CORIMUNO-ANA: Trial Evaluating Efficacy Of Anakinra In Patients With Covid-19 Infection

Overview

The overall objective of the study is to determine the therapeutic effect and tolerance of Anakinra in patients with moderate, severe pneumonia or critical pneumonia associated with Coronavirus disease 2019 (COVID-19). Anakinra (ANA) is a recombinant human decoy IL-1Ra and therefore blocks IL-1α and IL-1β. The study has a cohort multiple Randomized Controlled Trials (cmRCT) design. Randomization will occur prior to offering Anakinra administration to patients enrolled in the COVIMUNO-19 cohort. Anakinra will be administered to consenting adult patients hospitalized with CORVID-19 either diagnosed with moderate or severe pneumonia requiring no mechanical ventilation or critical pneumonia requiring mechanical ventilation. Patients who will chose not to receive Anakinra will receive standard of cares. Outcomes of Anakinra -treated patients will be compared with outcomes of standard of care treated patients as well as outcomes of patients treated with other immune modulators.

Full Title of Study: “CORIMUNO-ANA: Trial Evaluating Efficacy Of Anakinra In Patients With Covid-19 Infection, Nested In The CORIMUNO-19″

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: May 2020

Interventions

  • Drug: Anakinra
    • Treatment includes the administration of Two IV infusions / day of ANAKINRA KINERET® 200mg (Total 400 mg) at day 1 (D1), D2 and D3, two IV infusions / day of ANAKINRA KINERET® 100mg (Total 200 mg) at day 4 (D4), and one IV infusion of ANAKINRA KINERET® 100mg (Total 100 mg) at day 5 (D5). In case of absence of improvement at D4 (absence of clinical improvement AND absence of decrease of CRP level > 50%), 3 supplementary days of treatment at 400 mg/day will be done at D4, D5, D6 followed by a decrease at 200 mg/day at D7 and 100 mg/day at D8 and stop thereafter

Arms, Groups and Cohorts

  • Experimental: ANAKINRA
    • Treatment includes the administration of Two IV infusions / day of ANAKINRA KINERET® 200mg (Total 400 mg) at day 1 (D1), D2 and D3, two IV infusions / day of ANAKINRA KINERET® 100mg (Total 200 mg) at day 4 (D4), and one IV infusion of ANAKINRA KINERET® 100mg (Total 100 mg) at day 5 (D5). In case of absence of improvement at D4 (absence of clinical improvement AND absence of decrease of CRP level > 50%), 3 supplementary days of treatment at 400 mg/day will be done at D4, D5, D6 followed by a decrease at 200 mg/day at D7 and 100 mg/day at D8 and stop thereafter
  • No Intervention: Standard of care

Clinical Trial Outcome Measures

Primary Measures

  • Survival without needs of ventilator utilization at day 14
    • Time Frame: 14 days
    • Survival without needs of ventilator utilization (including non invasive ventilation and high flow) at day 14. Thus, events considered are needing ventilator utilization (including Non Invasive Ventilation, NIV or high flow), or death. New DNR order (if given after the inclusion of the patient) will be considered as an event at the date of the DNR.
  • WHO progression scale ≤ 5
    • Time Frame: 4 days
    • Proportion of patients alive without non-invasive ventilation of high low at day 4 (WHO progression scale ≤ 5). A patient with new DNR order at day 4 will be considered as with a score > 5.
  • Cumulative incidence of successful tracheal extubation (defined as duration extubation > 48h) or withdrawal of NIV or high flow (for > 48h), at day 14
    • Time Frame: 14 days
    • Cumulative incidence of successful tracheal extubation (defined as duration extubation > 48h) at day 14 if patients have been intubated before day 14 ; or removal of NIV or high flow (for > 48h) if they were included under oxygen by NIV or High flow (score 6) and remained without intubation. Death or new DNR order (if given after the inclusion of the patient) will be considered as a competing event.
  • Decrease of at least one point in WHO progression scale score
    • Time Frame: 4 days
    • Proportion of patients with a decrease of WHO score of at least 1 point at day 4

Secondary Measures

  • WHO progression scale
    • Time Frame: 7 and 14 days
    • WHO progression scale: Uninfected; non viral RNA detected: 0 Asymptomatic; viral RNA detected: 1 Symptomatic; Independent: 2 Symptomatic; Assistance needed: 3 Hospitalized; No oxygen therapy: 4 Hospitalized; oxygen by mask or nasal prongs: 5 Hospitalized; oxygen by NIV or High flow: 6 Intubation and Mechanical ventilation, pO2/FIO2>=150 OR SpO2/FIO2>=200: 7 Mechanical ventilation, (pO2/FIO2<150 OR SpO2/FIO2<200) OR vasopressors (norepinephrine >0.3 microg/kg/min): 8 Mechanical ventilation, pO2/FIO2<150 AND vasopressors (norepinephrine >0.3 microg/kg/min), OR Dialysis OR ECMO: 9 Dead: 10.
  • Survival
    • Time Frame: 14, 28 and 90 days
    • Overall survival.
  • 28-day ventilator free-days
    • Time Frame: 28 days
  • Respiratory acidosis
    • Time Frame: 4 days
    • arterial blood pH of <7.25 with a partial pressure of arterial carbon dioxide [Paco2] of ≥60 mm Hg for >6 hours.
  • PaO2/FiO2 ratio
    • Time Frame: day 1 to day 14
    • Evolution of PaO2/FiO2 ratio.
  • Time to oxygen supply independency
    • Time Frame: 14 days
    • Time to oxygen supply independency.
  • Duration of hospitalization
    • Time Frame: 90 days
    • Duration of hospitalization.
  • Time to negative viral excretion
    • Time Frame: 90 days
    • Time to negative viral excretion.
  • Time to ICU discharge
    • Time Frame: 90 days
    • Time to ICU discharge.
  • Time to hospital discharge
    • Time Frame: 90 days
    • Time to hospital discharge.

Participating in This Clinical Trial

Inclusion Criteria

1. Patients included in the CORIMUNO-19 cohort

2. Patients with C-reactive protein level (CRP) > 25 mg / L the day or the day before the infusion)

3. Patients belonging to one of the 2 following groups:

  • Group 1: patients meeting all of the following criteria: 1) Requiring more than 3L/min of oxygen; 2) WHO progression scale = 5; 3) No NIV or High flow
  • Group 2: patients with respiratory failure AND (requiring mechanical ventilation OR NIV OR High flow), with a WHO progression scale ≥ 6, and no do-not-resuscitate (DNR) order

Exclusion Criteria

  • Patients with exclusion criteria to the CORIMUNO-19 cohort.
  • Known hypersensitivity to Anakinra or to any of their excipients.
  • Pregnancy
  • Current documented bacterial infection.
  • Patient with any of following laboratory results out of the ranges detailed below at screening:
  • Absolute neutrophil count (ANC) ≤ 1.0 x 109/L
  • Haemoglobin level: no limitation
  • Platelets (PLT) < 50 G /L
  • SGOT or SGPT > 5N
  • Severe renal insufficiency with Glomerular filtration rate < 30 ml / mn

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Assistance Publique – Hôpitaux de Paris
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Xavier Mariette, MD, PhD, Principal Investigator, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris
  • Overall Contact(s)
    • Xavier Mariette, MD, PhD, 145213751, xavier.mariette@aphp.fr

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