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| Name | Class |
|---|---|
| Hospital Santa Marcelina | OTHER |
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The investigators propose a prospective, randomized, double-blind, placebo-controlled study, conducted in two phases. The purpose of the study is to evaluate the safety and efficacy of methotrexate in a cholesterol-rich non-protein nanoparticle (MTX -LDE) in adults diagnosed with mild Coronavirus-19(COVID-19) disease.
A total of 100 patients will be randomized to receive MTX-LDE or placebo each 7 days, up to 3 times, during in hospital treatment.
The objective of the study is to evaluate the safety and efficacy of (MTX -LDE) in patients with mild Coronavirus-19 (COVID-19) disease.
In phase 1, firstly 3 patients with moderate COVID-19 disease will receive MTX-LDE IV 15mg each 7 days, up to 3 times, during hospitalization. After that, 9 patients with moderate COVID-19 disease will receive MTX-LDE IV 30mg each 7 days, up to 3 times, during hospitalization. Follow-up assessments will occur daily following randomization during in hospital treatment and 2 weeks after discharge for evaluation of the occurrence of adverse events.The purpose of this phase will be evaluate safety and pharmacokinetics.
If no objection by data and safety monitoring board (DSMB), will be authorized to start the second phase.
In phase 2, 88 patients with moderate COVID-19 disease will be randomized to receive MTX-LDE IV 30mg or placebo-LDE IV each 7 days, up to 3 times, during hospitalization. Follow-up assessments will occur daily following randomization during in hospital treatment and 2 weeks after discharge for evaluation of the occurrence of any trial endpoints or other adverse events.The primary endpoint of this phase will be reduction in duration of hospitalization stay between groups.
Patients will undergo clinical and laboratory safety evaluations daily. An algorithm for drug suspension based on clinical and laboratory finding will be followed.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| MTX-LDE phase 1 | Experimental | Methotrexate carried by a lipid nanoparticle (MTX-LDE) |
|
| MTX-LDE phase 2 | Experimental | Methotrexate carried by a lipid nanoparticle (MTX-LDE) |
|
| Placebo-LDE phase 2 | Placebo Comparator | Lipid nanoparticle (LDE) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Methotrexate-LDE phase 1 | Drug | 3 patients will receive MTX-LDE at the dose of 15mg IV each 7 days during hospitalization, up to 3 times . After that, 9 patients will receive MTX-LDE at the dose of 30mg IV each 7 days during hospitalization, up to 3 times . All patients will receive Leucovorin (calcium foliate) 25mg IV, 24hr after administration of MTX-LDE |
| Measure | Description | Time Frame |
|---|---|---|
| Duration of hospital stay | Compare the duration of hospital stay between groups | 30 days after randomization |
| Measure | Description | Time Frame |
|---|---|---|
| Number of participants requiring mechanical ventilation | The secondary outcome is the need for mechanical ventilation between groups | 15 days after randomization |
| Number of participants requiring vasoactive drugs |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Raul Maranhão, MD;PhD | Contact | +551126615951 | raul.maranhao@incor.usp.br |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, Brazil | Recruiting | São Paulo | São Paulo | 05403900 | Brazil |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32293910 | Background | Liu PP, Blet A, Smyth D, Li H. The Science Underlying COVID-19: Implications for the Cardiovascular System. Circulation. 2020 Jul 7;142(1):68-78. doi: 10.1161/CIRCULATIONAHA.120.047549. Epub 2020 Apr 15. | |
| 32616381 | Background | Solinas C, Perra L, Aiello M, Migliori E, Petrosillo N. A critical evaluation of glucocorticoids in the management of severe COVID-19. Cytokine Growth Factor Rev. 2020 Aug;54:8-23. doi: 10.1016/j.cytogfr.2020.06.012. Epub 2020 Jun 24. |
| Label | URL |
|---|---|
| WHO COVID-19 Therapeutic Trial Synopsis | View source |
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This will be a randomized, double-blind, placebo-controlled, multi-center study.
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|
| Methotrexate-LDE phase 2 | Drug | 44 patients will receive MTX-LDE at the dose of 30mg IV each 7 days during hospitalization, up to 3 times dose of 30mg IV each 7 days during hospitalization, up to 3 times . All patients will receive Leucovorin (calcium foliate) 25mg IV, 24hr after administration of MTX-LDE |
|
|
| Placebo-LDE phase 2 | Drug | 44 patients will receive Placebo-LDE IV each 7 days during hospitalization, up to 3 times dose of 30mg IV each 7 days during hospitalization, up to 3 times . All patients will receive Leucovorin (calcium foliate) 25mg IV, 24hr after administration of Placebo-LDE |
|
The secondary outcome is the need for vasoactive drugs between groups
| 15 days after randomization |
| Number of participants requiring renal replacement therapy | The secondary outcome is the need for renal replacement therapy between groups | 15 days after randomization |
| Incidence of secondary infection | The secondary outcome is the incidence of secondary infection between groups | 15 days after randomization |
| Sequential Organ Failure Assessment (SOFA) score | The secondary outcome is the comparison of Sequential Organ Failure Assessment (SOFA) score between groups | Baseline and change from baseline to 15 days after randomization |
| World Health Organization (WHO) COVID-19 score | The secondary outcome is the comparison of World Health Organization (WHO) COVID-19 clinical score between groups | Baseline and change from baseline to 15 days after randomization |
| Interleukin 6 (IL-6) | The secondary outcome is the comparison of IL-6 levels between groups | Baseline and change from baseline to 15 days after randomization |
| Dimer-D | The secondary outcome is the comparison of dimer-D levels between groups | Baseline and change from baseline to 15 days after randomization |
| Chest CT scan | The secondary outcome is the comparison of chest CT scan between groups | Baseline and change from baseline to 15 days after randomization |
| Incidence and severity of laboratory alterations | The secondary outcome is the comparison of red blood cells; white blood cells;Platelets; Urea;Creatinine levels between groups | 30 days after randomization |
| Clinical side effects | Compare the incidence of clinical significant symptoms (new and persistent stomatitis, vomiting, diarrhea, alopecia, neurotoxicity, bradycardia, hypotension, local pain) reported between groups. | 30 days after randomization |
| Other adverse events | Compare the incidence of other adverse events (not expected) between groups | 30 days after randomization |
| Hospital Santa Marcelina | Not yet recruiting | São Paulo | São Paulo | Brazil |
|
| Institute Prevent Senior | Not yet recruiting | São Paulo | São Paulo | Brazil |
|
| 32635302 | Background | Vinciguerra M, Romiti S, Fattouch K, De Bellis A, Greco E. Atherosclerosis as Pathogenetic Substrate for Sars-Cov2 Cytokine Storm. J Clin Med. 2020 Jul 3;9(7):2095. doi: 10.3390/jcm9072095. |
| 32337664 | Background | Zhang S, Li L, Shen A, Chen Y, Qi Z. Rational Use of Tocilizumab in the Treatment of Novel Coronavirus Pneumonia. Clin Drug Investig. 2020 Jun;40(6):511-518. doi: 10.1007/s40261-020-00917-3. |
| 28347533 | Background | Barbieri LR, Lourenco-Filho DD, Tavares ER, Carvalho PO, Gutierrez PS, Maranhao RC, Stolf NAG. Influence of Drugs Carried in Lipid Nanoparticles in Coronary Disease of Rabbit Transplanted Heart. Ann Thorac Surg. 2017 Aug;104(2):577-583. doi: 10.1016/j.athoracsur.2016.12.044. Epub 2017 Mar 24. |
| 24065615 | Background | Bulgarelli A, Leite AC Jr, Dias AA, Maranhao RC. Anti-atherogenic effects of methotrexate carried by a lipid nanoemulsion that binds to LDL receptors in cholesterol-fed rabbits. Cardiovasc Drugs Ther. 2013 Dec;27(6):531-9. doi: 10.1007/s10557-013-6488-3. |
| 22113347 | Background | Bulgarelli A, Martins Dias AA, Caramelli B, Maranhao RC. Treatment with methotrexate inhibits atherogenesis in cholesterol-fed rabbits. J Cardiovasc Pharmacol. 2012 Apr;59(4):308-14. doi: 10.1097/FJC.0b013e318241c385. |
| 25585820 | Background | Maranhao RC, Tavares ER. Advances in non-invasive drug delivery for atherosclerotic heart disease. Expert Opin Drug Deliv. 2015 Jul;12(7):1135-47. doi: 10.1517/17425247.2015.999663. Epub 2015 Jan 14. |
| 28553113 | Background | Maranhao RC, Guido MC, de Lima AD, Tavares ER, Marques AF, Tavares de Melo MD, Nicolau JC, Salemi VM, Kalil-Filho R. Methotrexate carried in lipid core nanoparticles reduces myocardial infarction size and improves cardiac function in rats. Int J Nanomedicine. 2017 May 17;12:3767-3784. doi: 10.2147/IJN.S129324. eCollection 2017. |
| 32122636 | Result | Shah A, Kashyap R, Tosh P, Sampathkumar P, O'Horo JC. Guide to Understanding the 2019 Novel Coronavirus. Mayo Clin Proc. 2020 Apr;95(4):646-652. doi: 10.1016/j.mayocp.2020.02.003. Epub 2020 Feb 28. No abstract available. |
| 32007143 | Result | Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J, Yu T, Zhang X, Zhang L. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020 Feb 15;395(10223):507-513. doi: 10.1016/S0140-6736(20)30211-7. Epub 2020 Jan 30. |
| 32653469 | Result | Mitchell WB. Thromboinflammation in COVID-19 acute lung injury. Paediatr Respir Rev. 2020 Sep;35:20-24. doi: 10.1016/j.prrv.2020.06.004. Epub 2020 Jun 11. |
| 32211963 | Result | Zhou Z, Guo D, Li C, Fang Z, Chen L, Yang R, Li X, Zeng W. Coronavirus disease 2019: initial chest CT findings. Eur Radiol. 2020 Aug;30(8):4398-4406. doi: 10.1007/s00330-020-06816-7. Epub 2020 Mar 24. |
| 8961899 | Result | Cronstein BN. Molecular therapeutics. Methotrexate and its mechanism of action. Arthritis Rheum. 1996 Dec;39(12):1951-60. doi: 10.1002/art.1780391203. No abstract available. |
| ID | Term |
|---|---|
| D018352 | Coronavirus Infections |
| D007249 | Inflammation |
| D000086382 | COVID-19 |
| ID | Term |
|---|---|
| D003333 | Coronaviridae Infections |
| D030341 | Nidovirales Infections |
| D012327 | RNA Virus Infections |
| D014777 | Virus Diseases |
| D007239 | Infections |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D011024 | Pneumonia, Viral |
| D011014 | Pneumonia |
| D012141 | Respiratory Tract Infections |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
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