E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Coronavirus disease 2019 (COVID-19) in patients who have a high risk of developing serious or severe illness |
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E.1.1.1 | Medical condition in easily understood language |
Coronavirus disease 2019 (COVID-19) in patients who have a high chance of developing serious or severe illness |
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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 | 23.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10051905 |
E.1.2 | Term | Coronavirus infection |
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 |
•To evaluate the efficacy of GS-5245 in reducing the rate of COVID-19–related hospitalization or all-cause death |
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E.2.2 | Secondary objectives of the trial |
Secondary Objectives: •To evaluate the safety of GS-5245 administered in nonhospitalized participants with COVID-19 •To evaluate the efficacy of GS-5245 in reducing all-cause hospitalization •To evaluate the efficacy of GS-5245 in reducing COVID-19–related medically attended visits (MAVs) or all cause death •To evaluate the efficacy of GS-5245 in reducing COVID-19–related MAVs •To evaluate the efficacy of GS-5245 in reducing all cause deaths •To assess the impact of GS-5245 on symptom duration and severity •To evaluate the antiviral activity of GS-5245 on SARS-CoV-2 nasal swab viral load at Day 5
Exploratory Objectives: •To evaluate SARS-CoV-2 viral load throughout the evaluation period •To evaluate the emergence of viral resistance to GS-5245 •To evaluate anti-SARS-CoV-2 serostatus
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
There is an optional intensive PK substudy planned in approximately 30 participants. These participants will have intensive PK samples collected on Days 1 (after the first dose) and 5 (morning dose) at predose (within 1.0-hour before dosing) 0.25, 0.5, 0.75, 1.5, 3, 4-hour postdose. See Protocol Table 1 and Section 6.3.3. |
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E.3 | Principal inclusion criteria |
Participants must meet all the following inclusion criteria to be eligible for participation in this study: 1) Aged ≥ 18 years at screening. 2) Willing and able to provide written informed consent, or with a legal representative who can provide informed consent (where locally and nationally approved). 3) SARS-CoV-2 infection confirmed by PCR or an alternative assay ≤ 5 days before randomization. 4) Initial onset of COVID-19 signs/symptoms ≤ 5 days before randomization with ≥ 1 sign/symptom present at randomization (not including changes in taste or smell). 5) Not currently hospitalized or requiring hospitalization. 6) Presence of ≥ 1 risk factor (if unvaccinated) or ≥ 2 risk factors (if vaccinated at any point) for progression to severe disease. Vaccinated individuals are eligible for enrollment only if it has been at least 4 months since the most recent dose, including boosters. Risk factors are the following: a. Aged ≥ 50 years. b. Current or recent (≤ 6 months prior to randomization) cancer (other than localized skin cancer). c. Have human immunodeficiency virus infection. d. Prior splenectomy. e. Prior solid organ, stem cell, or bone marrow transplant. f. Have systemic rheumatologic or dermatologic disorders. g. Use of systemic immunosuppressive agents. h. Have cerebrovascular disease. i. Have cardiovascular disease, including heart failure. j. Have chronic kidney disease (provided participant does not meet exclusion criterion 7). k. Have chronic lung disease. k.i. Interstitial lung disease k.ii. Pulmonary embolism k.iii. Pulmonary hypertension k.iv. Bronchiectasis k.v. Chronic obstructive pulmonary disease l. Have chronic liver disease. m. Have cystic fibrosis. n. Have diabetes mellitus, type 1 and/or type 2. o. Have neurodevelopmental and neurodegenerative conditions. p. Have a body mass index ≥ 25. q. Have sickle cell disease.
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E.4 | Principal exclusion criteria |
Exclusion criteria for participation include: 1) Anticipated access to and use of authorized or approved COVID-19 therapies during the current COVID-19 illness < 5 days after randomization (therapies include nirmatrelvir/ritonavir, molnupiravir, intravenous remdesivir [RDV, Veklury®], monoclonal antibodies). 2) Received any approved, authorized, or investigational direct acting antiviral drug against SARS-CoV-2 for the treatment of COVID-19 < 28 days or < 5 half-lives, whichever is longer, before randomization. 3) Anticipated need for hospitalization < 48 hours after randomization. 4) New oxygen requirement < 24 hours before randomization. 5) Suspected or confirmed concurrent active systemic infection other than COVID-19 that may interfere with the evaluation of response to the study intervention. 6) Cirrhosis or acute liver injury/failure. 7) Undergoing dialysis, or known history of moderate to severe renal impairment, or known CLcr < 60 mL/min (as calculated by Cockcroft-Gault) or eGFR < 60 mL/min/1.73 m² within the last 6 months. Potential participants meeting the laboratory criterion may be enrolled if test results available before dosing show that renal function no longer meets this criterion. 8) Known history of any of the following abnormal laboratory results (< 6 months before randomization) unless confirmed as resolved to not meet criteria at screening. a. Alanine aminotransferase (ALT) ≥ 5 x upper limit of normal (ULN) b. Bilirubin ≥ 5 x ULN 9) Positive urine pregnancy test at screening. 10) Breastfeeding (nursing). 11) Unwilling to use protocol-mandated birth control. 12) Known hypersensitivity to the study drug, its metabolites, or formulation excipient. 13) Requirement for ongoing therapy with or prior use of any prohibited medications.
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E.5 End points |
E.5.1 | Primary end point(s) |
•Proportion of COVID-19–related hospitalization or all-cause death by Day 29 |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
At various timepoints throughout the study |
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E.5.2 | Secondary end point(s) |
Secondary Endpoints: •Incidence of treatment-emergent AEs and laboratory abnormalities •Proportion of participants with all-cause hospitalization by Day 29 •Proportion of participants with COVID 19 related MAVs or all-cause death by Day 29 •Proportion of participants with COVID 19 related MAVs by Day 29 •Proportion of participants with all-cause death at Day 29 •Time to sustained alleviation of targeted COVID-19 symptoms •Change from baseline in SARS-CoV-2 viral load at Day 5
Exploratory Endpoints: •Change from baseline in SARS-CoV-2 viral load at each applicable study visit •Proportion of participants with negative SARS CoV-2 polymerase chain reaction (PCR) at each applicable study visit •Emergence of viral resistance to GS-5245 •Baseline levels of anti-SARS-CoV-2 antibodies
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
At various timepoints throughout the study |
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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 | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
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 | No |
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) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
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 | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
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
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 10 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 144 |
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 |
Argentina |
Brazil |
Canada |
Colombia |
India |
Japan |
Kenya |
Korea, Republic of |
Mexico |
Peru |
Philippines |
Singapore |
South Africa |
Taiwan |
Thailand |
France |
Poland |
Sweden |
Bulgaria |
Romania |
Spain |
Switzerland |
Czechia |
Germany |
Italy |
Denmark |
Hungary |
Portugal |
Turkey |
United Kingdom |
Serbia |
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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 | 1 |
E.8.9.1 | In the Member State concerned months | 3 |
E.8.9.1 | In the Member State concerned days | 5 |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 3 |
E.8.9.2 | In all countries concerned by the trial days | 5 |