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    Clinical Trial Results:
    A randomized, controlled, multicenter, open label phase II clinical study to evaluate infliximab in the treatment of patients with severe COVID-19 disease (INFLIXCOVID)

    Summary
    EudraCT number
    2021-002098-25
    Trial protocol
    DE  
    Global end of trial date
    31 Mar 2023

    Results information
    Results version number
    v1(current)
    This version publication date
    06 Dec 2023
    First version publication date
    06 Dec 2023
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    ZKSJ0137_INFLIXCOVID
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT04922827
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Friedrich Schiller University Jena
    Sponsor organisation address
    Fürstengraben 1, Jena, Germany, 07737
    Public contact
    Center for Clinical Studies, University Hospital Jena, 0049 36419396648, ZKS-Projektmanagement@med.uni-jena.de
    Scientific contact
    Clinic for Internal Medicine IV , University Hospital Jena, 0049 36419324401 , Andreas.Stallmach@med.uni-jena.de
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    20 Jun 2023
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    31 Mar 2023
    Global end of trial reached?
    Yes
    Global end of trial date
    31 Mar 2023
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Evaluation of the efficacy of the TNF-α antibody infliximab in the treatment of patients with severe COVID-19 compared with the standard of care (SOC).
    Protection of trial subjects
    Subjects allocated to the interventional group received investigational medicinal product (IMP) once, according to the Summary of Product Characteristics (SmPC) with respect to the type and duration of application. The dosage of 5mg/kg bodyweight was equivalent to patients with chronic inflammatory bowel disease, ankylosing spondylitis or psoriasis. Study-specific treatment risks were reduced to a minimum, namely, blood sampling was linked to routine sampling as far as possible, and transthoracic echocardiography is a non-invasive procedure bearing no patient-relevant risks.
    Background therapy
    Both treatment groups received standard of care treatment according to the current guidelines.
    Evidence for comparator
    -
    Actual start date of recruitment
    29 Sep 2021
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Germany: 9
    Worldwide total number of subjects
    9
    EEA total number of subjects
    9
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    2
    From 65 to 84 years
    6
    85 years and over
    1

    Subject disposition

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    Recruitment
    Recruitment details
    9 patients were recruited and randomized within a time period from 29th of September 2021 until 31st of March 2023.

    Pre-assignment
    Screening details
    All 9 randomized patients were treated according to their allocation. One screening failure.

    Period 1
    Period 1 title
    Treatment period (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Infliximab + Standard of Care
    Arm description
    Infliximab and Standard of Care. Within 3 h after randomization i. v. administration of 5 mg/kg body weight infliximab is applied. The infusion duration is two hours. The further treatment of COVID-19 is carried out according to the current treatment recommendations. The following additional treatments for COVID-19 are allowed within the study: - dexamethasone 1x 6 mg - remdesivir The following additional treatments for COVID-19 are not allowed within the study up to and including day 28 after randomization: - treatment with TNF-α antibodies outside of study medication - treatment with other experimental procedures
    Arm type
    Experimental

    Investigational medicinal product name
    Remsima 100 mg powder for concentrate for solution for infusion
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate and solvent for solution for infusion
    Routes of administration
    Infusion
    Dosage and administration details
    single dosage 5 mg/kg i. v., infusion duration of 2 h

    Arm title
    Standard of Care
    Arm description
    Standard of Care. The treatment of COVID-19 is carried out according to the current treatment recommendations. The following additional treatments for COVID-19 are allowed within the study: - dexamethasone 1x 6 mg - remdesivir The following additional treatments for COVID-19 are not allowed within the study up to and including day 28 after randomization: - treatment with TNF-α antibodies outside of study medication - treatment with other experimental procedures
    Arm type
    No intervention

    Investigational medicinal product name
    No investigational medicinal product assigned in this arm
    Number of subjects in period 1
    Infliximab + Standard of Care Standard of Care
    Started
    4
    5
    Completed
    4
    5

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Infliximab + Standard of Care
    Reporting group description
    Infliximab and Standard of Care. Within 3 h after randomization i. v. administration of 5 mg/kg body weight infliximab is applied. The infusion duration is two hours. The further treatment of COVID-19 is carried out according to the current treatment recommendations. The following additional treatments for COVID-19 are allowed within the study: - dexamethasone 1x 6 mg - remdesivir The following additional treatments for COVID-19 are not allowed within the study up to and including day 28 after randomization: - treatment with TNF-α antibodies outside of study medication - treatment with other experimental procedures

    Reporting group title
    Standard of Care
    Reporting group description
    Standard of Care. The treatment of COVID-19 is carried out according to the current treatment recommendations. The following additional treatments for COVID-19 are allowed within the study: - dexamethasone 1x 6 mg - remdesivir The following additional treatments for COVID-19 are not allowed within the study up to and including day 28 after randomization: - treatment with TNF-α antibodies outside of study medication - treatment with other experimental procedures

    Reporting group values
    Infliximab + Standard of Care Standard of Care Total
    Number of subjects
    4 5 9
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
        Newborns (0-27 days)
    0
        Infants and toddlers (28 days-23 months)
    0
        Children (2-11 years)
    0
        Adolescents (12-17 years)
    0
        Adults (18-64 years)
    0
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    Units: years
        median (full range (min-max))
    70.5 (42 to 86) 79 (53 to 81) -
    Gender categorical
    Units: Subjects
        Female
    1 1 2
        Male
    3 4 7
    Subject analysis sets

    Subject analysis set title
    FAS
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Full analysis set according intention-to-treat principle

    Subject analysis sets values
    FAS
    Number of subjects
    9
    Age categorical
    Units: Subjects
        In utero
        Preterm newborn infants (gestational age < 37 wks)
        Newborns (0-27 days)
        Infants and toddlers (28 days-23 months)
        Children (2-11 years)
        Adolescents (12-17 years)
        Adults (18-64 years)
        From 65-84 years
        85 years and over
    Age continuous
    Units: years
        median (full range (min-max))
    75 (42 to 86)
    Gender categorical
    Units: Subjects
        Female
    2
        Male
    7

    End points

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    End points reporting groups
    Reporting group title
    Infliximab + Standard of Care
    Reporting group description
    Infliximab and Standard of Care. Within 3 h after randomization i. v. administration of 5 mg/kg body weight infliximab is applied. The infusion duration is two hours. The further treatment of COVID-19 is carried out according to the current treatment recommendations. The following additional treatments for COVID-19 are allowed within the study: - dexamethasone 1x 6 mg - remdesivir The following additional treatments for COVID-19 are not allowed within the study up to and including day 28 after randomization: - treatment with TNF-α antibodies outside of study medication - treatment with other experimental procedures

    Reporting group title
    Standard of Care
    Reporting group description
    Standard of Care. The treatment of COVID-19 is carried out according to the current treatment recommendations. The following additional treatments for COVID-19 are allowed within the study: - dexamethasone 1x 6 mg - remdesivir The following additional treatments for COVID-19 are not allowed within the study up to and including day 28 after randomization: - treatment with TNF-α antibodies outside of study medication - treatment with other experimental procedures

    Subject analysis set title
    FAS
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Full analysis set according intention-to-treat principle

    Primary: 28-day survival

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    End point title
    28-day survival [1]
    End point description
    28 day survival
    End point type
    Primary
    End point timeframe
    28 days
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Due to slow recruitment, the planned patient numbers could not be reached by far. Reached patient numbers do not allow for well founded statistical analysis.
    End point values
    Infliximab + Standard of Care Standard of Care FAS
    Number of subjects analysed
    4
    5
    9
    Units: Subjects
    4
    4
    8
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From randomization (V0) to Follow-Up day 90 after randomization (V5).
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    25.1
    Reporting groups
    Reporting group title
    Infliximab + Standard of Care
    Reporting group description
    Infliximab and Standard of care

    Reporting group title
    Standard of Care
    Reporting group description
    Standard of care

    Serious adverse events
    Infliximab + Standard of Care Standard of Care
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 4 (0.00%)
    2 / 5 (40.00%)
         number of deaths (all causes)
    0
    1
         number of deaths resulting from adverse events
    0
    1
    Cardiac disorders
    Atrial fibrillation
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    COVID-19
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Infliximab + Standard of Care Standard of Care
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    4 / 4 (100.00%)
    4 / 5 (80.00%)
    Vascular disorders
    Deep vein thrombosis
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences all number
    2
    0
    Inflammation
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Respiratory, thoracic and mediastinal disorders
    Hypercapnia
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Pneumothorax
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Respiratory failure
         subjects affected / exposed
    1 / 4 (25.00%)
    1 / 5 (20.00%)
         occurrences all number
    1
    2
    Investigations
    Fibrin D dimer increased
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Full blood count decreased
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Hyperkalaemia
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Hypernatraemia
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Hyponatraemia
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Cardiac disorders
    Atrial fibrillation
         subjects affected / exposed
    0 / 4 (0.00%)
    2 / 5 (40.00%)
         occurrences all number
    0
    3
    Cardiac failure
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Nervous system disorders
    Hypertonia
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Speech disorder
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Syncope
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Blood and lymphatic system disorders
    Thrombocytopenia
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Gastrointestinal disorders
    Gastrooesophageal reflux disease
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Vomiting
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Skin and subcutaneous tissue disorders
    Alopecia
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Renal and urinary disorders
    Polyuria
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Musculoskeletal and connective tissue disorders
    Pain in extremity
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Spinal pain
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Infections and infestations
    Infection
         subjects affected / exposed
    1 / 4 (25.00%)
    4 / 5 (80.00%)
         occurrences all number
    1
    2
    Lung abscess
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Opportunistic infection
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Urinary tract infection
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Viral infection
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Candida infection
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    COVID-19
         subjects affected / exposed
    0 / 4 (0.00%)
    2 / 5 (40.00%)
         occurrences all number
    0
    2
    Metabolism and nutrition disorders
    Hyperglycaemia
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    29 Apr 2022
    Extension of recruitment period.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    Low recruitment numbers due to strongly decreasing incidence of patients with severe COVID-19 infection. Therefore, no statements about positive effects on effectiveness of the IMP possible. Nevertheless, no negative safety signal from the IMP.

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/36056419
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