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COVID-19Phase 3MANTICONCT05205759

Non-inferiority Trial on Monoclonal Antibodies in COVID-19

A Phase 3 study testing Bamlanivimab Etesevimab, Sotrovimab and Casirivimab-Imdevimab in people with COVID-19, run by Azienda Ospedaliera Universitaria Integrata Verona at 20 sites in Italy.

Terminated

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

Official record
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Trial summary

Currently, 3 anti-SARS-CoV-2 monoclonal antibody products have received Emergency Use Authorizations from the Italian Medicines Agency (AIFA) for the treatment of mild to moderate COVID-19 in non hospitalized patients with laboratory-confirmed SARS-CoV-2 infection who are at high risk for progressing to severe disease… Read more about this study

Who is it for?
Ages 50 years and older
Conditions the study is for
COVID-19
What is being tested?
Bamlanivimab Etesevimab, Sotrovimab and Casirivimab-Imdevimab
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
319 participants
Where
20 sitesItaly
Study dates
9 Dec 2021to 5 Apr 2022
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 50 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age ≥ 50 years
  • Informed consent by the subject or legally authorized representative
  • Laboratory-confirmed SARS-CoV-2 infection, as determined by antigen or nucleic acid identification in any specimen, within 4 days of eligibility assessment
  • Peripheral oxygen saturation ≥ 94% on room air and not requiring supplemental oxygen
  • Onset of symptoms within 4 days of eligibility assessment. Onset time of symptoms is defined as the time when the patient experienced the presence of at least one of the following SARS-CoV-2 infection-associated symptoms for the first time [4]: cough, nasal congestion, sore throat, feeling hot or feverish, myalgia, fatigue, headache, anosmia/ageusia, nausea, vomiting, and/or diarrhoea

Who cannot join

  • Previously or currently hospitalized or requiring hospitalization
  • Respiratory distress with respiratory rate ≥ 25 breaths/min
  • Heart rate ≥ 125 beats per minute
  • Peripheral oxygen saturation ≤ 93% on room air at sea level
  • Known allergies to any of the components used in the formulation of the trial drugs
  • Hemodynamic instability requiring use of pressors within 24 hours of randomization
Show all 16Show fewer
  • Suspected or proven serious, active bacterial, fungal, viral, or other infection (besides COVID-19) that could potentially lead to hospitalization within 30 days
  • Any co-morbidity requiring surgery within 7 days or that is considered life-threatening within 90 days
  • History of positive SARS-CoV-2 test prior to 4 days of the eligibility assessment
  • Previous treatment with a SARS-CoV-2 specific monoclonal antibody
  • History of convalescent COVID-19 plasma treatment
  • Participation in a clinical study involving an investigational intervention within the last 30 days
  • Pregnancy or breast feeding
  • Investigator site personnel directly affiliated with this study
  • Sexually active women of childbearing potential or sexually active men who are unwilling to practice effective contraception prior to the initial dose/start of the first treatment, during the study, and for at least 6 months after the last dose
  • Inability to participate to the study follow-up

Trial locations and contacts

20 sites in 1 country.

20 sites in 1 country

Italy20 sites
  • IRCCS Policlinico di S. Orsola

    Bologna

  • PO SS Trinità di Cagliari

    Cagliari

  • Azienda Ospedaliera Cannizzaro

    Catania

  • Azienda Ospedaliera Universitaria Policlinico Vittorio Emanuele

    Catania

  • PO Garibaldi Nesima

    Catania

  • Azienda Socio-Sanitaria Territoriale di Cremona

    Cremona

  • Ospedale S. Maria Annunziata

    Florence

  • Covid Hospital Jesolo

    Jesolo

  • Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico

    Milan

  • Azienda Ospedaliera dei Colli, presidio ospedaliero Cotugno

    Naples

  • Azienda Ospedaliera di Padova

    Padova

  • AOU Policlinico

    Palermo

  • Azienda Ospedaliera S. Maria della Misericordia

    Perugia

  • Università degli Studi di Pescara

    Pescara

  • Fondazione Policlinico Universitario A. Gemelli

    Roma

  • Ospedale San Paolo ASL 2 Savonese

    Savona

  • AOU Città della Salute e Scienza, Presidio Molinette

    Torino

  • Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI)

    Trieste

  • Azienda Sanitaria Universitaria Friuli Centrale

    Udine

  • Azienda Ospedaliera di Verona

    Verona, 37134

Other trials in Italy

About this study

Official title: Adaptive, Randomized, Non-inferiority Trial to Evaluate the Efficacy of Monoclonal Antibodies in Outpatients With Mild or Moderate COVID-19

Currently, 3 anti-SARS-CoV-2 monoclonal antibody products have received Emergency Use Authorizations from the Italian Medicines Agency (AIFA) for the treatment of mild to moderate COVID-19 in non hospitalized patients with laboratory-confirmed SARS-CoV-2 infection who are at high risk for progressing to severe disease and/or hospitalization (bamlanivimab plus etesevimab, sotrovimab, and casirivimab plus imdevimab). Differently from casirivimab/imdevimab and sotrovimab, the European Medicines Agency (EMA) has never recommended authorising the combination bamlanivimab/etesevimab for treating COVID-19. Moreover, the evidence on sotrovimab relies on the interim analysis results of an ongoing randomised placebo-controlled clinical trial [1], unlike the combinations bamlanivimab/etesevimab and casirivimab/imdevimab, whose results of the randomised placebo-controlled trials were published after having completed the enrolment [2,3]. The study aims at assessing the non-inferiority of bamlanivimab plus etesevimab and sotrovimab vs. casirivimab plus imdevimab on COVID-19 progression in patients aged at least 50 years at an early stage of the disease. The progression of COVID-19 disease (hospitalization, need for supplementary oxygen therapy at home, death) within 14 days of randomisation is the composite outcome variable on which the calculation of the sample size is based. Based on available data regarding the reduction in the number of hospitalisations and medical visits with the use of casirivimab plus imdevimab at an early-stage of COVID-19, a disease progression of 5% has been estimated in the reference arm. 5% delta margin was considered clinically relevant, taking into account both the estimates of disease progression in the study population in absence of early treatment with monoclonal antibodies (20%, based on national data) and the efficacy of the reference standard. Therefore, 1260 participants will be randomly assigned in an equal ratio between the reference standard and each of the other two experimental arms (1:1:1). Randomization will be computer-generated in permuted blocks with a stratification based on site.

Read the detailed description

Sample size. The parameters for the sample size estimation were derived from the only double-blind, randomised, placebo-controlled trial assessing the clinical efficacy of casirivimab/imdevimab (reference standard) [3]. Hospitalisation related to COVID-19 or all-cause mortality in this study occurred in 7 of 736 patients in the casirivimab/imdevimab 1200-mg group (1.0%) and in 24 of 748 patients in the placebo group who underwent randomisation concurrently (3.2%) (relative risk reduction, 70.4%; P=0.002). Assuming a non-inferiority margin of 5%, 420 patients per group were needed to achieve 90% power with a 1-sided α level of .025, allowing for 5% dropout. A 5% non-inferiority margin was chosen as the maximal difference between treatments in COVID-19 progression that would be clinically acceptable by consultation with Infectious Diseases and clinical trial specialists involved in the protocol development.

Conditions
COVID-19
Being tested
Bamlanivimab Etesevimab, Sotrovimab, Casirivimab-Imdevimab
Keywords
Coronavirus Infections, Monoclonal antibodies, Bamlanivimab Etesevimab, Casirivimab Imdevimab, Sotrovimab
Medical subject headings
COVID-19, Coronavirus Infections

What participants receive

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

  • Bamlanivimab EtesevimabDrug

    Single intravenous infusion of bamlanivimab 700 mg and etesevimab 1400 mg, administered together [1 bamlanivimab vial (700 mg/20 mL) and 2 etesevimab vials (700 mg/20 mL)] in a 250-mL prefilled 0.9% Sodium Chloride infusion bag over one hour.

  • SotrovimabDrug

    Single intravenous infusion of sotrovimab 500 mg (500 mg/8 mL), administered in 100 mL prefilled 0.9% sodium chloride injection infusion solution over 1/2 hour.

  • Casirivimab-ImdevimabDrug

    Single intravenous infusion of casirivimab 600 mg + imdevimab 600 mg, administered together in 250 mL prefilled 0.9% sodium chloride injection infusion solution over one hour. Casirivimab and imdevimab are each supplied in individual single use vials. Casirivimab is available as 300 mg/2.5 mL (120 mg/mL) or 1332 mg/11.1 mL (120 mg/mL). Imdevimab is available as 300 mg/2.5 mL (120 mg/mL) or 1332 mg/11.1 mL (120 mg/mL).

Study groups in NCT05205759
Study groupRoleWhat they receive
Bamlanivimab EtesevimabExperimentalBamlanivimab 700 mg + Etesevimab 1400 mg administered in 250 mL prefilled 0.9% sodium chloride injection infusion solution over one hour
Receives: Drug: Bamlanivimab Etesevimab
SotrovimabExperimentalSotrovimab 500 mg administered in 100 mL prefilled 0.9% sodium chloride injection infusion solution over 1/2 hour
Receives: Drug: Sotrovimab
Casirivimab ImdevimabActive comparatorCasirivimab 600 mg + Imdevimab 600 mg administered in 250 mL prefilled 0.9% sodium chloride injection infusion solution over one hour
Receives: Drug: Casirivimab-Imdevimab

What is being measured

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

  1. COVID-19 progression

    (1) hospitalization or (2) need of supplemental oxygen therapy at home or (3) death within 14 days of randomisation

    Measured: 14 days

Secondary outcomes (9)
  1. Visits to the Emergency Room

    Number of visits to the Emergency Room without subsequent hospitalization within 28 days of randomization

    Measured: 28 days

  2. Duration of supplemental oxygen therapy

    Days of supplemental oxygen therapy within 90 days of randomization

    Measured: 90 days

  3. Duration of hospitalization

    Days of any hospitalization within 90 days of randomization

    Measured: 90 days

  4. Non-invasive ventilation

    Rate of patients undergoing non-invasive ventilation within 28 days of randomization

    Measured: 28 days

  5. Duration of non-invasive ventilation

    Days of non-invasive ventilation within 90 days of randomization

    Measured: 90 days

  6. Mechanical ventilation

    Rate of patients undergoing mechanical ventilation within 28 of randomization

    Measured: 28 days

  7. Duration of mechanical ventilation

    Days of mechanical ventilation within 90 days of randomization

    Measured: 90 days

  8. 28-day mortality

    Death rate at 28 days of randomization

    Measured: 28 days

  9. Duration of symptoms

    Days of symptoms within 90 days of randomization

    Measured: 90 days

Timeline

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

  1. First posted25 Jan 2022
  2. Study start9 Dec 2021
  3. Primary completion5 Feb 2022
  4. Study completion5 Apr 2022

Why it stopped: Stop for futility after the onset of the omicron wave

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
Single blind
Who is masked
Participant
Enrolment
319 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05205759
Sponsor's protocol ID
MANTICO
Other IDs
2021-002612-31
Acronym
MANTICO
Status last verified
Jul 2022
First submitted
15 Jan 2022
Last updated
26 Jul 2022
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Gupta A, Gonzalez-Rojas Y, Juarez E, Crespo Casal M, Moya J, Falci DR, Sarkis E, Solis J, Zheng H, Scott N, Cathcart AL, Hebner CM, Sager J, Mogalian E, Tipple C, Peppercorn A, Alexander E, Pang PS, Free A, Brinson C, Aldinger M, Shapiro AE; COMET-ICE Investigators. Early Treatment for Covid-19 with SARS-CoV-2 Neutralizing Antibody Sotrovimab. N Engl J Med. 2021 Nov 18;385(21):1941-1950. doi: 10.1056/NEJMoa2107934. Epub 2021 Oct 27.

    PubMed 34706189
  • Dougan M, Nirula A, Azizad M, Mocherla B, Gottlieb RL, Chen P, Hebert C, Perry R, Boscia J, Heller B, Morris J, Crystal C, Igbinadolor A, Huhn G, Cardona J, Shawa I, Kumar P, Adams AC, Van Naarden J, Custer KL, Durante M, Oakley G, Schade AE, Holzer TR, Ebert PJ, Higgs RE, Kallewaard NL, Sabo J, Patel DR, Dabora MC, Klekotka P, Shen L, Skovronsky DM; BLAZE-1 Investigators. Bamlanivimab plus Etesevimab in Mild or Moderate Covid-19. N Engl J Med. 2021 Oct 7;385(15):1382-1392. doi: 10.1056/NEJMoa2102685. Epub 2021 Jul 14.

    PubMed 34260849
  • Weinreich DM, Sivapalasingam S, Norton T, Ali S, Gao H, Bhore R, Xiao J, Hooper AT, Hamilton JD, Musser BJ, Rofail D, Hussein M, Im J, Atmodjo DY, Perry C, Pan C, Mahmood A, Hosain R, Davis JD, Turner KC, Baum A, Kyratsous CA, Kim Y, Cook A, Kampman W, Roque-Guerrero L, Acloque G, Aazami H, Cannon K, Simon-Campos JA, Bocchini JA, Kowal B, DiCioccio AT, Soo Y, Geba GP, Stahl N, Lipsich L, Braunstein N, Herman G, Yancopoulos GD; Trial Investigators. REGEN-COV Antibody Combination and Outcomes in Outpatients with Covid-19. N Engl J Med. 2021 Dec 2;385(23):e81. doi: 10.1056/NEJMoa2108163. Epub 2021 Sep 29.

    PubMed 34587383
  • U.S. Department of Health and Human Services Food and Drug Administration. Assessing COVID19-Related Symptoms in Outpatient Adult and Adolescent Subjects in Clinical Trials of Drugs and Biological Products for COVID-19 Prevention or Treatment. Available at https://www.fda.gov/regulatory-information/search-fda-guidance-documents/assessing-covid-19-related-symptoms-outpatient-adult-and-adolescent-subjects-clinical-trials-drugs. Accessed 30 March 2022.

  • Mazzaferri F, Mirandola M, Savoldi A, De Nardo P, Morra M, Tebon M, Armellini M, De Luca G, Calandrino L, Sasset L, D'Elia D, Sozio E, Danese E, Gibellini D, Monne I, Scroccaro G, Magrini N, Cattelan A, Tascini C; MANTICO Working Group; Tacconelli E. Exploratory data on the clinical efficacy of monoclonal antibodies against SARS-CoV-2 Omicron variant of concern. Elife. 2022 Nov 22;11:e79639. doi: 10.7554/eLife.79639.

    PubMed 36413383

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Bamlanivimab Etesevimab, Sotrovimab and Casirivimab-Imdevimab in people with COVID-19, run by Azienda Ospedaliera Universitaria Integrata Verona at 20 sites in Italy.

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 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: stopped early, as of the sponsor's last update on 26 Jul 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 20 sites in Italy. 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 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: Stop for futility after the onset of the omicron wave). 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?

COVID-19 progression (time frame: 14 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 NCT05205759, which also lists 5 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 26 Jul 2022.

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