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COVID-19NCT05819918

Calcifediol in the Treatment of COVID 19

An observational study of COVID-19, run by Maimónides Biomedical Research Institute of Córdoba at 1 site 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

Patients hospitalized with COVID-19 treated with calcifediol during the first outbreaks of the pandemic (until the first vaccinations) are compared with the aim of determining the therapeutic, clinical, functional, and biochemical variables that modify the response (admission to ICU or death) to calcifediol during… 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?
Calcifediol and Best available therapy
How many people
728 participants
Where
1 siteSpain
Study dates
1 Apr 2022to 17 Apr 2023
Phase
Observational
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
  • Adult, Older adult

Study population: Patients requiring hospital admission due to respiratory infection confirmed by SARS-CoV-2 (radiographic pattern of viral pneumonia and positive PCR for SARS-CoV-2) with a CURB65 severity scale (recommending hospital admission in case of a total score > 1). Patients meeting ALL inclusion criteria and NO exclusion criteria will be included in the study.

Who may be able to join

  • Age ≥ 18 and < 90 years.
  • Diagnosis confirmed by positive polymerase chain reaction (PCR) for COVID-19.
  • Radiological image compatible with pulmonary involvement by COVID-19.
  • Admission to "Reina Sofia university Hospital (HURS)" Pneumology Department.

Who cannot join

  • Patients for whom electronic medical record data cannot be collected.

Trial locations and contacts

1 site in 1 country.

Spain1 site
  • Hospital Universitario Reina Sofia

    Córdoba, Córdoba, 14004

Other trials in Spain

About this study

Official title: Calcifediol in the Treatment of COVID 19. Modification of Therapeutic Response by Best Available Treatment or Other Treatment or Clinical Variables

Patients hospitalized with COVID-19 treated with calcifediol during the first outbreaks of the pandemic (until the first vaccinations) are compared with the aim of determining the therapeutic, clinical, functional, and biochemical variables that modify the response (admission to ICU or death) to calcifediol during hospitalization for COVID 19

Read the detailed description

The ongoing pandemic of coronavirus disease-19 (COVID-19), caused by the β-coronavirus SARS-CoV-2, is the greatest challenge ever faced by modern medicine and public health systems worldwide. In early outbreaks, approximately 20% progressed to severe symptomatology, of which 5% developed acute respiratory distress syndrome (ARDS), septic shock and multi-organ failure accompanied by a high risk of death. In this scenario, the scientific community employed strong social containment measures and developed vaccines effective in preventing severe clinical forms of COVID-19. Vaccines against the causative virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have shown a preventive effect against the occurrence and severity of COVID-19, and social and economic activities are gradually recovering worldwide.

The rapid mutation rate of this virus family including multiple mutations in the receptor binding domain of the spike protein that have been associated with increased transmissibility and immune evasion after natural infection and vaccination, calls into question both the efficacy of vaccines and their long-term safety and the efficacy of monoclonal antibodies withdrawn for lack of effectiveness. Moreover, the cost/benefit of newly licensed oral antivirals for high-risk patients in higher-income countries remains inadequately documented.

These data update the repositioning strategy employed since the beginning of the pandemic for the use of safe drugs, approved for another indication and reproposed to improve symptoms and clinical outcomes in COVID-19 patients.

Numerous drugs have been investigated with this strategy and many studies have been published. Calcifediol (25OH vitamin D3) is one of them. Calcifediol is the prohormone of the vitamin D endocrine system (VDES). It requires hydroxylation to convert to calcitriol (1,25(OH)2 vitamin D3) , the active form that exerts its functions by activating the vitamin D receptor (VDR), which is expressed in the immune system and many other affected organs in COVID, including the lungs.

Available data strongly suggest that treatment with calcifediol can decrease the severity of COVID-19, decreasing the need for intensive care unit (ICU) admissions and decreasing the risk of mortality. It is a cost-effective treatment, without major adverse effects, and widely available, which could have positive implications for the treatment of the disease worldwide.

Another family of repositioned drugs has been the corticosteroids. Commonly used for decades for their immunosuppressive/anti-inflammatory properties by inhibiting the expression of multiple pro-inflammatory cytokines and chemokines, and the (in)activation of various immune cells. However, at the start of the pandemic in 2020, corticosteroid treatment in COVID-19 was formally contraindicated or not recommended.

Corticosteroids had been widely used during outbreaks of severe acute respiratory syndrome (SARS)-CoV and Middle East respiratory syndrome (MERS)-CoV, but review of their use in those epidemics suggested that corticosteroid use could increase mortality and secondary infection rates by delaying viral clearance. Therefore, World Health Organization (WHO) interim guidance on the clinical management of severe acute respiratory infection when SARS-CoV-2 infection was suspected (published on 28 January 2020) advised against the use of corticosteroids unless otherwise indicated.

For this reason, the three studies described that treated COVID with high-dose calcifediol and best available therapy did not use corticosteroids (except rarely and after a consensus clinical decision by the treating physicians). Thus, the results obtained did not have the confounding factor of modulation of innate and acquired immunity by corticosteroid treatment.

Following the RECOVERY trial, one of the largest randomized controlled trials for COVID-19 treatment, clinical practice guidelines were modified worldwide to authorize the standard use of dexamethasone or other corticosteroids as the best available treatment in hospitalized patients with severe COVID-19 requiring intensive oxygen therapy. However, the appropriate time interval for corticosteroid administration is a matter of debate, and the response to treatment is also likely to be related to the natural history of each patient's clinical and biological evolution. In addition, it is unclear how long treatment should last; since prolonged corticosteroid treatment may not be safe, due to interference with clotting and metabolic pathways, disease symptoms and long-term persistence of COVID-19.

Therefore, systemic glucocorticoids, included as the best available treatment, could, depending on the timing of their introduction, modify and/or confound the beneficial effect of calcifediol evidenced in the pre-corticoid stage of the pandemic. Other variables may also act as a confounding factor in the response to calcifediol treatment.

Conditions
COVID-19
Being tested
Calcifediol, Best available therapy
Medical subject headings
COVID-19

What participants receive

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

  • CalcifediolDrug

    Subjects hospitalized with COVID-19 treated with calcifediol

  • Best available therapyDrug

    Subjects hospitalized with COVID-19 treated with Azithromycin, hydroxychloroquine, corticoids and others authorized treatments.

Study groups in NCT05819918
Study groupRoleWhat they receive
CalcifediolNot described
Receives: Drug: Calcifediol
Best therapy availableNot described
Receives: Drug: Best available therapy

What is being measured

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

  1. Need for ICU admission

    Measure the need for ICU admission by differentiating the groups calcifediol yes/no; corticosteroids yes/no.

    Measured: from hospitalization till discharge /death

  2. Mortality

    Measure mortality by differentiating groups: calcifediol yes/no; corticosteroids yes/no.

    Measured: from hospitalization till discharge /death

  3. Composite variable poor prognosis, (ICU&death)

    Measure the composite variable poor prognosis, (ICU\&death) by differentiating the groups calcifediol yes/no; corticosteroids yes/no.

    Measured: from hospitalization till discharge /death

Secondary outcomes (2)
  1. clinical variables that calcifediol response

    To detect clinical variables that may modify the response to calcifediol.

    Measured: from hospitalization till discharge /death

  2. drug modifying calcifediol response

    To detect clinical variables that may modify the response to calcifediol.

    Measured: from hospitalization till discharge /death

Timeline

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

  1. First posted19 Apr 2023
  2. Study start1 Apr 2022
  3. Primary completion17 Apr 2023
  4. Study completion17 Apr 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Retrospective
Enrolment
728 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05819918
Sponsor's protocol ID
TD-CCRC-21
Status last verified
Apr 2023
First submitted
17 Apr 2023
Last updated
28 Apr 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. JAMA. 2020 Aug 25;324(8):782-793. doi: 10.1001/jama.2020.12839.

    PubMed 32648899
  • Grana C, Ghosn L, Evrenoglou T, Jarde A, Minozzi S, Bergman H, Buckley BS, Probyn K, Villanueva G, Henschke N, Bonnet H, Assi R, Menon S, Marti M, Devane D, Mallon P, Lelievre JD, Askie LM, Kredo T, Ferrand G, Davidson M, Riveros C, Tovey D, Meerpohl JJ, Grasselli G, Rada G, Hrobjartsson A, Ravaud P, Chaimani A, Boutron I. Efficacy and safety of COVID-19 vaccines. Cochrane Database Syst Rev. 2022 Dec 7;12(12):CD015477. doi: 10.1002/14651858.CD015477.

    PubMed 36473651
  • Giliberto Capano, Michael Howlett, Darryl S L Jarvis, M Ramesh, Long-term policy impacts of the coronavirus: normalization, adaptation, and acceleration in the post-COVID state, Policy and Society, 2022; 41 (1): 1-12, doi: 10.1093/polsoc/puab018.

  • Kato Y, Nishiyama K, Nishimura A, Noda T, Okabe K, Kusakabe T, Kanda Y, Nishida M. Drug repurposing for the treatment of COVID-19. J Pharmacol Sci. 2022 Jul;149(3):108-114. doi: 10.1016/j.jphs.2022.04.007. Epub 2022 Apr 25.

    PubMed 35641023
  • San Filippo S, Crovetto B, Bucek J, Nahass RG, Milano M, Brunetti L. Comparative Efficacy of Early COVID-19 Monoclonal Antibody Therapies: A Retrospective Analysis. Open Forum Infect Dis. 2022 Feb 14;9(4):ofac080. doi: 10.1093/ofid/ofac080. eCollection 2022 Apr.

    PubMed 35299987
  • Jayk Bernal A, Gomes da Silva MM, Musungaie DB, Kovalchuk E, Gonzalez A, Delos Reyes V, Martin-Quiros A, Caraco Y, Williams-Diaz A, Brown ML, Du J, Pedley A, Assaid C, Strizki J, Grobler JA, Shamsuddin HH, Tipping R, Wan H, Paschke A, Butterton JR, Johnson MG, De Anda C; MOVe-OUT Study Group. Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients. N Engl J Med. 2022 Feb 10;386(6):509-520. doi: 10.1056/NEJMoa2116044. Epub 2021 Dec 16.

    PubMed 34914868
  • Reis S, Metzendorf MI, Kuehn R, Popp M, Gagyor I, Kranke P, Meybohm P, Skoetz N, Weibel S. Nirmatrelvir combined with ritonavir for preventing and treating COVID-19. Cochrane Database Syst Rev. 2022 Sep 20;9(9):CD015395. doi: 10.1002/14651858.CD015395.pub2.

    PubMed 36126225
  • Quesada-Gomez JM, Entrenas-Castillo M, Bouillon R. Vitamin D receptor stimulation to reduce acute respiratory distress syndrome (ARDS) in patients with coronavirus SARS-CoV-2 infections: Revised Ms SBMB 2020_166. J Steroid Biochem Mol Biol. 2020 Sep;202:105719. doi: 10.1016/j.jsbmb.2020.105719. Epub 2020 Jun 11.

    PubMed 32535032
  • Entrenas Castillo M, Entrenas Costa LM, Vaquero Barrios JM, Alcala Diaz JF, Lopez Miranda J, Bouillon R, Quesada Gomez JM. "Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study". J Steroid Biochem Mol Biol. 2020 Oct;203:105751. doi: 10.1016/j.jsbmb.2020.105751. Epub 2020 Aug 29.

    PubMed 32871238
  • Nogues X, Ovejero D, Pineda-Moncusi M, Bouillon R, Arenas D, Pascual J, Ribes A, Guerri-Fernandez R, Villar-Garcia J, Rial A, Gimenez-Argente C, Cos ML, Rodriguez-Morera J, Campodarve I, Quesada-Gomez JM, Garcia-Giralt N. Calcifediol Treatment and COVID-19-Related Outcomes. J Clin Endocrinol Metab. 2021 Sep 27;106(10):e4017-e4027. doi: 10.1210/clinem/dgab405.

    PubMed 34097036
  • Alcala-Diaz JF, Limia-Perez L, Gomez-Huelgas R, Martin-Escalante MD, Cortes-Rodriguez B, Zambrana-Garcia JL, Entrenas-Castillo M, Perez-Caballero AI, Lopez-Carmona MD, Garcia-Alegria J, Lozano Rodriguez-Mancheno A, Arenas-de Larriva MDS, Perez-Belmonte LM, Jungreis I, Bouillon R, Quesada-Gomez JM, Lopez-Miranda J. Calcifediol Treatment and Hospital Mortality Due to COVID-19: A Cohort Study. Nutrients. 2021 May 21;13(6):1760. doi: 10.3390/nu13061760.

    PubMed 34064175
  • Loucera C, Pena-Chilet M, Esteban-Medina M, Munoyerro-Muniz D, Villegas R, Lopez-Miranda J, Rodriguez-Bano J, Tunez I, Bouillon R, Dopazo J, Quesada Gomez JM. Real world evidence of calcifediol or vitamin D prescription and mortality rate of COVID-19 in a retrospective cohort of hospitalized Andalusian patients. Sci Rep. 2021 Dec 3;11(1):23380. doi: 10.1038/s41598-021-02701-5.

    PubMed 34862422
  • Shimba A, Ikuta K. Glucocorticoids Regulate Circadian Rhythm of Innate and Adaptive Immunity. Front Immunol. 2020 Sep 18;11:2143. doi: 10.3389/fimmu.2020.02143. eCollection 2020.

    PubMed 33072078
  • Dagens A, Sigfrid L, Cai E, Lipworth S, Cheng V, Harris E, Bannister P, Rigby I, Horby P. Scope, quality, and inclusivity of clinical guidelines produced early in the covid-19 pandemic: rapid review. BMJ. 2020 May 26;369:m1936. doi: 10.1136/bmj.m1936.

    PubMed 32457027
  • Stockman LJ, Bellamy R, Garner P. SARS: systematic review of treatment effects. PLoS Med. 2006 Sep;3(9):e343. doi: 10.1371/journal.pmed.0030343.

    PubMed 16968120

Questions about this trial

What is this clinical trial studying?

An observational study of COVID-19, run by Maimónides Biomedical Research Institute of Córdoba at 1 site 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 4 inclusion and 1 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 28 Apr 2023. 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 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.

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?

Need for ICU admission (time frame: from hospitalization till discharge /death). The study lists 3 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 NCT05819918, which also lists 22 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 28 Apr 2023.

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