E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Confirmed infection with SARS-CoV-2 (COVID-19) |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Diseases [C] - Virus Diseases [C02] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | HLT |
E.1.2 | Classification code | 10047465 |
E.1.2 | Term | Viral infections NEC |
E.1.2 | System Organ Class | 10021881 - Infections and infestations |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 23.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10084268 |
E.1.2 | Term | COVID-19 |
E.1.2 | System Organ Class | 10021881 - Infections and infestations |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
Part 1
• Ascertain the safety and tolerability of BIO101, in order to facilitate recruitment to part 2
• Obtain preliminary indication of activity of BIO101, in preventing respiratory deterioration in the target population
Part 2
• Re-assess the sample size that is needed for the confirmatory part of the study
• Provide confirmation on the benefit of BIO101 in the target population
• Identify and assess potential biomarkers for further understanding of the effect of BIO101 in the target population
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E.2.2 | Secondary objectives of the trial |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Age: 45 and older.
2. Modified per Amendment 10:
2.1 A confirmed diagnosis of COVID-19 infection, within the last 28days, prior to randomization, as determined by PCR or other approved commercial or public health assay, in a specimen as specified by the test used.
3. Hospitalized, in observation or planned to be hospitalized due to COVID-19 infection symptoms with anticipated hospitalization duration >=3 days
4. Modified per Amendment 10:
4.1 With evidence of pneumonia based on all of the following:
a. Clinical findings on a physical examination
b. Respiratory symptoms developed within the past 14 days
5. Modified per Amendment 10:
5.1 With evidence of respiratory decompensation that started not more than 7 days before start of study medication and present at screening, meeting one of the following criteria, as assessed by healthcare staff:
a. Tachypnea: ≥25 breaths per minute
b. Arterial oxygen saturation ≤92%
c. A special note should be made if there is suspicion of COVID-19-related myocarditis or pericarditis, as the presence of these is a stratification criterion
6. Without a significant deterioration in liver function tests:
a. ALT and AST ≤ 5x upper limit of normal (ULN)
b. Gamma-glutamyl transferase (GGT) ≤ 5x ULN
c. Total bilirubin ≤ 5×ULN
7. Willing to participate and able to sign an informed consent form (ICF). Or, when relevant, a legally authorized representative (LAR) might sign the ICF on behalf of the study participant
8. Female participants should be:
at least 5 years post-menopausal (i.e., persistent amenorrhea 5 years in the absence of an alternative medical cause) or surgically sterile
OR
a. Have a negative urine pregnancy test at screening
b. Be willing to use a contraceptive method as outlined in inclusion criterion 9 from screening to 30 days after last dose.
9. Male participants who are sexually active with a female partner must agree to the use of an effective method of birth control throughout the study and until 3 months after the last administration of investigational product;
Note: medically acceptable methods of contraception that may be used by the participant and/or partner include combined oral contraceptive, contraceptive vaginal ring, contraceptive injection, intrauterine device, etonogestrel implant, each supplemented with a condom, as well as sterilization and vasectomy.
10. Female participant who are lactating must agree not to breastfeed during the study and up to 14 days after the intervention
11. Male subjects must agree not to donate sperm for the purpose of reproduction throughout the study and until 3 months after the last administration of investigational product;
12. Inclusion criterion 12 removed per Amendment 10.
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E.4 | Principal exclusion criteria |
1. Not needing or not willing to remain in a healthcare facility during the entire study medication (i.e. while receiving study medication)
2. Moribund condition (death likely in days) or not expected to survive for >7 days – due to other and non-COVID-19 related conditions
3. Participant on invasive mechanical ventilation via an endotracheal tube, or extracorporeal membrane oxygenation (ECMO), or high-flow Oxygen*
4. Participant not able to take medications by mouth (as capsules or as a powder, mixed in water).
5. Disallowed concomitant medication:
a. Consumption of any herbal products containing 20 hydroxyecdysone and derived from Leuzea carthamoides; Cyanotis vaga or Cyanotis arachnoidea is not allowed (e.g. performance enhancing agents)
6. Any known hypersensitivity to any of the ingredients, or excipients of the study medication, BIO101
7. Exclusion criterion 7 removed per Amendment 10
8. Exclusion criterion 8 removed per Amendment 10
* High-flow oxygen is defined as delivery of oxygen at a flow of ≥16 L/min. |
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E.5 End points |
E.5.1 | Primary end point(s) |
For end-of-part-1 interim analysis:
For safety analysis intended to facilitate recruitment for part 2, time frame – up to 28 days:
Safety and tolerability to BIO101:
• SUSARs, SAEs, AESIs, AEs
• Vital signs
• Safety labs (including testicular biomarkers)
• ECGs
For interim analysis intended to obtain indication of activity of BIO101, time frame – up to 28 days:
Primary:
• Proportion of subjects with ‘negative’ events, of either of the following:
o All-cause mortality
o Respiratory failure, defined as any of the following:
- Requiring mechanical ventilation (including cases that will not be intubated due to resource restrictions and triage)
- Requiring ECMO
- Requiring high-flow oxygen
Secondary:
• SpO2/FiO2
• Inflammatory markers including:
o IL 6
o TNFα
o D-dimer
• RAS / MAS biomarkers:
o Angiotensin 2
o Angiotensin-converting enzyme (ACE) levels
For part-2 sample size interim analysis:
For sample size re-assessment for part 2, time frame – up to 28 days:
• Proportion of participants with ‘negative’ events, of either of the following:
o All-cause mortality
o Respiratory failure, defined as any of the following:
- Requiring mechanical ventilation (including cases that will not be intubated due to resource restrictions and triage)
- Requiring ECMO
- Requiring high-flow oxygen
For the final analysis:
Primary, time frame – up to 28 days:
• Proportion of participants with ‘negative’ events, of either of the following:
o All-cause mortality
o Respiratory failure, defined as any of the following:
- Requiring mechanical ventilation (including cases that will not be intubated due to resource restrictions and triage)
- Requiring ECMO
- Requiring high-flow oxygen
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
For end-of-part-1 interim analysis:
For safety analysis intended to facilitate recruitment for part 2, time frame – up to 28 days:
For interim analysis intended to obtain indication of activity of BIO101, time frame – up to 28 days:
For part-2 sample size interim analysis:
For sample size re-assessment for part 2, time frame – up to 28 days:
For the final analysis:
Primary, time frame – up to 28 days:
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E.5.2 | Secondary end point(s) |
Key secondary:
• Proportion of participants with ‘positive’ events:
o official discharge from hospital care by the department due to improvement in patient condition (self-discharge by patient is not considered a positive event)
Additional secondary endpoints:
• SpO2/FiO2
• Oxygen saturation in arterial blood, measured by pulse-oximetry (SpO2)
• Proportion of participants with events of all-cause mortality
• Time to events, of either of the following:
o All-cause mortality
o Respiratory failure, defined as any of the following:
- Requiring mechanical ventilation (including cases that will not be intubated due to resource restrictions and triage)
- Requiring ECMO
- Requiring high-flow oxygen
• Time to event: official discharge from hospital care due to improvement
• The National Early Warning Score 2 (NewS2)
• For participants who experienced a ‘positive’ event: proportion of participants with sustained positive outcome (to assess durability of effect after those participants discontinued study medication), within the 14-day and 60-day post-intervention time frame.
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
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E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
placebo-controlled, group sequential and adaptive |
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E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 10 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Belgium |
Brazil |
France |
United Kingdom |
United States |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial months | 6 |