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Obesity, COVID-19 InfectionPhase 2NIVISCONCT04413838

Efficiency and Security of NIVOLUMAB Therapy in Obese Individuals With COVID-19(COrona VIrus Disease) Infection

A Phase 2 study testing NIVOLUMAB in people with Obesity, COVID-19 Infection, run by Hospices Civils de Lyon at 1 site in France.

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 The sponsor has not verified this record for over two years, so it may be out of date.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

Although SARS-CoV-2 (Severe Acute Respiratory Syndrome-associated coronavirus) due to COVID-19 evolves poorly towards ARDS (Acute Respiratory Distress Syndrome) and death, there is to date no validated drug available for severe forms of COVID-19. Read more about this study

Who is it for?
Ages 18 to 70 years
Conditions the study is for
Obesity, COVID-19 Infection
What is being tested?
NIVOLUMAB
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
120 participants
Where
1 siteFrance
Study dates
15 Jun 2020to 15 Sep 2021
Phase
Phase 2
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 70 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients between 18 and 70 years old
  • COVID-19+ patients diagnosed upon biological testing (PCR Coronavirus SARS-CoV2)
  • Hospitalized patients
  • Obese individuals (BMI≥30kg/m²)
  • Lymphocyte counts between 500 and 1500/mm3.
  • Patients upon oxygen (either using mask or nasal cannula).
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  • Patients within their first 7 days after the beginning of symptoms.
  • Women of childbearing potential: effective contraception for the duration of the study and 5 months after the administration of treatment.
  • Patient who understands and accepts the need for a long term follow-up,
  • Patients who agrees to be included in the study and who signs the informed consent form,
  • Patients affiliated to a healthcare insurance plan.

Who cannot join

  • CRITERIA LINKED TO THE DISEASE SEVERITY :
  • Patients hospitalized in ICU or constant care unit.
  • Patients with clinical symptoms requiring ICU admission (respiratory rate>30/min, oxygen requirement> 4Liters/min (using high concentration mask) to reach and maintain O2saturation>90%, qSOFA≥ 2(quick score of Sepsis-related Organ Failure Assessment), or associated multi-visceral failure.
  • Patients with high biological probability of macrophage activation syndrome (hemoglobin < 9.2 g/dl AND a blood platelets < 110000/mm3 AND AST > 30 U/l AND ferritin > 600 mg/l).
  • CRITERIA LINKED TO THE TREATMENT TOXICITY :
  • Patients currently treated for cancer or with personal history of cancer within the last 3 years.
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  • Patients with Chronic Obstructive Pulmonary Disease (COPD) (GOLD 3 and 4 stages).
  • Chronic respiratory insufficiency treated with oxygen.
  • Patients aged above 70 years old.
  • Active smoking.
  • Personal history of thoracic radiotherapy.
  • Patients with known sensibility to NIVOLUMAB or one of its component.
  • Patients upon immunosuppressive dosage of corticoids.
  • Patients upon immunosuppressive therapy or immunosuppressed patients.
  • Patients already presenting severe autoimmune disease, for whom additional immunologic activation response would potentially precipitate lethal prognosis
  • GENERAL CRITERIA:
  • Minor Patients
  • Mentally unbalanced patients, under supervision or guardianship,
  • Patient deprived of liberty,
  • Patient who does not understand French/ is unable to give consent,
  • Patient already included in a trial who may interfere with the study or in a period of exclusion following participation in a previous study.
  • Pregnant (controlled by a pregnancy test) or lactating woman

Trial locations and contacts

1 site in 1 country.

France1 site
  • Hôpital Lyon Sud Service Endocrinologie, Diabète et Nutrition

    Pierre-Bénite, 69495

    Pr

    Emmanuel DISSE

Other trials in France

About this study

Official title: Study of the Efficiency and Security of NIVOLUMAB Therapy, Used in Immuno-stimulation, in Hospitalized Obese Individuals at Risk to Evolve Towards Severe Forms of COVID-19 Infection. Multicentric, Paralleled, Randomized, Controlled Trial

Although SARS-CoV-2 (Severe Acute Respiratory Syndrome-associated coronavirus) due to COVID-19 evolves poorly towards ARDS (Acute Respiratory Distress Syndrome) and death, there is to date no validated drug available for severe forms of COVID-19. Patients with COVID-19 undergo a drastic decrease of T lymphocytes (LT) count, while the remaining ones display an "exhausted" phenotype, due to immunosuppressive pathway activation among which the Programed cell Death 1 (PD1) receptor pathways. LT exhaustion is responsible for host anergy towards viral infection and leads to increased risk of severe forms of COVID-19. Moreover, while the number of systemic LT PD1+ correlates with poor prognosis clinical stages of COVID-19 infection, healing from COVID-19 associates with LT PD1 expression normalization. Chinese epidemiologic data identified clinical risk factors of poor clinical evolution (i.e. ARDS or death), among which is found obesity, similarly to observation previously obtained during H1N1 infection (flu virus).

Obese persons display meta-inflammation and immune dysfunction, a condition similar to ageing, thus termed "Inflamm-aging", thus also used during obesity. Inflamm-aging, characterized by cytotoxic LT exhaustion and reduced NK cell (Natural Killer cell) cytotoxic function secondary to PD1 pathway activation, could contribute to the poor prognosis observed during cancer and infection in obese individuals. We hypothesize that the immunocompromised profile observed during obesity contribute to their vulnerability towards COVID-19.

Read more

In cancer or certain infection diseases, NIVOLUMAB, an anti-PD1 monoclonal antibody, restores exhausted LT immunity. We thus hypothesize that NIVOLUMAB-induced immunity normalization could (i) stimulate anti-viral response also during COVID-19 infection and (ii) prevent ARDS development, which has previously been associated with low LT count concomitant with increased inflammatory cytokine production.

This randomized controlled therapeutic trial, using an add-on strategy to usual standard of care, aims at demonstrating the efficacy and safety of NIVOLUMAB-induced cytotoxic LT normalization, to improve clinical outcomes in hospitalized COVID-19+ adult obese individuals with low LT, since they are at risk of poor prognosis. We postulate that NIVOLUMAB will increase the number of individuals able to stop oxygen therapy at D15

Being tested
NIVOLUMAB, Routine standard of care
Keywords
COVID-19, Obesity, Nivolumab, Immunotherapy, Anti-PD1
Medical subject headings
Obesity, COVID-19

What participants receive

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

  • NIVOLUMABDrug

    IV injection within 30 minutes of 24ml file (=240 mg) containing NIVOLUMAB BMS(Bristol-Myers Squibb) 10mg/ml (immune check point inhibitor targeting PD-1) on top of routine standard of care for COVID-19 infection

  • Routine standard of careOther

    No intervention is planned in this arm. Patients will follow routine standard of care for the COVID-19 treatment

Study groups in NCT04413838
Study groupRoleWhat they receive
NIVOLUMAB on top of routine standard of careExperimentalThis correspond to COVID-19+ patients diagnosed upon biological testing (PCR Coronavirus SARS-CoV2), hospitalized, obese (BMI≥30kg/m²), with low lymphocyte counts, without high biological probability of macrophage activation syndrome (hemoglobin < 9.2 g/dl AND a blood platelets < 110000/mm3 AND aspartate aminotransferase (AST) > 30 U/l AND ferritin > 600 mg/l) and upon oxygen (either using mask or nasal cannula) but without criteria for ICU admission benefiting from a NIVOLUMAB treatment and routine standard of care for COVID-19 infection at the time of study inclusion
Receives: Drug: NIVOLUMAB
Standard of care for COVID-19 infectionOtherThis correspond to COVID-19+ patients diagnosed upon biological testing (PCR Coronavirus SARS-CoV2), hospitalized, obese (BMI≥30kg/m²), with low lymphocyte counts, without high biological probability of macrophage activation syndrome (hemoglobin < 9.2 g/dl AND a blood platelets < 110000/mm3 AND AST > 30 U/l AND ferritin > 600 mg/l) and upon oxygen (either using mask or nasal cannula) but without criteria for ICU admission benefiting from a routine standard of care for COVID-19 infection at the time of study inclusion
Receives: Other: Routine standard of care

What is being measured

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

  1. Patient's clinical state

    Patient's clinical state will be evaluated by the proportion of patients able to be weaned of oxygen at D15 after randomization (randomization date is the day where the experimental treatment (i.e. NIVOLUMAB) is administered).

    Measured: 15 days after randomization

Secondary outcomes (28)
  1. Readmission

    Proportion of in-coming patients in ICU at D7 and D15 post-randomization

    Measured: 7 days and 15 days after randomization

  2. Mortality

    Proportion of death at D7 and D15 post-randomization

    Measured: 7 days and 15 days after randomization

  3. Oxygen flow needs

    Proportion of patients weaned out of oxygen at D7 post-randomization

    Measured: 7 days after randomization

  4. Requirement of oxygen

    Mean oxygen flow needed

    Measured: 7 days and 15 days after randomization

  5. Discharge from hospital

    Proportion of out-coming patients from hospitalization at D7 and D15 post-randomization

    Measured: 7 days and 15 days after randomization

  6. Adverse events

    Report of all adverse events linked or not to experimental treatment during the study

    Measured: Within 15 days post-randomization and 90 days and 6 months after randomization

  7. Presence of nasopharyngeal SARS-CoV-2

    Presence or not of nasopharyngeal SARS-CoV-2 determined by PCR response

    Measured: On day 0 before randomization and 15 days after randomization

  8. nasopharyngeal SARS-CoV-2 viral charge

    Presence or not of nasopharyngeal SARS-CoV-2 Quantified by PCR

    Measured: On day 0 before randomization and 15 days after randomization

  9. Number of total Lymphocytes T

    Number of total LT (using immuno-phenotyping) will explore the immune response

    Measured: On day 0 before randomization and 15 days after randomization

  10. Number of CD3+ Lymphocytes T(lymphocyte subpopulation of CD3+ T cells)

    Number of CD3+ LT (using immuno-phenotyping) will explore the immune response

    Measured: On day 0 before randomization and 15 days after randomization

  11. Number of CD4+ Lymphocytes T(lymphocyte subpopulation of CD4+ T cells)

    Number of total CD4+ LT (using immuno-phenotyping) will explore the immune response

    Measured: On day 0 before randomization and 15 days after randomization

  12. Number of CD8+ Lymphocytes T(lymphocyte subpopulation of CD8+ T cells)

    Evaluation of number of CD8+ LT (using immuno-phenotyping) will explore the immune response

    Measured: On day 0 before randomization and 15 days after randomization

  13. Interleukin 6 (IL-6)

    Systemic concentration measurement of IL-6 will explore the inflammatory response

    Measured: On day 0 before randomization and 15 days after randomization

  14. Interleukin 10 (IL-10)

    Systemic concentration measurement of IL-10 will explore the inflammatory response

    Measured: On day 0 before randomization and 15 days after randomization

  15. Tumor Necrosis Factor alpha (TNFα )

    Systemic concentration measurement of TNFα will explore the inflammatory response

    Measured: On day 0 before randomization and 15 days after randomization

  16. Interferon gamma (IFNγ)

    Systemic concentration measurement of IFNγ will explore the inflammatory response

    Measured: On day 0 before randomization and 15 days after randomization

  17. Type I Interferon (type I IFN)

    Systemic concentration measurement of type I IFN will explore the inflammatory response

    Measured: On day 0 before randomization and 15 days after randomization

  18. Tim3 expression

    Evaluation of Tim3 expression on CD4+ and CD8+ lymphocytes will explore the fundamental research on obesity and COVID-19

    Measured: On day 0 before randomization and 15 days after randomization

  19. PD1 expression

    Evaluation of PD1 expression on CD4+ and CD8+ lymphocytes will explore the fundamental research on obesity and COVID-19

    Measured: On day 0 before randomization and 15 days after randomization

  20. PD-L1 expression

    Measurement of PD-L1 expression on monocytes will explore explore the fundamental research on obesity and COVID-19

    Measured: On day 0 before randomization and 15 days after randomization

  21. Human Leukocyte Antigen - DR isotype gene expression (HLA-DR expression)

    Measurement of HLA-DR expression on monocytes will explore explore the fundamental research on obesity and COVID-19

    Measured: On day 0 before randomization and 15 days after randomization

  22. Production of IFNγ by lymphocytes T

    The cytotoxic LT production of IFNγ will explore the fundamental research on obesity and COVID-19

    Measured: On day 0 before randomization and 15 days after randomization

  23. Production of granzyme B by lymphocytesT

    The cytotoxic LT production of granzyme B will explore the fundamental research on obesity and COVID-19

    Measured: On day 0 before randomization and 15 days after randomization

  24. Lipopolysaccharides (LPS)

    Measurement of LPS will explore the endotoxemia and perform fundamental research on obesity and COVID-19

    Measured: On day 0 before randomization and 15 days after randomization

  25. LBP(LPS-Binding Protein)

    Measurement of LBP (endotoxin transporter) will explore the endotoxemia and perform fundamental research on obesity and COVID-19

    Measured: On day 0 before randomization and 15 days after randomization

  26. sCD14

    Measurement of sCD14 (endotoxin transporter) will explore the endotoxemia and perform fundamental research on obesity and COVID-19

    Measured: On day 0 before randomization and 15 days after randomization

  27. High Density Lipoproteins

    Measurement of High Density Lipoproteins proteomic will explore the lipoprotein metabolism and perform fundamental research on obesity and COVID-19

    Measured: On day 0 before randomization and 15 days after randomization

  28. Apolipoprotein

    Measurement of apolipoprotein proteomic will explore the lipoprotein metabolism and perform fundamental research on obesity and COVID-19

    Measured: On day 0 before randomization and 15 days after randomization

Timeline

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

  1. First posted4 Jun 2020
  2. Study start15 Jun 2020 (estimated)
  3. Primary completion15 Jun 2021 (estimated)
  4. Study completion15 Sep 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 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
120 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04413838
Sponsor's protocol ID
69HCL20_0478
Acronym
NIVISCO
Status last verified
May 2020
First submitted
2 Jun 2020
Last updated
4 Jun 2020
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing NIVOLUMAB in people with Obesity, COVID-19 Infection, run by Hospices Civils de Lyon at 1 site in France.

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 11 inclusion and 22 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 4 Jun 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in France. 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.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

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

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 Emmanuel DISSE, Pr (+33 4 78 86 14 84, emmanuel.disse@chu-lyon.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Patient's clinical state (time frame: 15 days after randomization). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 4 Jun 2020; AzTrials last refreshed its copy on 7 Nov 2026.

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