed 33306283
  • Azzi Y, Bartash R, Scalea J, Loarte-Campos P, Akalin E. COVID-19 and Solid Organ Transplantation: A Review Article. Transplantation. 2021 Jan 1;105(1):37-55. doi: 10.1097/TP.0000000000003523.

    PubMed 33148977

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Remdesivir and Baricitinib in people with COVID-19, run by National Institute of Allergy and Infectious Diseases (NIAID) at 71 sites in 8 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 14 inclusion and 20 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 14 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 71 sites in United States, United Kingdom, Singapore, Spain, Mexico and 3 more countries. 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 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 26 Apr 2021). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

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?

Time to Recovery (time frame: Day 1 through Day 29). The study lists 4 primary outcomes in all. 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 NCT04401579, which also lists 7 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 14 Mar 2022.

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