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COVID-19Phase 2NCT04445272

Clinical Trial to Evaluate the Effectiveness and Safety of Tocilizumab for Treating Patients With COVID-19 Pneumonia

A Phase 2 study testing Tocilizumab in people with COVID-19, run by Fundacion SEIMC-GESIDA at 42 sites in Spain.

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

At present, no treatment has been approved for COVID-19. However, in light of the increased interest on using the anti-cytokine therapy targeting IL-6 tocilizumab in COVID-19 infected patients due to its potential benefit, the Spanish Agency for Medicine and Health Products (Agencia Española de Medicamentos y… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
COVID-19
What is being tested?
Tocilizumab
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
495 participants
Where
42 sitesSpain
Study dates
22 May 2020to 23 Dec 2020
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 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Provide oral informed consent to participate in this study.
  • At least 18 years of age.
  • Diagnosed with COVID-19 pneumonia by RT-PCR.
  • Have received the first dose of tocilizumab a maximum of two days before the inclusion or is candidate for tocilizumab treatment
  • Hospitalized or admitted to ICU

Who cannot join

  • The patient has any other medical condition or is receiving concomitant medication that could, in the opinion of the investigator, compromise the patient's safety or collected data
  • Known severe allergic reactions to tocilizumab or other monoclonal antibodies
  • Active acute and severe infections, including tuberculosis infection
  • Pregnant or breastfeeding, or positive pregnancy test in a pre-dose examination

Trial locations and contacts

42 sites in 1 country.

42 sites in 1 country

Spain42 sites
  • Complejo Hospitalario Universitario de Albacete

    Albacete

  • Hospital Universitario Fundación Alcorcón

    Alcorcón, Madrid

  • Hospital Infanta Cristina

    Badajoz

  • Hospital Clínic i Provincial Barcelona

    Barcelona

  • Hospital de la Santa Creu i Sant Pau

    Barcelona

  • Hospital Universitario de Burgos

    Burgos

  • Hospital Universitario de Fuenlabrada

    Fuenlabrada, Madrid

  • Hospital Universitario de Galdakao

    Galdakao, Bizkaia

  • Hospital Universitario de Getafe

    Getafe, Madrid

  • Hospital Universitario de Cabueñes

    Gijón, Principality of Asturias

  • Hospital Universitario Dr. Josep Trueta

    Girona

  • Hospital Universitario Clínico San Cecilio

    Granada

  • Hospital Universitario Virgen de las Nieves

    Granada

  • Hospital Jerez de la Frontera

    Jerez de la Frontera, Cádiz

  • Hospital Universitari de Bellvitge

    L'Hospitalet de Llobregat, Barcelona

  • Hospital General Universitario Gregorio Marañón

    Madrid

  • Hospital Universitario Fundación Jiménez Díaz

    Madrid

  • Hospital Universitario HM Sanchinarro

    Madrid

  • Hospital Universitario Infanta Leonor

    Madrid

  • Hospital Universitario Ramón y Cajal

    Madrid

  • Hospital Regional Universitario de Málaga

    Málaga

  • Hospital Sant Joan de Déu de Manresa

    Manresa, Barcelona

  • Hospital de Mataró

    Mataró, Barcelona

  • Hospital Rey Juan Carlos

    Móstoles, Madrid

  • Hospital Universitario Rey Juan Carlos

    Móstoles, Madrid

  • Hospital Clínico Universitario Virgen de la Arrixaca

    Murcia

  • Complexo Hospitalario Universitario de Ourense

    Ourense

  • Hospital Universitari Son Espases

    Palma de Mallorca, Balearic Islands

  • Complejo Hospitalario de Navarra

    Pamplona, Navarre

  • Hospital Universitario Salamanca

    Salamanca

  • Hospital Universitario Infanta Sofía

    San Sebastián de los Reyes, Madrid

  • Hospital Universitario Marqués Valdecilla

    Santander, Cantabria

  • Hospital Universitario Virgen de la Macarena

    Seville

  • Hospital Universitario Virgen del Rocío

    Seville

  • Hospital Nuestra Señora del Prado

    Talavera de la Reina, Toledo

  • Hospital Virgen de la Salud

    Toledo

  • Hospital Público General del Tomelloso

    Tomelloso, Ciudad Real

  • Hospital Clinico Universitario de Valencia

    Valencia

  • Hospital Universitari i Poliectenic La Fe

    Valencia

  • Hospital Universitario Dr. Peset

    Valencia

  • Hospital Clínico Universitario Lozano Blesa

    Zaragoza

  • Hospital Universitario Miguel Servet

    Zaragoza

Other trials in Spain

About this study

Official title: A Multicentre, Open-label Clinical Trial to Evaluate the Effectiveness and Safety of Intravenous Tocilizumab for Treating Patients With COVID-19 Pneumonia: the BREATH-19 Study

At present, no treatment has been approved for COVID-19. However, in light of the increased interest on using the anti-cytokine therapy targeting IL-6 tocilizumab in COVID-19 infected patients due to its potential benefit, the Spanish Agency for Medicine and Health Products (Agencia Española de Medicamentos y Productos Sanitarios, AEMPS) have initiated the controlled distribution of the drug. Tocilizumab is indeed proposed as a potential treatment for severe COVID-19 in Spain. Based on the positive results of tocilizumab in the treatment of COVID-19 patients and the experience of tocilizumab in inducing rapid reversal of CSS in other pathologies several clinical trials and observational studies are being conducted to assess the effectiveness and safety of tocilizumab in COVID-19 patients. Further studies with a large sample size are required to confirm the effectiveness of tocilizumab in patients with COVID-19 pneumonia.

The need for the management of severe COVID-19 disease is imperative, and every effort should be made to collect relevant clinical outcomes. The aim of the present study is to evaluate the effectiveness of IV tocilizumab in treating patients with COVID-19 pneumonia who are currently hospitalized or admitted to ICU by describing improvement of respiratory function and mortality rate. This large real-world cohort therefore provides a unique opportunity to study this potential medicine during the current emergency situation, and support the findings from other ongoing clinical trials and observational studies, such as the Roche-sponsored Phase III study that is planned to start early April.

Read the detailed description

Cytokine storm syndrome (CSS) is caused by the excessive release of cytokines during an exaggerated immune response. CSS can be triggered by infections or therapeutic interventions, being more severe depending on the degree and duration of immune activation. CSS is as a significant on-target side-effect of chimeric antigen receptor (CAR) T-cell therapies, which have been subject to assessment for the treatment of haematological malignancies. Tocilizumab (intravenous, IV) is indicated for the treatment of chimeric antigen receptor CAR T cell-induced severe or life-threatening CSS.

Based on the experience with tocilizumab in the CSS, and that some patients infected with SARS-CoV-2 can develop CSS, leading to potentially fatal damage to lung tissue, the drug is being investigated in China and Italy, and clinical trials are being conducted/planned in these and several other countries. Real-word experience with tocilizumab IV have shown that in a substantial proportion of COVID-19 patients with severe pneumonia, fever returned to normal and respiratory function based on oxygen intake and lung opacities improved remarkably. Laboratory parameters such as C-reactive protein (CRP) that seem to be increased in patients infected decreased significantly with tocilizumab, and lymphocytes levels also returned to normal.

All these findings have led the Spanish Agency for Medicine and Health Products (AEMPS) to initiate the controlled distribution of tocilizumab IV, in light of the increased interest on the anti-cytokine therapy targeting IL-6 in COVID-19 infected patients. Therefore, tocilizumab might be among the therapeutic armamentarium for preventing the fatal consequences of acute respiratory and multi organ failure in around 20% of the COVID-19 infected patients.

The aim of the present study is to evaluate the effectiveness and safety of IV tocilizumab in patients with COVID-19 severe pneumonia who are currently hospitalized or admitted to ICU. This large real-world cohort provides a unique opportunity to study a potential medicine during the current emergency situation, and support the findings from the Roche-sponsored Phase III study that is planned to start in early April.

Conditions
COVID-19
Being tested
Tocilizumab
Keywords
COVID-19
Medical subject headings
COVID-19

What participants receive

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

Study groups in NCT04445272
Study groupRoleWhat they receive
TocilizumabExperimentalPatients will receive IV tocilizumab as per clinical practice and at the discretion of treating investigator, following the posology indicated in the SmPC, or the recommendations proposed by the Spanish Ministry of Health: The recommended posology by the SmPC is 8 mg per kg in patients weighing greater than or equal to 30 kg or 12 mg per kg in patients weighing less than 30 kg. If no clinical improvement in the signs and symptoms up to 3 additional doses of tocilizumab may be administered. The interval between consecutive doses should be at least 8 hours. The recommendations of the Spanish Ministry of Health: Patients more than 80 kg: first dose 600 mg; second dose 600 mg. Patients less than 80 kg: first dose 600 mg; second dose 400 mg. A third dose might be considered 16 to 24 hours after if: fever persists or a worsening of the laboratory parameters Given the exceptionality of the situation modification of doses according to the physician experience will be allowed.
Receives: Drug: Tocilizumab

What is being measured

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

  1. To calulate the time of intubation

    Calculate the mean time of intubation

    Measured: through study completion, and average of 1 month

  2. To calculate the time with oxygen therapy

    Calculate the mean time with oxygen therapy

    Measured: through study completion, and average of 1 month

  3. To calculate the time with Non-invasive mechanical ventilation

    Calculate the mean time with Non-invasive mechanical ventilation

    Measured: through study completion, and average of 1 month

  4. To evaluate mortality rate

    Number of patients deaths of the total of patients included

    Measured: through study completion, and average of 1 month

Secondary outcomes (27)
  1. To calculate respiratory function parameters

    To calculate the mean ofPaO2/FiO2

    Measured: through study completion, and average of 1 month

  2. To calculate respiratory function parameters

    To calculate the mean of levels of oxygen saturation

    Measured: through study completion, and average of 1 month

  3. To calculate respiratory function parameters

    To calculate the mean of SaO2/FiO2

    Measured: through study completion, and average of 1 month

  4. To evaluate radiological lung extension

    Evaluate the lung extension of pneumonia

    Measured: through study completion, and average of 1 month

  5. To evaluate radiological evolution

    Evaluate the type of lung affection

    Measured: through study completion, and average of 1 month

  6. To describe the duration of hospitalization and ICU use

    Days of hospitalization in survivors and/or days at ICU throughout the study

    Measured: through study completion, and average of 1 month

  7. To evaluate the requirement of additional organ support

    Percentage of patients with extracorporeal membrane oxygenation

    Measured: through study completion, and average of 1 month

  8. To evaluate the requirement of additional organ support

    Percentage of patients with molecular adsorbent recirculating system

    Measured: through study completion, and average of 1 month

  9. To evaluate the requirement of additional organ support

    Percentage of patients with dialysis

    Measured: through study completion, and average of 1 month

  10. To evaluate the requirement of additional organ support

    Percentage of patients with other support therapy

    Measured: through study completion, and average of 1 month

  11. To evaluate the effect of IV tocilizumab on the serum levels of inflammatory markers

    Analyze the levels of IL-6

    Measured: through study completion, and average of 1 month

  12. To calculate the number of adverse events in patients with COVID-19 pneumonia treated with Tocilizumab

    Incidence of adverse events

    Measured: through study completion, and average of 1 month

  13. To calculate the number of adverse events in patients with COVID-19 pneumonia treated with Tocilizumab

    Incidence of adverse events by dose of Tocilizumab

    Measured: through study completion, and average of 1 month

  14. To assess time to reverse-transcriptase polymerase chain reaction (RT-PCR) virus negativity

    To evaluate the time to RT-PCR virus negativity

    Measured: through study completion, and average of 1 month

  15. To evaluate the effect of IV tocilizumab on the serum levels of inflammatory

    Analyze the levels of CRP

    Measured: through study completion, and average of 1 month

  16. To evaluate the effect of IV tocilizumab on the serum levels of inflammatory

    Analyze the levels of procalcitonin (PCT)

    Measured: through study completion, and average of 1 month

  17. To evaluate the effect of IV tocilizumab on the serum levels of inflammatory

    Analyze the levels of ID-dimer

    Measured: through study completion, and average of 1 month

  18. To evaluate the effect of IV tocilizumab on the serum levels of inflammatory

    Analyze the levels of ferritin

    Measured: through study completion, and average of 1 month

  19. To calculate the number of serious adverse events in patients with COVID-19 pneumonia treated with Tocilizumab

    Indicende of serious adverse events

    Measured: through study completion, and average of 1 month

  20. To calculate the number of serious adverse events in patients with COVID-19 pneumonia treated with Tocilizumab

    Indicende of serious adverse events based on dose of Tocilizumab

    Measured: through study completion, and average of 1 month

  21. To calculate the number of adverse events of special interest in patients with COVID-19 pneumonia treated with Tocilizumab

    Indicende of adverse events of special interest based on dose of Tocilizumab

    Measured: through study completion, and average of 1 month

  22. To evaluate mortality rate

    Number of patients deaths of the total of patients included based on dose of Tocilizumab

    Measured: through study completion, and average of 1 month

  23. To evaluate respiratory function

    Time with intubation, oxygen therapy and Non-invasive mechanical ventilation based on dose of Tocilizumab

    Measured: through study completion, and average of 1 month

  24. To evaluate mortality rate

    Number of patients deaths of the total of patients included based on severity of disease at the start of the study treatment

    Measured: through study completion, and average of 1 month

  25. To evaluate mortality rate

    Number of patients deaths of the total of patients included based on presence of cytokine storm syndrome at the start of treatment

    Measured: through study completion, and average of 1 month

  26. To evaluate respiratory function

    Time with intubation, oxygen therapy and Non-invasive mechanical ventilation based on severity of disease at the start of the study treatment

    Measured: through study completion, and average of 1 month

  27. To evaluate respiratory function

    Time with intubation, oxygen therapy and Non-invasive mechanical ventilation based on presence of cytokine storm syndrome at the start of treatment

    Measured: through study completion, and average of 1 month

Timeline

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

  1. First posted24 Jun 2020
  2. Study start22 May 2020
  3. Primary completion23 Dec 2020
  4. Study completion23 Dec 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 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
Phase II, one-arm, open label, multicentre study
Masking
None (open label)
Enrolment
495 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04445272
Sponsor's protocol ID
BREATH-19 (FSG011-20)
Status last verified
Jun 2020
First submitted
13 Jun 2020
Last updated
2 Jun 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Maude SL, Barrett D, Teachey DT, Grupp SA. Managing cytokine release syndrome associated with novel T cell-engaging therapies. Cancer J. 2014 Mar-Apr;20(2):119-22. doi: 10.1097/PPO.0000000000000035.

    PubMed 24667956

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Tocilizumab in people with COVID-19, run by Fundacion SEIMC-GESIDA at 42 sites in Spain.

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

Who may be eligible to take part?

The sponsor lists 5 inclusion and 4 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 2 Jun 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 42 sites in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

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

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?

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?

To calulate the time of intubation (time frame: through study completion, and average of 1 month). 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 NCT04445272, which also lists 1 linked publication.

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 2 Jun 2021.

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