CONVALESCENT PLASMA FOR ILL PATIENTS BY COVID-19

NCT ID: NCT04356482

Last Updated: 2020-06-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE1/PHASE2

Total Enrollment

90 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-05-20

Study Completion Date

2020-12-31

Brief Summary

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The present study will try to respond first in an initial phase, what is the minimum effective dose necessary of convalescent plasma for getting better in severly ill (not intubated) or very severely ill (intubated) patients.

Once the dose will be determined by each type of patient group (severely ill vs. very severely ill) has been determined, phase 2 of the study will begin, where the safety and efficacy of the use of plasma will be evaluated based on clinical, imaging and laboratory criteria.

So, our hypotheses are:

1. Is there a minimum effective dose to treat seriously ill patients with convalescent plasma with COVID-19?
2. the plasma dose with the minimum effective effect will improve the clinical, laboratory and clearance conditions of the presence of the virus in the severely ill patient?

Detailed Description

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Specific objectives

1. Show the efficacy and safety of fresh plasma in different doses in severe cases and in very severe cases.
2. Assess whether fresh plasma can overcome negative prognostic factors in very severe ill patients with COVID-19 infection. These factors are age, high SOFA score, and high D-dimer.
3. To evaluate the titration of antiCOVID-19 antibodies and if its quantification is related to the therapeutic response.

The responses to drug treatments that exist in our country such as hydroxychloroquine ± azithromycin, lopinavir / ritonavir and tocilizumab (anti-IL-6) are very heterogeneous, with high cost and diverse and serious adverse events in some cases. Absent randomized-controlled studies and case series or small cohort studies have not been shown to be more effective than supportive treatments in these patients. One more factor is that intubated patients cannot swallow and these medications are for oral posology; the only way to administer is through a nasogastric tube, so we cannot assure that its absorption is as expected and that the blood levels do not reach therapeutic levels.

Therefore, we propose a treatment that in the first instance is in our hands, which has already proven to be effective in infection with highly pathogenic viruses such as Ebola virus, Lassar fever and other coronavirus infections (SARS1 in 2003, MERS 2012). With regard to convalescent plasma, two studies have recently been published, a series of 5 and another of 10 cases, seriously ill and with no response to the mentioned therapies (hydroxychloroquine ± azithromycin and lopinavir / ritonavir, among others). The outcomes in this series of cases have been reported satisfactory in most with few minimal adverse events (rash).

Since the convalescent plasma dose is very ambiguous in the case-series reported, we will try to find this dose. Therefore, in this initial phase, we divided it into two severity groups:

1. . Severe ill group, convalescent plasma dose on day 0, evaluation on day +3 and if you continue with the clinic and laboratories, a second dose of plasma may be administered. Always watching the safety always (early and late transfusion reactions). Clinical evaluation (including oxygenation) as well as laboratory (days +6, +9, +12, +15, +18, +21 to find the necessary dose for response. The patients will be evaluated and if they meet the response points, the minimum effective plasma dose will be recommended for phase 2.
2. . Very severe ill group, convalescent plasma dose day 0, with evaluation on day +3, will add another dose of plasma if there is no improvement clinic or laboratory, reevaluate day +6 and if required, apply another dose of plasma if there will be not clinical or laboratory improvement. Always watching security. It is reassessed clinically (including respiratory parameters) on days +9, +12, +15, +18 and +21, to find the minimal dose necessary. This sequential treatment will help reduce the risk of water overload and also assess the presence of transfusion lung injury syndrome or TRALI. A second phase, the dose and safety of treatment will be evaluated.

In the second phase , both early and late or B will be evaluated as follows:

to. Sever ill cases: plasma will be applied according to the dose you will find in phase 1b. Security and response will be evaluated in this phase.

b. Very sever ill cases: Plasma will be applied according to the dose you will find in phase 1b and the safety and response phase will be evaluated.

It will also be open (the study will not be blinded), it will not be randomized, and it will be controlled only by the severity of the patient and their characteristics of the disease (severe vs. very severe), as well as being controlled by the amount of infusion of plasma (minimum effective dose).

SECURITY ANALYSIS

The security analysis will be between the researchers in the group and another externak group. They will analyze the first 5 patients in each group (severe and very severe), the main objective for security analysis is going to be mortality related directly to plasma infusion. Subsequently, every 20 patients in each group for phase 2 will be analyzed for safety and response.

Conditions

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COVID-19 SARS-CoV 2 Convalescence Plasma Doses

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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single arm

Determine the convalescent plasma dose to be administered to two groups: one severely ill (not intubated) and one very severely ill (intubated).

Second phase: safety and efficacy of the plasma dose found in the same two types of patients.

Group Type EXPERIMENTAL

convalescent plasma

Intervention Type BIOLOGICAL

In phase 1, different amounts of convalescent plasma will be evaluated depending on the severity of the case.

In phase 2, both clinical, laboratory, imaging and viral presence (effectiveness) and safety will be evaluated.

Interventions

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convalescent plasma

In phase 1, different amounts of convalescent plasma will be evaluated depending on the severity of the case.

In phase 2, both clinical, laboratory, imaging and viral presence (effectiveness) and safety will be evaluated.

Intervention Type BIOLOGICAL

Other Intervention Names

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no apply

Eligibility Criteria

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Inclusion Criteria

All patients with COVID-19 test positive and... Severe ill patient

1. Respiratory difficulty
2. Sat O2 \<93% without O2 but improves with the use of supplemental oxygen
3. CT scan image: COVID-19 compatible pneumonia
4. one or more of at least: SOFA = 0 D-dimer ≥500 Age ≥ 65 years Comorbidities such as high blood pressure, diabetes mellitus type I and II, chronic kidney failure, controlled or cured cancer, ≥ 1 degree of obesity

Very severe ill:

1. Respiratory difficulty that does not improve with supplemental oxygen, requiring intubation and connecting to ventilatory support of no more than 72hrs or 3 days.
2. CT image: COVID-19 compatible pneumonia
3. one or more of at least: SOFA ≥1 Dimer D ≥ 750 Age ≥ 65 years Comorbidities such as hypertension, diabetes mellitus type I and II, Chronic Kidney Failure, Controlled or cured cancer, ≥ 1 degree of obesity.
4. Survival over 5 days.


a) Pregnant women are accepted

Exclusion Criteria

1. patients with asymptomatic/mild disease for COVID-19
2. Children less than 16 years old
3. patients with atypical pneumonia without COVID-19 diagnostic for PCR-RT
Minimum Eligible Age

16 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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SECRETARIA DE SALUD DEL ESTADO DE SONORA

UNKNOWN

Sponsor Role collaborator

CENTRO ESTATAL DE LA TRANSFUSION SANGUINEA

UNKNOWN

Sponsor Role collaborator

HOSPITAL CENTRAL NACIONAL PEMEX NORTE

UNKNOWN

Sponsor Role collaborator

HOSPITAL DE ZONA No. 2 IMSS

UNKNOWN

Sponsor Role collaborator

HOSPITAL DE ZONA No.14 IMSS

UNKNOWN

Sponsor Role collaborator

HOSPITAL GENERAL DEL ESTADO DE SONORA

UNKNOWN

Sponsor Role collaborator

Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado

OTHER_GOV

Sponsor Role lead

Responsible Party

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Luis Villela

MD,MSc

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Luis M Villela, MD

Role: PRINCIPAL_INVESTIGATOR

ISSSTESON

Locations

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Hospital Del Issste Regional En Guadalajara Jalisco

Guadalajara, Jalisco, Mexico

Site Status NOT_YET_RECRUITING

Secretaria de Salud Del Estado de Sonora, Hospital General Del Estado

Hermosillo, Sonora, Mexico

Site Status NOT_YET_RECRUITING

Hospital Central Norte Pemex

Mexico City, , Mexico

Site Status RECRUITING

Countries

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Mexico

Central Contacts

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Luis M Villela, MD

Role: CONTACT

+526624756529

Diego Espinoza, MD

Role: CONTACT

+526623862375

Facility Contacts

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CARLOS BEST, MD

Role: primary

+523310722818

LUIS villela, MD

Role: primary

+526624756529

Melani Otañez, MD

Role: backup

+526629374833

FERNANDO PEREZ-JACOBO, MD

Role: primary

+525540821871

References

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Duan K, Liu B, Li C, Zhang H, Yu T, Qu J, Zhou M, Chen L, Meng S, Hu Y, Peng C, Yuan M, Huang J, Wang Z, Yu J, Gao X, Wang D, Yu X, Li L, Zhang J, Wu X, Li B, Xu Y, Chen W, Peng Y, Hu Y, Lin L, Liu X, Huang S, Zhou Z, Zhang L, Wang Y, Zhang Z, Deng K, Xia Z, Gong Q, Zhang W, Zheng X, Liu Y, Yang H, Zhou D, Yu D, Hou J, Shi Z, Chen S, Chen Z, Zhang X, Yang X. Effectiveness of convalescent plasma therapy in severe COVID-19 patients. Proc Natl Acad Sci U S A. 2020 Apr 28;117(17):9490-9496. doi: 10.1073/pnas.2004168117. Epub 2020 Apr 6.

Reference Type BACKGROUND
PMID: 32253318 (View on PubMed)

Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020 May;46(5):846-848. doi: 10.1007/s00134-020-05991-x. Epub 2020 Mar 3. No abstract available.

Reference Type RESULT
PMID: 32125452 (View on PubMed)

Rajam G, Sampson J, Carlone GM, Ades EW. An augmented passive immune therapy to treat fulminant bacterial infections. Recent Pat Antiinfect Drug Discov. 2010 Jun;5(2):157-67. doi: 10.2174/157489110791233496.

Reference Type RESULT
PMID: 20370679 (View on PubMed)

Keller MA, Stiehm ER. Passive immunity in prevention and treatment of infectious diseases. Clin Microbiol Rev. 2000 Oct;13(4):602-14. doi: 10.1128/CMR.13.4.602.

Reference Type RESULT
PMID: 11023960 (View on PubMed)

Burnouf T, Seghatchian J. Ebola virus convalescent blood products: where we are now and where we may need to go. Transfus Apher Sci. 2014 Oct;51(2):120-5. doi: 10.1016/j.transci.2014.10.003.

Reference Type RESULT
PMID: 25457751 (View on PubMed)

Jahrling PB, Frame JD, Rhoderick JB, Monson MH. Endemic Lassa fever in Liberia. IV. Selection of optimally effective plasma for treatment by passive immunization. Trans R Soc Trop Med Hyg. 1985;79(3):380-4. doi: 10.1016/0035-9203(85)90388-8.

Reference Type RESULT
PMID: 3898484 (View on PubMed)

Shen C, Wang Z, Zhao F, Yang Y, Li J, Yuan J, Wang F, Li D, Yang M, Xing L, Wei J, Xiao H, Yang Y, Qu J, Qing L, Chen L, Xu Z, Peng L, Li Y, Zheng H, Chen F, Huang K, Jiang Y, Liu D, Zhang Z, Liu Y, Liu L. Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma. JAMA. 2020 Apr 28;323(16):1582-1589. doi: 10.1001/jama.2020.4783.

Reference Type RESULT
PMID: 32219428 (View on PubMed)

Other Identifiers

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TERAPLASCOV2

Identifier Type: -

Identifier Source: org_study_id

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