Infusion of Prostacyclin (Iloprost) vs Placebo for 72-hours in COVID-19 Patients With Respiratory Failure

NCT ID: NCT04420741

Last Updated: 2024-05-07

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 80 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2020-06-15
• Study Completion Date: 2021-04-23

Brief Summary

The purpose of this trial is to investigate the efficacy and safety of continuous intravenous administration of low dose iloprost versus placebo for 72-hours, in 80 patients with COVID-19 suffering from respiratory failure. The study hypothesis is that iloprost may be beneficial as an endothelial rescue treatment as it is anticipated to deactivate the endothelium and restore vascular integrity in COVID-19 patients suffering from respiratory failure caused by endothelial breakdown, ultimately improving survival. Given that the pulmonary system, apart from the brain, is the most highly vascularized vital organ in the body, extensive endothelial damage is a central feature of acute respiratory distress syndrome (ARDS) with respiratory failure being the rationale for the current study COMBAT-COVID-19.

Detailed Description

Patients with the most severe type of sepsis, those with septic shock have a mortality rate between 30% to 45% due to multiple organ failure. The poor outcome of shocked patients, and especially those with sepsis, may by related to microvascular endothelial dysfunction.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by coronavirus 2 (SARS-CoV-2) and, thus, being a novel cause of sepsis. The disease was first identified in 2019 in Wuhan, the capital of Hubei, China, and has since spread globally, resulting in the 2019-20 coronavirus pandemic. Common symptoms include fever, cough and shortness of breath, muscle pain and sputum production. While many cases result in mild symptoms, some progress to pneumonia and multi-organ failure. In particular COVID-19 is associated with ARDS with respiratory failure and high mortality.

Evidence support that iloprost infusion significantly improved endothelial function and integrity, The main objective in this trial is to investigate whether continuous infusion of lov dose iloprost at a dose of 1 ng/kg/min for 72-hours is safe and significantly reduce the need of respiratory support in the intensive care unit (ICU) compared to infusion of placebo in patients with COVID-19 induced pulmonary endotheliopathy (SHINE).

Patients that are eligible for this trial will be temporarily incompetent due to acute severe illness relating to respiratory failure, therefore informed consent will be obtained from a scientific guardian. Next-of kin and subsequently the patient will co-sign as soon as possible hereafter. During the trial, patient will be given continuous infusion of low dose iloprost or placebo for 72 hours and additional blood samples will be obtained at baseline and at 24 hours. Follow up on respiratory failure and mortality will be performed on dag 28 and 90.

This trial is conducted in accordance with the Helsinki 2 Declaration and International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use, Guideline for Good Clinical Practice (ICH-GCP) and in compliance with the protocol. As part of the quality assurance on-site monitoring visit will be performed by the an independent GCP-unit including source data verification. Standard Operation Procedure (SOP) to address protocol specific procedures such as data collection and adverse event reporting are developed.

The number of patients participating is based on a power calculation using the data on days alive and free from mechanical ventilation in the ICU within 28 days from a randomized, double blind, placebo controlled clinical trial in patients with acute respiratory distress syndrome ARDS (NTC 02622724).

The number of patients may be increased if required for regulatory approval for this indication.

Conditions

COVID-19; Respiratory Failure

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: QUADRUPLE

Study Groups

Iloprost

Patients randomized to active treatment (n=40 patients) will receive continuous infusion of iloprost for 72 hours after inclusion or until discharge to ward or death, whichever comes first.

Group Type: EXPERIMENTAL

Iloprost

Intervention Type: DRUG

Continuously infusion for 72 hours at 3 ml/hours. Treatment dose 1 ng/kg/min

Isotonic saline

Patients randomized to placebo treatment (n=40 patients) will receive continuous infusion of placebo for 72 hours after inclusion or until discharge to ward or death, whichever comes first.

Group Type: PLACEBO_COMPARATOR

Isotonic saline

Intervention Type: DRUG

Continuously infusion for 72 hours at 3 ml/hours

Interventions

Iloprost

Continuously infusion for 72 hours at 3 ml/hours. Treatment dose 1 ng/kg/min

Intervention Type: DRUG

Isotonic saline

Continuously infusion for 72 hours at 3 ml/hours

Intervention Type: DRUG

Other Intervention Names

Ilomedin

Eligibility Criteria

Inclusion Criteria

• Adult intensive care patients (aged 18 years or above)
• Confirmed COVID-19 infection
• Need for mechanical ventilation (< 72 hours at time of screening)
• Soluble thrombomodulin (sTM) ≥ 4 ng/mL

Exclusion Criteria

• Withdrawal from active therapy
• Pregnancy (non-pregnancy confirmed by patient being postmenopausal (age 60 or above) or having a negative urine- or plasma-hCG)
• Known hypersensitivity to iloprost or to any of the other ingredients.
• Previously included in this trial or a prostacyclin trial within 30 days
• Consent cannot be obtained
• Life-threatening bleeding defined by the treating physician
• Known severe heart failure (NYHA class IV)
• Suspected acute coronary syndrome

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Pär Johansson

OTHER

Sponsor Role: lead

Responsible Party

Pär Johansson

Sponsor

Responsibility Role: SPONSOR_INVESTIGATOR

Principal Investigators

Anders Perner, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Copenhagen University Hospital, Intensive care Unit 4131

Pär I Johansson, MD, DMSc

Role: STUDY_DIRECTOR

Copenhagen University Hospital, Capital Blood Bank 2034

Locations

Dept. of Anaesthesia and Intensive Care, Bispebjerg Hospital

Copenhagen, , Denmark

Dept. of Intensive Care, Copenhagen University Hospital, Rigshospitalet

Copenhagen, , Denmark

Dept. of Intensive Care, Copenhagen University Hospital Herlev

Herlev, , Denmark

Dept. of Anaesthesia and Intensive Care, Nordsjaelands Hospital

Hillerød, , Denmark

Dept. of Anaesthesia and Intensive Care, Hvidovre Hospital

Hvidovre, , Denmark

Countries

Denmark

References

Johansson PI, Soe-Jensen P, Bestle MH, Clausen NE, Kristiansen KT, Lange T, Stensballe J, Perner A. Prostacyclin in Intubated Patients with COVID-19 and Severe Endotheliopathy: A Multicenter, Randomized Clinical Trial. Am J Respir Crit Care Med. 2022 Feb 1;205(3):324-329. doi: 10.1164/rccm.202108-1855OC.

Reference Type: BACKGROUND

PMID: 34813414 (View on PubMed)

Johansson PI, Bestle M, Soe-Jensen P, Kristiansen KT, Stensballe J, Clausen NE, Perner A. The effect of prostacyclin (Iloprost) infusion at a dose of 1 ng/kg/min for 72 hours compared to placebo in mechanically ventilated patients with COVID-19: A structured summary of a study protocol for a randomized controlled trial. Trials. 2020 Aug 26;21(1):746. doi: 10.1186/s13063-020-04696-2.

Reference Type: RESULT

PMID: 32847626 (View on PubMed)

Other Identifiers

2020-001296-33

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

COMBAT-COVID-19

Identifier Type: -

Identifier Source: org_study_id