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Covid19Phase 3E-SPERANZANCT04695704

Efficacy of Montelukast in Mild-moderate Respiratory Symptoms in Patients With Long-COVID-19:

A Phase 3 study testing Montelukast in people with Covid19 and SARS (Disease), run by Fundacio d'Investigacio en Atencio Primaria Jordi Gol i Gurina at 8 sites in Spain.

Terminated

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

Official record
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Trial summary

Recently, a new clinical presentation called "long covid" has been reported, for patients with symptoms lasting for more than 4 weeks from the onset of the disease. Typically, the symptoms comprise dyspnea, cough, headache, arthralgia, fever, abdominal pain, asthenia and skin manifestations This project aims to… Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
Covid19, SARS (Disease)
What is being tested?
Montelukast
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
86 participants
Where
8 sitesSpain
Study dates
11 Aug 2021to 28 Aug 2023
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 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients 18 to 80 years old with SARS-CoV-2 infection (positive CRP <10 days from the onset of symptoms) treated in Primary Health Care.
  • Persistent respiratory symptoms (more than 1 and <12 months of evolution)
  • Mild-moderate dyspnea: score at the beginning of the study according to the modified Medical Research Council (mMRC) scale from 0 to 3
  • The patient must be competent to complement the follow-up evaluations.
  • The patient agrees to participate in the study and take assigned medication during the 4 weeks.
  • Sign the informed consent

Who cannot join

  • Severity criteria: fever> 38ºC, or O2 saturation <93%.
  • Patients with SARS-Cov-2 pneumonia in the acute / subacute phase.
  • Patients who have required hospital admission for SARS-Cov-2.
  • Chronic Obstructive Pulmonary Disease (COPD), asthma, bronchiectasis, pulmonary fibrosis, obstructive sleep apnea syndrome (OSAS), chronic respiratory failure from any cause, home oxygen therapy.
  • Use of montelukast or zafirlukast ≤ 30 days prior to inclusion
  • Use of any dose of systemic corticosteroids ≤ 30 days prior to inclusion
Show all 14Show fewer
  • Use of gemfibrocil.
  • Hypersensitivity to montelukast or to any of the excipients included (e.g. lactose.
  • Any condition (including the inability to swallow pills) that, in the opinion of the researcher, would prevent the completion of taking the medication.
  • Active malignancy, current or recent chemotherapy treatment (<6 months).
  • Medical history of infection by the Human Immunodeficiency Virus (HIV) or any serious immunocompromised state.
  • Pregnancy, planning to get pregnant or patients of childbearing age not undergoing birth control methods.
  • Breastfeeding mother.
  • Any other condition for which, in the opinion of the principal investigator, it is considered that the subject does not fit the study.

Trial locations and contacts

8 sites in 1 country.

8 sites in 1 country

Spain8 sites
  • Primary Health Center Raval nord

    Barcelona, 08001

  • Primaty health Center Corbera

    Corbera de Llobregat, Barcelona, 08757

  • Primary Health Center Jaume Soler

    Cornellà de Llobregat, Barcelona, 08940

  • Primary Health Center 17 Setember

    el Prat de Llobregat, Barcelona, 08820

  • Primary Health Center Camps Blancs

    Sant Boi de Llobregat, Barcelona, 08830

  • Primary Health Center Molí Nou

    Sant Boi de Llobregat, Barcelona, 08830

  • Primary Health Center Vinyets

    Sant Boi de Llobregat, Barcelona, 08830

  • Primary Health Center ElPla

    Sant Feliu de Llobregat, Barcelona, 08980

Other trials in Spain

About this study

Official title: Double-blind Randomized Clinical Trial, Placebo-controlled to Assess the Efficacy of Montelukast in Mild-moderate Respiratory Symptoms in Patients With Long-COVID-19: E-SPERANZA COVID-19 PROJECT

Recently, a new clinical presentation called "long covid" has been reported, for patients with symptoms lasting for more than 4 weeks from the onset of the disease. Typically, the symptoms comprise dyspnea, cough, headache, arthralgia, fever, abdominal pain, asthenia and skin manifestations This project aims to evaluate the efficacy of Montelukast in improving the quality of life associated with respiratory symptoms in patients with persistent COVID-19 symptoms. The main objective is to compare the efficacy of low-dose Montelukast versus placebo to improve respiratory symptoms in patients with persistent COVID-19 symptoms.

Read the detailed description

In December 2019, the first case of a new coronavirus causing pneumonia was described in Wuhan (China), designated as SARS-CoV-2 by the World Health Organization.

From the start of the SARS-CoV-2 alert until May 21st, 2020, 250,287 cases of coronavirus disease (COVID-19) were reported in Spain. The importance of the COVID-19 pandemic with its high humanitarian and economic cost, urgently requires effective therapies to reduce the severity, complications and mortality associated with this infection.

As the number of cases of COVID-19 increases, so does information regarding the management and evolution of the disease. More recently, a new clinical presentation called "long COVID-19" has been reported, for patients with symptoms lasting for more than 4 weeks from the onset of the disease. Typically, the symptoms comprise dyspnea, cough, headache, arthralgia, fever, abdominal pain, asthenia and skin manifestations.

The inflammatory process produced at the pulmonary and extra pulmonary level, and the immune response triggered have been identified as important mechanisms in the pathophysiology of COVID-19.

Coronavirus infection activates the cytokine cascade at the immune level, in which leukotriene are possibly involved in the development of respiratory symptoms in patients with persistent symptoms after infection by SARS-CoV-2.

Leukotriene antagonists (LTRAs) have a bronchodilator action and inhibit inflammation of the airways, resulting in a significant improvement in asthma symptoms and allergic rhinitis. In asthma, they improve respiratory function, inhalation rate of inhaled β2 agonist, airway inflammation, airway hyper responsiveness, inhaled corticosteroid dosage, and reduce exacerbations.

Regarding the treatment of acute SARS-CoV-2 infection, to date, the available evidence is limited; there are few conclusive clinical trials that allow recommendations based on scientific evidence.

To date, no treatment has been evaluated in long COVID-19. The hypothesis of using Montelukast would be based on the pathophysiological response of the disease mediated by the immune system against the SARS-CoV-2 infection.

Montelukast blocks the action of substances such as leukotriene C4, D4 and E4 by binding to the CysLT1 receptor in the lungs and bronchi. This reduces the bronchoconstriction caused by leukotriene and results in less inflammation.

Montelukast effectively attenuated both lung inflammation induced by Lipopolysaccharides in a mouse model with Acute Respiratory Distress Syndrome, as in human neutrophils.

Individuals affected by long COVID-19 have self-organized to gain visibility. They have made a self-completed form to describe the characteristics of the disease. The "Persistent COVID19" network in Catalonia currently gathers more than 3000 people.

From the contact with the "Persistent COVID19 association" in Catalonia, and in search of a response to this symptomatology, which can be very disabling, a pilot study was carried out in patients with persistent COVID-19 symptoms with off-label use of Montelukast.

Empirical treatment with Montelukast at a dose of 10 mg / day for 14 days was started in 13 patients with long COVID-19, some with symptoms of more than a month of evolution since the beginning of the COVID-19 clinic. The patients were followed up to evaluate the improvement of the symptoms with a numerical scale from 0 to 100 and COPD Assessment Test Scale (CAT), 3 weeks after starting treatment.

An improvement in symptoms was observed a few days after treatment and a good evolution of the sensation of dyspnea, chest pain, symptoms of discomfort, dry cough, and nasal symptoms. Likewise, the incorporation of the patients to their work activity during that period was observed. To date, the improvement continues to exist, without evidence of clinical deterioration.

Being tested
Montelukast, placebo
Keywords
SARS-CoV-2, Montelukast, Leukotriene Antagonists, Primary Health Care, Clinical Trial, Quality of Life, Long Term Covid
Medical subject headings
COVID-19, Severe Acute Respiratory Syndrome, Disease

What participants receive

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

  • MontelukastDrug

    Also called antileukotriene

    10 mg oral montelukast once daily for 28 days

  • placeboOther

    10 mg oral placebo once daily for 28 days

Study groups in NCT04695704
Study groupRoleWhat they receive
MontelukastExperimental10mg oral montelukast once daily for 28 days.
Receives: Drug: Montelukast
PlaceboPlacebo comparatororal placebo once daily for 28 days.
Receives: Other: placebo

What is being measured

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

  1. COP Assessment Test Scale (CAT)

    Quality of life of respiratory symptoms according to COPD Assessment Test (CAT The COPD Assessment Test (CAT) is a questionnaire for people with COPD, designed to measure the impact of COPD on a person's life, and how this changes over time.Quality of life of respiratory symptoms according to COPD Assessment Test (CAT). This is a validated self-administered scale to quantify and monitor the impact of COPD on well-being and daily life. It consists of 8 items (from 0 to 5 points), and a total score of 0-40 (0-9 mild, 10-20 moderate, 21-30 severe and 31-40 very severe), being higher scores worse outcome. A difference of 2 or more points in health status is considered clinically significant.

    Measured: 7, 14, 21 and 28 days

Secondary outcomes (10)
  1. 1min sit-to-stand test

    Exercise capacity: number of repetitions performed in the 1min sit-to-stand test

    Measured: 14 and 28 days

  2. O2 desaturation

    O2 desaturation ≥ 4% with effort (1min sit-to-stand test)

    Measured: 14 and 28 days

  3. Visual Analogical Scale (VAS)

    Symptoms evaluated using numeric Visual Analogical Scale (VAS): asthenia, headache, ageusia, anosmia, and rhinitis . It is numbered from 0-10, where 0 is the absence and 10 the greatest intensity, meaning higher scores worse outcome. The patient selects the number that best evaluates the intensity of the symptom.

    Measured: 7, 14, 21 and 28 days

  4. All-cause mortality

    Mortality from any cause during the study

    Measured: 7, 14, 21 and 28 days

  5. Number of visits to primary care

    Number of visits of any kind to primary health care settings (phone visit or face to face visit) during the study period.

    Measured: 28 days

  6. Number of visits to the emergency room

    Number of visits to emergency room form primary health o hospital settings during the study period.

    Measured: 28 days

  7. Number of hospital admissions.

    Number of hospital admissions during the study period.

    Measured: 28 days

  8. Medication side effects

    Number and type of adverse reactions during the study period related to medication.

    Measured: 7, 14, 21 and 28 days

  9. Days of sick leave

    Number of days of incapacity for work (sick leave) during the study period.

    Measured: 28 days

  10. Factors of inflamatory and prothrombotic processes: D-Dimer, N-terminal prohormone of brain natriuretic peptide (NT Pro-BNP), C-reactive protenin and Antinuclear antibodies (ANA)

    To analyze wether the factors of inflamatory and prothrombotic processes (D-Dimer, Pro-BNP, C-reactive protein, and ANA) at the begining of the study are response predictors to the treatment.

    Measured: 0 and 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 posted5 Jan 2021
  2. Study start11 Aug 2021
  3. Primary completion24 Jul 2023
  4. Study completion28 Aug 2023

Why it stopped: The incidence of respiratory Long COVID has decreased in the new waves, thus made impossible to achieve the required study sample.

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
Model description
Double-blind randomized placebo-controlled clinical trial,.
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
86 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04695704
Sponsor's protocol ID
4R21/006
Acronym
E-SPERANZA
Status last verified
Jul 2024
First submitted
4 Jan 2021
Last updated
3 Jul 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Mera-Cordero F, Bonet-Monne S, Almeda-Ortega J, Garcia-Sangenis A, Cunillera-Puertolas O, Contreras-Martos S, Alvarez-Munoz G, Monfa R, Balanzo-Joue M, Morros R, Salvador-Gonzalez B. Double-blind placebo-controlled randomized clinical trial to assess the efficacy of montelukast in mild to moderate respiratory symptoms of patients with long COVID: E-SPERANZA COVID Project study protocol. Trials. 2022 Jan 6;23(1):19. doi: 10.1186/s13063-021-05951-w.

    PubMed 34991703

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Montelukast in people with Covid19 and SARS (Disease), run by Fundacio d'Investigacio en Atencio Primaria Jordi Gol i Gurina at 8 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 6 inclusion and 14 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 3 Jul 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 8 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. 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 was stopped early (reason given: The incidence of respiratory Long COVID has decreased in the new waves, thus made impossible to achieve the required study sample.). 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?

COP Assessment Test Scale (CAT) (time frame: 7, 14, 21 and 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 NCT04695704, 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 3 Jul 2024.

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