Remdesivir and Convalescent Plasma Therapy for Treatment of COVID-19 Infection in Nepal : A Registry Study

NCT04669990 | Unknown

• 1 other identifier: 749-2020
• Study Type: observational
• Target: 2,000
• Locations: 1 country
• Sites: 4

Brief Summary

The pandemic COVID-19 does not have an established treatment. Clinical trials of antiviral drugs against SARS CoV-2 are currently in progress. Clinical study done by NIH which included 1059 patients indicated that those who received Remdesivir had a median recovery time of 11 days as compared with 15 days in those who received placebo. Remdesivir has recently received full approval for COVID-19 by US FDA, and emergency use authorization (EUA) by multiple countries including European Commission and Indian Health Service. Remdesivir appears to demonstrate the most benefit in those with severe COVID-19 on supplemental oxygen. The NIH Panel recommends using Remdesivir for 5 days or until hospital discharge, whichever comes first. The interim analysis of WHO's SOLIDARITY trial, however, failed to show mortality benefit with Remdesivir. Review of literature suggests the transfusion of convalescent plasma has been used successfully in observational and retrospective studies. A recent metanalysis showed that convalescent plasma reduced mortality by 57% compared to matched-patients receiving standard treatments. The objective of NHRC sponsored initial clinical study protocol (Convalescent Plasma study) was to provide a coordinated approach for collection and preparation, distribution and guidance for safe and effective administration of convalescent plasma with antibodies against SAR CoV-2 for treatment of patients with COVID-19 infection who are most likely to benefit from this investigational treatment. On August 9th, 2020, the Government of Nepal gave permission to use Remdesivir in COVID-19 patients of Nepal only as a study drug when the original protocol was amended to add a second study arm to use Remdesivir for treatment of patients with moderate to severe COVID-19. The enrollment goal of these two protocols have been reached and collection of study data will be completed by the end of October 2020. On October 18th, the GoN MoHP also announced and directed to provide access for Remdesivir directly through the pharmacies. Therefore, this registry study has been designed to replace the compassionate use study of Remdesivir and Convalescent plasma.

Conditions

Covid19

Outcome Measures

Primary Outcomes (5)

• Demographics of recipients

  \- type of patients receiving plasma therapy : Age in Years, Sex: M/F

  9 Months

• Co-morbidity of recipient

  \- recipient comorbidities: Smoking, Diabetes, Heart disease, Chronic lung disease, chronic liver disease, cancer, organ transplant, HIV infection, TB. HIV, HBV, HCV, Syphillis

  9 Months

• Adverse events of convalescent COVID-19 plasma and Remdesivir Therapy

  * any expected and unexpected adverse events during or after treatment (upto 7 days) * any other complications related or unrelated to plasma transfusion and Remdesivir during hospital stay

  9 Months

• Hospital and ICU length of stay

  \- number of days of hospital stay and ICU stay

  9 Months

• Disposition of patients including survival

  \- condition at discharge: complete recovery, partial recovery with complications, death

  9 Months

Interventions

Remdesivir DRUG

The objective of this Registry study is to continue to collect safety and outcome data for COVID-19 patients who are treated with Remdesivir and convalescent plasma therapy (CPT).

Also known as: Convalescent Plasma

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients will be recruited from all COVID-19 treating hospitals of Nepal which are participating in this clinical study.

You may qualify if:

• All patients who receive treatment with CPT or Remdesivir will be eligible for the study. Treatment decision will be based on decision of the treating physicians. However, following guidelines for treatment are provided based on current standard of care: For Remdesivir: Patients with severe COVID-19 infection who require to be on oxygen supplementation.
• For convalescent plasma therapy: Patients who meet one of the following criteria are likely to benefit from convalescent plasma therapy:
• Patients on life-threatening COVID-19 infection when combined with Remdesivir.
• Patients who progress to life-threatening infection despite being on remdesivir for 48 hours or longer. The following definitions are used to define severe and life threatening COVID-19 infection.
• Severe COVID-19 infection is defined by one or more of the following criteria:
• Shortness of breath (dyspnea)
• Respiratory frequency ≥ 30/min
• Blood oxygen saturation ≤ 93%
• Partial pressure of arterial oxygen to fraction of inspired oxygen ratio \< 300
• Lung infiltrates increased more than 50% within 24 to 48 hours
• Life-threatening COVID-19 infection is defined as one or more of the following:
• Respiratory failure
• Septic shock
• Multiple organ dysfunction or failure

You may not qualify if:

• If the diagnosis is not confirmed with PCR or similar alternative tests for COVID-19 infection
• Any patient with contraindications for receiving plasma transfusion should not receive plasma
• Any patient with contraindications for receiving Remdesivir should not receive Remdesivir

Sponsors & Collaborators

• Nepal Health Research Council: lead

Study Sites (4)

Narayani Hospital

Birgunj, Nepal

RECRUITING

Seti Provincial Hospital

Dhangadi, Nepal

RECRUITING

BP Koirala Institute of Health Sciences (BPKIHS)

Dharān, Nepal

RECRUITING

Bheri Provincial Hospital

Nepalgunj, Nepal

RECRUITING

MeSH Terms

Conditions

COVID-19

Interventions

remdesivir

Condition Hierarchy (Ancestors)

Pneumonia, Viral; Pneumonia; Respiratory Tract Infections; Infections; Virus Diseases; Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Lung Diseases; Respiratory Tract Diseases

Central Study Contacts

Janak Koirala, MD,MPH

CONTACT

9818762117; clinicaltrialsnepal@gmail.com

Saroj Bhattarai, M.Sc

CONTACT

9840388970; bhattaraisaroj23@gmail.com

Study Design

• Study Type: observational
• Observational Model: CASE ONLY
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Member-Secretary

Study Record Dates

• First Submitted: December 14, 2020
• First Posted: December 17, 2020
• Study Start: November 19, 2020
• Primary Completion: October 31, 2021
• Study Completion: November 19, 2021
• Last Updated: December 17, 2020

Record last verified: 2020-12

Locations

NE (4)