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COVID-19Phase 2NCT04575610

IRAK4 Inhibition in Treatment of COVID-19 With ARDS (I-RAMIC)

A Phase 2 study testing PF-06650833 in people with COVID-19, run by Yale University at 1 site in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

The purpose of this study is to assess the efficacy of PF-06650833 in addition to standard-of-care compared to standard-of-care treatment alone in improving outcomes in patients with COVID-19. Read more about this study

Who is it for?
Ages 18 to 75 years
Conditions the study is for
COVID-19
What is being tested?
PF-06650833
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
7 participants
Where
1 siteUnited States
Study dates
27 Nov 2020to 6 Oct 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 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adult male and female patients, including women of childbearing potential, at least 18 years of age, inclusive
  • Participant (or legally authorized representative) capable of giving signed informed consent
  • Laboratory-confirmed novel coronavirus (SARS-CoV-2) infection
  • Clinical findings and an imaging study consistent with ARDS;
  • PaO2 / FiO2 ratio < 300;
  • A requirement for mechanical ventilation ≤ 48 hours prior to enrollment.
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  • Evidence of increased inflammation as assessed by hsCRP > ULN AND at least ONE of the following being > upper limit of normal (as available):
  • ferritin
  • procalcitonin
  • D-dimer
  • fibrinogen
  • LDH
  • PT/PTT

Who cannot join

  • Suspected or known active systemic bacterial, viral (except SARS-CoV2 infection), or fungal infections
  • Active herpes zoster infection
  • Known active or latent tuberculosis (TB) or history of inadequately treated TB
  • Active hepatitis B or hepatitis C
  • Known history of human immunodeficiency virus (HIV) infection with a detectable viral load or CD4 count < 500 cells / mm3 (patients for whom documented viral load or CD4 counts are available will be excluded)
  • Active hematologic cancer
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  • Metastatic or intractable cancer
  • Pre-existing neurodegenerative disease
  • Severe hepatic impairment defined as Child-Pugh Class B or Class C at baseline
  • Severe renal impairment with an estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73 m2
  • Severe anemia (Hb < 8.0 g/dL)
  • Any of the following abnormal laboratory values:
  • absolute lymphocyte count <250 cells/mm3
  • absolute neutrophil Count (ANC) <1000 cells/mm3
  • Platelet count <50,000 cells/mm3
  • ALT or AST > 5X ULN, or other evidence of hepatocellular synthetic dysfunction or total bilirubin > 2X ULN
  • Any other medical condition or laboratory abnormality that may increase the risk of study participation or, in the investigator's judgment, make the participant inappropriate for the study
  • Prohibited concomitant therapy (see section 1.12.7.2)
  • Pregnancy (a negative urine or serum pregnancy test is required for inclusion)
  • Immunocompromised patients, patients with known immunodeficiencies or taking potent immunosuppressive agents (e.g., azathioprine, cyclosporine)
  • Anticipated survival < 72 hours as assessed by the Investigator.
  • Participation in other clinical trials of investigational treatments for COVID-19
  • Known history of nephrolithiasis

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Yale New Haven Hospital

    New Haven, Connecticut, 06510

Other trials in United States

About this study

Official title: Investigation of IRAK4 Inhibition to Mitigate the Impact of COVID-19 in Severe SARS-CoV-2 (I-RAMIC)

The purpose of this study is to assess the efficacy of PF-06650833 in addition to standard-of-care compared to standard-of-care treatment alone in improving outcomes in patients with COVID-19.

Read the detailed description

Proposed is a randomized, double-blind, placebo-controlled, parallel group Phase 2 study of the efficacy and safety of PF-06650833, an investigational drug, in hospitalized adult male and female patients with SARS-CoV-2-induced ARDS who need mechanical ventilation.

The primary objective of this study is to assess the efficacy of PF-06650833 in addition to standard-of-care compared to standard-of-care treatment alone in improving outcomes in patients with COVID-19, evidence of increased inflammation, and ARDS requiring mechanical ventilation or extracorporeal membrane oxygenation at time of admission.

The secondary objectives of this study are to evaluate:

  1. Proportion of patients alive, extubated, and receiving no more that low flow oxygen supplementation by nasal cannula or face mask (excluding extubation for compassionate purposes in terminal patients). This would correspond to an at least 2-point improvement in the National Institute of Allergy and Infectious Diseases (NIAID) ordinal scale (1 = non hospitalized, no limitations on activity, and 8 = death) at Days 29 and 61
  2. Proportion of patients alive, extubated, and receiving any level oxygen supplementation, including non-invasive positive pressure ventilation or high flow oxygen device (excluding extubation for compassionate purposes in terminal patients). This would correspond to an at least 1-point improvement in the NIAID ordinal scale (1 = non hospitalized, no limitations on activity, and 8 = death) at Days 29 and 61
  3. Percentage of patients in each category of the NIAID 8-point ordinal scale of disease severity (Days 8, 15, 22, 29, and 61). The ordinal scale is an assessment of the clinical status at the first assessment of a given study day. The scale is as follows:
  • Not hospitalized, no limitations on activities;
  • Not hospitalized, limitation on activities and/or requiring home oxygen*
  • Hospitalized, not requiring supplemental oxygen* - no longer requires ongoing medical care
  • Hospitalized, not requiring supplemental oxygen* - requiring ongoing medical care (COVID-19 related or otherwise)
  • Hospitalized, requiring supplemental oxygen*;
  • Hospitalized, on non-invasive ventilation (NIV)** or high flow oxygen device;
  • Hospitalized, on invasive mechanical ventilation or ECMO;
  • Death
  • For patients on chronic home O2 supplementation, supplemental O2 is defined as >= home O2 requirement.
  • Use of NIV for chronic conditions [e.g. Obstructive sleep apnea (OSA)] is not applicable
  1. Mortality rate at Day 61
  2. Time to a 1-point improvement in the NIAID 8-point ordinal scale of disease severity
  3. Time to a 2-point improvement in the NIAID 8-point ordinal scale of disease severity
  4. Change from baseline in the ordinal scale from Day 1 to Days 3, 5, 8, 11, 15, 22, and
  5. Arterial partial pressure of oxygen (PaO2) / Fractional concentration of inspired oxygen (FiO2) ratio (or P/F ratio)
  6. Change of the Sequential Organ Failure Assessment (SOFA). The SOFA evaluates 6 variables, each representing an organ system (one for the respiratory, cardiovascular, hepatic, coagulation, renal and neurological systems), and scored from 0 (normal) to 4 (high degree of dysfunction/failure). Thus, the maximum score may range from 0 to 24.
  7. Duration (days) of mechanical ventilation
  8. Ventilator free days
  9. Safety as assessed by reporting of adverse events (AEs), changes in clinical laboratory parameters (e.g., haemoglobin (Hb), white blood cell (WBC) count, platelets, hepatic transaminases, bilirubin, serum creatinine)
Conditions
COVID-19
Being tested
PF-06650833, Placebo
Keywords
Protein Kinase Inhibitors, Enzyme Inhibitors, Molecular Mechanisms of Pharmacological Action
Medical subject headings
COVID-19

What participants receive

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

  • PF-06650833Drug

    Subjects randomized to the PF-06650833 arm of the study will receive 200 mg IR suspension formulation every 6 hours (via nasogastric [NG] tube, orogastric [OG] tube, or equivalent) if unable to take tablets by mouth (PO). Subjects for whom concomitant administration of a strong inhibitor of cytochrome P450 (CYP) 3A4 will have the dose of the IR formulation to 200 mg once daily (QD). Subjects who can take tablets PO will receive 400 mg PF-06650833 (2-200 mg tablets) of the MR formulation QD under fasted conditions (preferably at least 4 hours after and 1.5 hours before a meal). No dose adjustment is needed for subjects taking the MR tablet preparation, except if co-administered with ritonavir in which case the dose should be reduced to 200 mg MR QD. All dosing of PF-06650833 will be in addition to current hospital SOC therapy.

  • PlaceboDrug

    Matching placebo tablets will be administered.

Study groups in NCT04575610
Study groupRoleWhat they receive
PF-06650833 + Standard of CareExperimentalSubjects randomized to the PF-06650833 arm of the study will receive 200 mg IR suspension formulation every 6 hours (via nasogastric [NG] tube, orogastric [OG] tube, or equivalent) if unable to take tablets by mouth (PO). All dosing of PF-06650833 will be in addition to current hospital SOC therapy.
Receives: Drug: PF-06650833
Placebo + Standard of CareActive comparatorMatching placebo tablets will be administered.
Receives: Drug: Placebo

What is being measured

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

  1. All-cause mortality at Day 29

    All-cause mortality at Day 29 (end of planned treatment period).

    Measured: Up to 29 days

Secondary outcomes (24)
  1. Disease Severity (8 point scale)

    Proportion of patients alive, extubated, and receiving no more than low flow oxygen supplementation by nasal cannula or face mask (excluding extubation for compassionate purposes in terminal patients). This would correspond to an at least 2 point decrease in the NIAID ordinal scale. The NIAID scale is as follows:

    1. Not hospitalized, no limitations on activities
    2. Not hospitalized, limitations on activities and/or requiring home oxygen
    3. Hospitalized, not requiring supplemental oxygen - no longer requires ongoing medical care
    4. Hospitalized, not requiring supplemental oxygen - requiring ongoing medical care (COVID-19 related or otherwise)
    5. Hospitalized, requiring supplemental oxygen
    6. Hospitalized, on non-invasive ventilation or high-flow oxygen devices
    7. Hospitalized, on invasive mechanical ventilation or ECMO
    8. Death

    Measured: 29 days

  2. Disease Severity (8 point scale)

    Proportion of patients alive, extubated, and receiving no more than low flow oxygen supplementation by nasal cannula or face mask (excluding extubation for compassionate purposes in terminal patients). This would correspond to an at least 2 point decrease in the NIAID ordinal scale (1 = not hospitalized, no limitations on activities, and 8 = death) at Day 61.

    Measured: 61 days

  3. Disease Severity (8 point scale)

    Proportion of patients alive, extubated, and receiving any level oxygen supplementation, including non-invasive positive pressure ventilation or high flow oxygen device (excluding extubation for compassionate purposes in terminal patients). This would correspond to an at least 1-point decrease in the NIAID ordinal scale (1 = not hospitalized, no limitations on activities, and 8 = death) at Day 29.

    Measured: 29 days

  4. Disease Severity (8 point scale)

    Proportion of patients alive, extubated, and receiving any level oxygen supplementation, including non-invasive positive pressure ventilation or high flow oxygen device (excluding extubation for compassionate purposes in terminal patients). This would correspond to an at least 1-point decrease in the NIAID ordinal scale (1 = not hospitalized, no limitations on activities, and 8 = death) at Day 61.

    Measured: 61 days

  5. Disease Severity (8 point scale)

    Percentage of patients in each category of the NIAID 8-point ordinal scale of disease severity at Day 8. The ordinal scale is an assessment of the clinical status at the first assessment of a given study day in which 1 = not hospitalized, no limitations on activities, and 8 = death.

    Measured: 8 days

  6. Disease Severity (8 point scale)

    Percentage of patients in each category of the NIAID 8-point ordinal scale of disease severity at Day 15. The ordinal scale is an assessment of the clinical status at the first assessment of a given study day in which 1 = not hospitalized, no limitations on activities, and 8 = death.

    Measured: 15 days

  7. Disease Severity (8 point scale)

    Percentage of patients in each category of the NIAID 8-point ordinal scale of disease severity at Day 22. The ordinal scale is an assessment of the clinical status at the first assessment of a given study day in which 1 = not hospitalized, no limitations on activities, and 8 = death.

    Measured: 22 days

  8. Disease Severity (8 point scale)

    Percentage of patients in each category of the NIAID 8-point ordinal scale of disease severity at Day 29. The ordinal scale is an assessment of the clinical status at the first assessment of a given study day in which 1 = not hospitalized, no limitations on activities, and 8 = death.

    Measured: 29 days

  9. Disease Severity (8 point scale)

    Percentage of patients in each category of the NIAID 8-point ordinal scale of disease severity at Day 61. The ordinal scale is an assessment of the clinical status at the first assessment of a given study day in which 1 = not hospitalized, no limitations on activities, and 8 = death.

    Measured: 61 days

  10. Mortality

    Mortality rate at day 61

    Measured: 61 days

  11. Disease Severity (8 point scale)

    Time to a 1-point decrease in the NIAID 8-point ordinal scale of disease severity (1 = not hospitalized, no limitations on activities, and 8 = death).

    Measured: 29 days

  12. Disease Severity (8 point scale)

    Time to a 2-point decrease in the NIAID 8-point ordinal scale of disease severity.

    Measured: 29 days

  13. Disease Severity (8 point scale)

    Change from baseline in the ordinal scale from Day 1 to Days 3.

    Measured: 3 days

  14. Disease Severity (8 point scale)

    Change from baseline in the ordinal scale from Day 1 to Days 5.

    Measured: 5 days

  15. Disease Severity (8 point scale)

    Change from baseline in the ordinal scale from Day 1 to Days 8.

    Measured: 8 days

  16. Disease Severity (8 point scale)

    Change from baseline in the ordinal scale from Day 1 to Days 11.

    Measured: 11 days

  17. Disease Severity (8 point scale)

    Change from baseline in the ordinal scale from Day 1 to Days 15.

    Measured: 15 days

  18. Disease Severity (8 point scale)

    Change from baseline in the ordinal scale from Day 1 to Days 22.

    Measured: 22 days

  19. Disease Severity (8 point scale)

    Change from baseline in the ordinal scale from Day 1 to Days 29.

    Measured: 29 days

  20. P/F ratio

    PaO2 (partial pressure of oxygen) / FiO2 (fraction of inspired oxygen, FiO2) ratio (or P/F ratio)

    Measured: Up to 29 days

  21. Change of the SOFA score.

    The SOFA evaluates 6 variables, each representing an organ system (one for the respiratory, cardiovascular, hepatic, coagulation, renal and neurological systems), and scored from 0 (normal) to 4 (high degree of dysfunction/failure). Thus, the maximum score may range from 0 to 24.

    Measured: Up to 29 days

  22. Duration (days) of mechanical ventilation

    The duration is days spent on mechanical ventilation.

    Measured: Up to 29 days

  23. Ventilator free days.

    The number of days hospitalized not on a ventilator.

    Measured: Up to 29 days

  24. Number of participants with treatment-related adverse events as assessed by CTCAE v4.0

    Measured: Up to 29 days

Timeline

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

  1. First posted5 Oct 2020
  2. Study start27 Nov 2020
  3. Primary completion6 Oct 2021
  4. Study completion6 Oct 2021

Why it stopped: Study terminated due to lack of enrollment reflecting the decrease in number of COVID infections. There were no safety and/or efficacy concerns involved in the decision to stop enrollment.

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
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
7 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04575610
Sponsor's protocol ID
2000028042
Status last verified
Oct 2021
First submitted
5 Aug 2020
Last updated
26 Oct 2021
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing PF-06650833 in people with COVID-19, run by Yale University at 1 site in United States.

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 13 inclusion and 23 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: stopped early, as of the sponsor's last update on 26 Oct 2021. 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 United States. 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 was stopped early (reason given: Study terminated due to lack of enrollment reflecting the decrease in number of COVID infections. There were no safety and/or efficacy concerns involved in the decision to stop enrollment.). Results are not available in the source record.

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?

All-cause mortality at Day 29 (time frame: Up to 29 days). 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 26 Oct 2021.

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