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Covid19Phase 3NCT04469114

Tofacitinib in Hospitalized Patients With COVID-19 Pneumonia

A Phase 3 study testing Tofacitinib 10 mg in people with Covid19, run by Hospital Israelita Albert Einstein at 17 sites in Brazil.

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

Tofacitinib suppresses pro-inflammatory signaling that may be important pathogenetically to progression to more severe lung disease and acute respiratory distress syndrome (ARDS) in patients with COVID-19. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Covid19
What is being tested?
Tofacitinib 10 mg
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
289 participants
Where
17 sitesBrazil
Study dates
16 Sep 2020to 9 Jan 2021
Phase
Phase 3
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

  • Male or female participants older than 18 years
  • Laboratory-confirmed novel coronavirus (SARS-CoV-2) infection as determined by polymerase chain reaction (PCR) prior to Day 1.
  • Evidence of pneumonia assessed by radiographic imaging (chest x-ray or chest CT scan).
  • Hospitalized for less than 72 hours and receiving supportive care for COVID-19

Who cannot join

  • Require non-invasive ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) on Day 1 at the time of randomization
  • History of or known current thrombosis. Only if current thrombosis is suspected by the investigator, imaging testing is recommended (per local guidance) to exclude thrombosis.
  • Have a personal or first-degree family history of blood clotting disorders.
  • Participants who are immunocompromised, with known immunodeficiencies, or taking potent immunosuppressive agents (eg, azathioprine, cyclosporine).
  • Participants with any current malignancy or lymphoproliferative disorders that requires active treatment
  • Severe hepatic impairment, defined as Child-Pugh class C.
Show all 16Show fewer
  • Severe anemia (hemoglobin <8 g/dL).
  • Absolute lymphocyte count <500 cells/mm;
  • Absolute neutrophil count <1000 cells/mm.
  • Known allergy to tofacitinib.
  • Other medical or psychiatric condition including recent (within the past year) or active suicidal ideation/behavior or laboratory abnormality that may increase the risk associated with study participation or, in the investigator's judgment, make the participant inappropriate for the study.
  • Suspected or known active systemic bacterial, fungal, or viral infections (with the exception of COVID-19) including but not limited to: active herpes zoster infection; known active tuberculosis or history of inadequately treated tuberculosis; known B hepatitis, C hepatitis, or HIV.
  • Have received any of these within 4 weeks prior to the first dose of study intervention: any JAK inhibitors, potent immunosuppressants, or any biologic agents including IL-6 inhibitors (eg, tocilizumab) or IL-1 inhibitors (eg, anakinra) within the past 30 days; any potent cytochrome P450 inducer, such as rifampin, within the past 28 days or 5 half-lives, whichever is longer.
  • Have received estrogen-containing contraception or treatment with herbal supplements within 48 hours prior to the first dose of study intervention.
  • Have received treatment with corticosteroids equivalent to prednisone or methylprednisolone >20 mg/day for equal or more than 14 consecutive days prior to screening.
  • Current participation in other trials.

Trial locations and contacts

17 sites in 1 country.

17 sites in 1 country

Brazil17 sites
  • Centro de Pesquisa Clínica do Coração

    Aracaju

  • Hospital Universitário São Francisco de Assis Na Providência de Deu

    Bragança Paulista

  • Irmandade do Sr. Bom Jesus dos Passos da Santa Casa de Misericórdia de Bragança Paulista

    Bragança Paulista

  • Hospital do Coração do Brasil

    Brasília

  • Instituto de Pesquisa Clínica de Campinas

    Campinas

  • Hospital Regional do Litoral Norte

    Caraguatatuba

  • Unimed Fortaleza Sociedade Corporativa Médica LTD

    Fortaleza

  • Hospital Regional Jorge Rossmann

    Itanhaém

  • Hospital Bruno Born

    Lajeado

  • Hospital São Vicente de Paulo

    Passo Fundo

  • Fundação Faculdade Regional de Medicina de São José do Rio Preto

    São José do Rio Preto

  • Hospital Regional de Registro

    São José dos Campos

  • Hospital Regional de São José dos Campos

    São José dos Campos

  • Beneficência Portuguesa

    São Paulo

  • BP Mirante

    São Paulo

  • Hospital Israelita Albert Einstein

    São Paulo

  • Instituto do Coração

    São Paulo

Other trials in Brazil

About this study

Official title: A Multicenter, Randomized, Double-blind, Placebo-controlled, Parallel-design Trial of Tofacitinib in Hospitalized Participants With COVID-19 Pneumonia

Tofacitinib suppresses pro-inflammatory signaling that may be important pathogenetically to progression to more severe lung disease and acute respiratory distress syndrome (ARDS) in patients with COVID-19. The purpose of the study is to assess the safety and efficacy of tofacitinib plus standard pharmacologic and supportive measures in treating hospitalized participants with COVID-19 pneumonia.

Read the detailed description

COVID-19 is a viral disease caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that can cause severe pneumonia and ARDS. Respiratory viral load may peak within 5 days after onset, while symptoms are still mild. Many patients rapidly (within 1 to 2 weeks of infection) develop dyspnea and pneumonia and require hospitalization for respiratory support.

Preliminary clinical data from COVID-19 patients indicate that severe symptoms with SARS-CoV-2 infection are associated with an exaggerated immune response driven by interleukin (IL)-6 IL-10, tumor necrosis factor (TNF)α, and other cytokines. The ultimate result is progressive destruction of the alveolar epithelium leading to pneumonia and/or ARDS. Moreover, the exudative phase of ARDS is thought to be due to an influx of myeloid cells (neutrophils and macrophages) and elevations of inflammatory cytokines, with higher levels of both IL-6 and IL-8 levels being correlated with increased mortality. Therefore, immunomodulatory therapy may be beneficial in reducing the deleterious effects of lung inflammation and mitigating progressive lung injury.

Tofacitinib is an inhibitor of Janus kinase (JAKs) 1 and 3, with partial selectivity to JAK 2. Tofacitinib suppresses pro-inflammatory signaling that may be important pathogenetically to progression to more severe lung disease and ARDS in patients with COVID-19.

The purpose of the study is to assess the safety and efficacy of tofacitinib plus standard pharmacologic and supportive measures in treating hospitalized participants with COVID-19 pneumonia.

Participants with laboratory confirmed SARS-CoV-2 infection as determined by a positive PCR, who have agreed to participate, will be screened within 72h hours after admission to the hospital to determine eligibility.

Eligible participants will be randomized on Day 1 to the tofacitinib plus standard of care treatment group or the placebo plus standard of care treatment group in a 1:1 ratio, stratified by site. Participants will receive treatment for up to 14 days or until discharge from the hospital, whichever is earlier.

Participants will be assessed daily (up to Day 28) while hospitalized for clinical, safety, and laboratory parameters. Follow-up visits will occur on Day 14 and on Day 28.

Conditions
Covid19
Being tested
Tofacitinib 10 mg, Placebo
Medical subject headings
COVID-19

What participants receive

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

  • Tofacitinib 10 mgDrug

    Tofacitinib 10mg administered orally twice daily for 14 days or until hospital discharge

  • PlaceboDrug

    Tofacitinib-matching placebo administered orally twice daily for 14 days or until hospital discharge

Study groups in NCT04469114
Study groupRoleWhat they receive
TofacitinibExperimentalTofacitinib 10mg twice daily for 14 days or until hospital discharge
Receives: Drug: Tofacitinib 10 mg
PlaceboPlacebo comparatorPlacebo twice daily for 14 days or until hospital discharge
Receives: Drug: Placebo

What is being measured

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

  1. Death or respiratory failure until Day 28

    1, 2 or 3 on the 8-point National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity. The minimum value is 1 (worst outcome) and the maximum value is 8 (best outcome).

    1. Death.
    2. Hospitalized, on invasive mechanical ventilation or 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, with no limitations on activities.

    Measured: 28 days

Secondary outcomes (11)
  1. National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity at Day 14

    NIAID ordinal scale of disease severity

    Measured: 14 days

  2. Status of alive and not on mechanical ventilation or ECMO at Day 14 and 28 NIAID ordinal scale of disease severity at Day 14

    Categories 3 to 8 in the National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity at Day 14 and Day 28

    Measured: 14 and 28 days

  3. Status of requiring supplemental oxygen at Day 28

    Categories 1 to 4 in the National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity

    Measured: 28 days

  4. Status of being alive and not hospitalized at Day 14 and 28

    Categories 7 and 8 in the National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity

    Measured: 14 and 28 days

  5. National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale of disease severity at Day 14 NIAID ordinal scale of disease severity at Day 28

    NIAID ordinal scale of disease severity

    Measured: 28 days

  6. Number of patients with cure

    Number of patients with resolution of fever, cough, and need for ventilatory or oxygen support.

    Measured: 28 days

  7. Number of patients at the ICU or on ventilatory support at Day 28

    Number of patients at the ICU or on ventilatory support

    Measured: 28 days

  8. Number of days free from mechanical ventilation at 28 days

    Number of days free from mechanical ventilation

    Measured: 28 days

  9. Number of days in hospital

    Number of days in hospital

    Measured: 28 days

  10. Number of days in ICU

    Number of days in ICU

    Measured: 28 days

  11. Death or respiratory failure at Day 28

    Categories 1 to 3 in the National Institute of Allergy and Infectious Diseases (NIAID)

    Measured: 28 days

Timeline

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

  1. First posted13 Jul 2020
  2. Study start16 Sep 2020
  3. Primary completion9 Jan 2021
  4. Study completion9 Jan 2021

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
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
289 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04469114
Sponsor's protocol ID
34810620.0.1001.0071
Status last verified
Jul 2020
First submitted
10 Jul 2020
Last updated
9 Aug 2021
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Guimaraes PO, Damiani LP, Tavares CAM, Halpern ASR, Deuring JJ, Rizzo LV, Berwanger O. Laboratory profiles of patients hospitalized with COVID-19 pneumonia treated with tofacitinib or placebo: a post hoc analysis from the STOP-COVID trial. Einstein (Sao Paulo). 2024 Nov 4;22:eAO0821. doi: 10.31744/einstein_journal/2024AO0821. eCollection 2024.

    PubMed 39504090
  • 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
  • Guimaraes PO, Quirk D, Furtado RH, Maia LN, Saraiva JF, Antunes MO, Kalil Filho R, Junior VM, Soeiro AM, Tognon AP, Veiga VC, Martins PA, Moia DDF, Sampaio BS, Assis SRL, Soares RVP, Piano LPA, Castilho K, Momesso RGRAP, Monfardini F, Guimaraes HP, Ponce de Leon D, Dulcine M, Pinheiro MRT, Gunay LM, Deuring JJ, Rizzo LV, Koncz T, Berwanger O; STOP-COVID Trial Investigators. Tofacitinib in Patients Hospitalized with Covid-19 Pneumonia. N Engl J Med. 2021 Jul 29;385(5):406-415. doi: 10.1056/NEJMoa2101643. Epub 2021 Jun 16.

    PubMed 34133856

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Tofacitinib 10 mg in people with Covid19, run by Hospital Israelita Albert Einstein at 17 sites in Brazil.

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 4 inclusion and 16 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 9 Aug 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 17 sites in Brazil. 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?

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?

Death or respiratory failure until Day 28 (time frame: 28 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 NCT04469114, 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 9 Aug 2021.

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