Skip to main content
Top
Published in: Trials 1/2023

Open Access 01-12-2023 | SARS-CoV-2 | Study protocol

PROphylaxis for paTiEnts at risk of COVID-19 infecTion (PROTECT-V)

Authors: Toby J. L. Humphrey, Davinder Dosanjh, Thomas F. Hiemstra, Alex Richter, Michael Chen-Xu, Wendi Qian, Vivekanand Jha, Katrina Gatley, Rakshya Adhikari, Francis Dowling, Rona M. Smith

Published in: Trials | Issue 1/2023

Login to get access

Abstract

Background

Despite the introduction of vaccination, there remains a need for pre-exposure prophylactic agents against SARS-CoV-2. Several patient groups are more vulnerable to SARS-CoV-2 infection by virtue of underlying health conditions, treatments received or suboptimal responses to vaccination.

Methods

PROTECT-V is a platform trial testing pre-exposure prophylactic interventions against SARS-CoV-2 infection in vulnerable patient populations (organ transplant recipients; individuals with oncological/haematological diagnoses, immune deficiency or autoimmune diseases requiring immunosuppression or on dialysis). Multiple agents can be evaluated across multiple vulnerable populations sharing placebo groups, with the option of adding additional treatments at later time points as these become available. The primary endpoint is symptomatic SARS-CoV-2 infection, and each agent will be independently evaluated in real time when the required number of events occurs. Presently, three agents are approved in the platform: intranasal niclosamide, nasal and inhaled ciclesonide and intravenous sotrovimab.

Discussion

Despite the introduction of vaccination, there remains a need for pre-exposure prophylactic agents against SARS-CoV-2. Several patient groups are more vulnerable to COVID-19 disease by virtue of underlying health conditions, treatments received or suboptimal responses to vaccination.

Trial registration

ClinicalTrials.gov NCT04870333. EudraCT 2020-004144-28
Literature
1.
go back to reference Krueger KM, Ison MG, Ghossein C. Practical guide to vaccination in all stages of CKD, including patients treated by dialysis or kidney transplantation. Am J Kidney Dis. 2020;75:417–25.CrossRefPubMed Krueger KM, Ison MG, Ghossein C. Practical guide to vaccination in all stages of CKD, including patients treated by dialysis or kidney transplantation. Am J Kidney Dis. 2020;75:417–25.CrossRefPubMed
2.
go back to reference Bingham CO 3rd, et al. Immunization responses in rheumatoid arthritis patients treated with rituximab: results from a controlled clinical trial. Arthritis Rheum. 2010;62:64–74.CrossRefPubMed Bingham CO 3rd, et al. Immunization responses in rheumatoid arthritis patients treated with rituximab: results from a controlled clinical trial. Arthritis Rheum. 2010;62:64–74.CrossRefPubMed
3.
go back to reference van Assen S, et al. Humoral responses after influenza vaccination are severely reduced in patients with rheumatoid arthritis treated with rituximab. Arthritis Rheum. 2010;62:75–81.CrossRefPubMed van Assen S, et al. Humoral responses after influenza vaccination are severely reduced in patients with rheumatoid arthritis treated with rituximab. Arthritis Rheum. 2010;62:75–81.CrossRefPubMed
5.
go back to reference Jeon S, Ko M, Lee J, et al. Identification of antiviral drug candidates against SARS-CoV-2 from FDA-approved drugs. Antimicrob Agents Chemother. 2020;64(7):e00819–20. Jeon S, Ko M, Lee J, et al. Identification of antiviral drug candidates against SARS-CoV-2 from FDA-approved drugs. Antimicrob Agents Chemother. 2020;64(7):e00819–20.
6.
go back to reference Pindiprolu SKSS, Pindiprolu SH. Plausible mechanisms of niclosamide as an antiviral agent against COVID-19. Medical Hypotheses. 2020;140. Pindiprolu SKSS, Pindiprolu SH. Plausible mechanisms of niclosamide as an antiviral agent against COVID-19. Medical Hypotheses. 2020;140.
7.
go back to reference Gassen NC, et al. SKP2 attenuates autophagy through Beclin1-ubiquitination and its inhibition reduces MERS-Coronavirus infection. Nat Commun. 2019;10(1):5770. Gassen NC, et al. SKP2 attenuates autophagy through Beclin1-ubiquitination and its inhibition reduces MERS-Coronavirus infection. Nat Commun. 2019;10(1):5770.
8.
go back to reference Matsuyama S, Kawase M, Nao N, Shirato K, Ujike M, Kamitani W, et al. The inhaled steroid ciclesonide blocks SARS-CoV-2 RNA replication by targeting the viral replication-transcription complex in cultured cells. J Virol. 2020;95(1):e01648–20.CrossRefPubMedPubMedCentral Matsuyama S, Kawase M, Nao N, Shirato K, Ujike M, Kamitani W, et al. The inhaled steroid ciclesonide blocks SARS-CoV-2 RNA replication by targeting the viral replication-transcription complex in cultured cells. J Virol. 2020;95(1):e01648–20.CrossRefPubMedPubMedCentral
9.
go back to reference Peters MC, Sajuthi S, Deford P, et al. COVID-19–related genes in sputum cells in asthma. Relationship to demographic features and corticosteroids. Am J Respir Crit Care Med. 2020;202(1):83–90.CrossRefPubMedPubMedCentral Peters MC, Sajuthi S, Deford P, et al. COVID-19–related genes in sputum cells in asthma. Relationship to demographic features and corticosteroids. Am J Respir Crit Care Med. 2020;202(1):83–90.CrossRefPubMedPubMedCentral
10.
go back to reference Lipworth B, Chan R, Lipworth S, et al. Weathering the cytokine storm in susceptible patients with severe SARS-CoV-2 infection. J Allergy Clin Immunol Pract. 2020;8(6):1798–801.CrossRefPubMedPubMedCentral Lipworth B, Chan R, Lipworth S, et al. Weathering the cytokine storm in susceptible patients with severe SARS-CoV-2 infection. J Allergy Clin Immunol Pract. 2020;8(6):1798–801.CrossRefPubMedPubMedCentral
12.
go back to reference Herold T, Jurinovic V, Arnreich C, et al. Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19. J Allergy Clin Immunol. 2020;146(1):128–36 e4.CrossRefPubMedPubMedCentral Herold T, Jurinovic V, Arnreich C, et al. Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19. J Allergy Clin Immunol. 2020;146(1):128–36 e4.CrossRefPubMedPubMedCentral
13.
go back to reference Zhang J, Hao Y, Ou W, et al. Serum interleukin-6 is an indicator for severity in 901 patients with SARS-CoV-2 infection: a cohort study. J Transl Med. 2020;18:406.CrossRefPubMedPubMedCentral Zhang J, Hao Y, Ou W, et al. Serum interleukin-6 is an indicator for severity in 901 patients with SARS-CoV-2 infection: a cohort study. J Transl Med. 2020;18:406.CrossRefPubMedPubMedCentral
17.
go back to reference Lipworth BJ, Kaliner MA, LaForce CF, et al. Effect of ciclesonide and fluticasone on hypothalamicpituitary-adrenal axis function in adults with mild-to-moderate persistent asthma. Ann Allergy Asthma Immunol. 2005;94(4):465–72.CrossRefPubMed Lipworth BJ, Kaliner MA, LaForce CF, et al. Effect of ciclesonide and fluticasone on hypothalamicpituitary-adrenal axis function in adults with mild-to-moderate persistent asthma. Ann Allergy Asthma Immunol. 2005;94(4):465–72.CrossRefPubMed
18.
go back to reference Anderson WJ, McFarlane LC, Lipworth BJ. Prospective follow-up of novel markers of bone turnover in persistent asthmatics exposed to low and high doses of inhaled ciclesonide over 12 months. J Clin Endocrinol Metab. 2012;97(6):1929–36.CrossRefPubMed Anderson WJ, McFarlane LC, Lipworth BJ. Prospective follow-up of novel markers of bone turnover in persistent asthmatics exposed to low and high doses of inhaled ciclesonide over 12 months. J Clin Endocrinol Metab. 2012;97(6):1929–36.CrossRefPubMed
19.
go back to reference Chervinsky P, Kunjibettu S, Miller DL, et al. Long-term safety and efficacy of intranasal ciclesonide in adult and adolescent patients with perennial allergic rhinitis. Ann Allergy Asthma Immunol. 2007;99(1):69–76.CrossRefPubMed Chervinsky P, Kunjibettu S, Miller DL, et al. Long-term safety and efficacy of intranasal ciclesonide in adult and adolescent patients with perennial allergic rhinitis. Ann Allergy Asthma Immunol. 2007;99(1):69–76.CrossRefPubMed
20.
go back to reference Pinto D, Park YJ, Beltramello M, Walls AC, Tortorici MA, Bianchi S, et al. Cross-neutralization of SARS-CoV-2 by a human monoclonal SARS-CoV antibody. Nature. 2020;583(7815):290–5.CrossRefPubMed Pinto D, Park YJ, Beltramello M, Walls AC, Tortorici MA, Bianchi S, et al. Cross-neutralization of SARS-CoV-2 by a human monoclonal SARS-CoV antibody. Nature. 2020;583(7815):290–5.CrossRefPubMed
21.
go back to reference Ko SY, Pegu A, Rudicell RS, Yang ZY, Joyce MG, Chen X, et al. Enhanced neonatal Fc receptor function improves protection against primate SHIV infection. Nature. 2014;514(7524):642–5.CrossRefPubMedPubMedCentral Ko SY, Pegu A, Rudicell RS, Yang ZY, Joyce MG, Chen X, et al. Enhanced neonatal Fc receptor function improves protection against primate SHIV infection. Nature. 2014;514(7524):642–5.CrossRefPubMedPubMedCentral
22.
go back to reference Zalevsky J, Chamberlain AK, Horton HM, Karki S, Leung IW, Sproule TJ, et al. Enhanced antibody half-life improves in vivo activity. Nat Biotechnol. 2010;28(2):157–9.CrossRefPubMedPubMedCentral Zalevsky J, Chamberlain AK, Horton HM, Karki S, Leung IW, Sproule TJ, et al. Enhanced antibody half-life improves in vivo activity. Nat Biotechnol. 2010;28(2):157–9.CrossRefPubMedPubMedCentral
23.
go back to reference Spiekermann GM, Finn PW, Ward ES, Dumont J, Dickinson BL, Blumberg RS, et al. Receptor-mediated immunoglobulin G transport across mucosal barriers in adult life: functional expression of FcRn in the mammalian lung. J Exp Med. 2002;196(3):303–10.CrossRefPubMedPubMedCentral Spiekermann GM, Finn PW, Ward ES, Dumont J, Dickinson BL, Blumberg RS, et al. Receptor-mediated immunoglobulin G transport across mucosal barriers in adult life: functional expression of FcRn in the mammalian lung. J Exp Med. 2002;196(3):303–10.CrossRefPubMedPubMedCentral
24.
go back to reference Gupta A, Gonzalez-Rojas Y, Juarez E, Crespo Casal M, Moya J, Falci DR, et al. Early treatment for COVID-19 with SARS-CoV-2 neutralizing antibody sotrovimab. N Engl J Med. 2021;385(21):1941–50.CrossRefPubMed Gupta A, Gonzalez-Rojas Y, Juarez E, Crespo Casal M, Moya J, Falci DR, et al. Early treatment for COVID-19 with SARS-CoV-2 neutralizing antibody sotrovimab. N Engl J Med. 2021;385(21):1941–50.CrossRefPubMed
25.
go back to reference Gupta A, Gonzalez-Rojas Y, Juarez E, et al. COMET-ICE Investigators. Effect of sotrovimab on hospitalization or death among high-risk patients with mild to moderate COVID-19: a randomized clinical trial. JAMA. 2022;327(13):1236–46. Gupta A, Gonzalez-Rojas Y, Juarez E, et al. COMET-ICE Investigators. Effect of sotrovimab on hospitalization or death among high-risk patients with mild to moderate COVID-19: a randomized clinical trial. JAMA. 2022;327(13):1236–46.
26.
go back to reference Wu MY, Carr EJ, Harvey R, Mears HV, Kjaer S, Townsley H, et al. WHO’s Therapeutics and COVID-19 Living Guideline on mAbs needs to be reassessed. Lancet. 2022;S0140-6736(22):01938–9. Wu MY, Carr EJ, Harvey R, Mears HV, Kjaer S, Townsley H, et al. WHO’s Therapeutics and COVID-19 Living Guideline on mAbs needs to be reassessed. Lancet. 2022;S0140-6736(22):01938–9.
27.
go back to reference Pedersen W, Hjuler I, Bisgaard H, et al. Nasal inhalation of budesonide from a spacer in children with perennial rhinitis and asthma. Allergy. 1998;53(4):383–7.CrossRefPubMed Pedersen W, Hjuler I, Bisgaard H, et al. Nasal inhalation of budesonide from a spacer in children with perennial rhinitis and asthma. Allergy. 1998;53(4):383–7.CrossRefPubMed
28.
go back to reference Pedersen B, Dahl R, Lindqvist N, et al. Nasal inhalation of the glucocorticoid budesonide from a spacer for the treatment of patients with pollen rhinitis and asthma. Allergy. 1990;45(6):451–6.CrossRefPubMed Pedersen B, Dahl R, Lindqvist N, et al. Nasal inhalation of the glucocorticoid budesonide from a spacer for the treatment of patients with pollen rhinitis and asthma. Allergy. 1990;45(6):451–6.CrossRefPubMed
Metadata
Title
PROphylaxis for paTiEnts at risk of COVID-19 infecTion (PROTECT-V)
Authors
Toby J. L. Humphrey
Davinder Dosanjh
Thomas F. Hiemstra
Alex Richter
Michael Chen-Xu
Wendi Qian
Vivekanand Jha
Katrina Gatley
Rakshya Adhikari
Francis Dowling
Rona M. Smith
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Trials / Issue 1/2023
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-023-07128-z

Other articles of this Issue 1/2023

Trials 1/2023 Go to the issue