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COVID-19Phase 2/3NECTARNCT05593770

International Sites: Novel Experimental COVID-19 Therapies Affecting Host Response

A Phase 2/3 study testing Fostamatinib in people with COVID-19 and SARS-CoV2 Infection, run by NEAT ID Foundation at 21 sites in 5 countries.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

The overarching goal of the Master Protocol is to find effective strategies for inpatient management of patients with COVID-19. Therapeutic goals for patients hospitalized for COVID-19 include hastening recovery and preventing progression to critical illness, multiorgan failure, or death. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Fostamatinib
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
28 participants
Where
21 sitesin 5 countries
Study dates
27 Oct 2022to 14 Dec 2023
Phase
Phase 2/3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Hospitalized for COVID-19
  • ≥18 years of age
  • SARS-CoV-2 infection, documented by:
  • nucleic acid test (NAT) or equivalent testing within 3 days prior to randomization OR
  • documented by NAT or equivalent testing more than 3 days prior to randomization AND progressive disease suggestive of ongoing SARS-CoV-2 infection per the responsible investigator (For non-NAT tests, only those deemed with equivalent specificity to NAT by the protocol team will be allowed. A central list of allowed non- NAT tests is maintained in Appendix E. Appendix E. Non-NAT Tests Deemed with Equivalent Specificity to NAT by the Protocol Team).
  • Hypoxemia, defined as SpO2 <92% on room air, new receipt of supplemental oxygen to maintain SpO2 ≥92%, or increased supplemental oxygen to maintain SpO2 ≥92% for a patient on chronic oxygen therapy
Show all 12Show fewer
  • Symptoms or signs of acute COVID-19, defined as one or more of the following:
  • cough
  • reported or documented body temperature of 100.4 degrees Fahrenheit or greater
  • shortness of breath
  • chest pain
  • infiltrates on chest imaging (x-ray, CT scan, lung ultrasound)

Who cannot join

  • Onset of COVID-19 symptom fulfilling inclusion criterion #5 >14 days prior to randomization
  • Hospitalized with hypoxemia (as defined in inclusion #4) for >72 hours prior to randomization (the 72-hour window for randomization begins when the patient first meets the hypoxemia inclusion criteria after hospital admission)
  • Pregnancy
  • Breastfeeding
  • Prisoners
  • End-stage renal disease (ESRD) on dialysis
Show all 18Show fewer
  • Patient undergoing comfort care measures only such that treatment focuses on end-of- life symptom management over prolongation of life.
  • The treating clinician expects inability to participate in study procedures or participation would not be in the best interests of the patient
  • Known allergy/hypersensitivity to IMP or its excipients
  • Fostamatinib Arm-Specific Exclusion Criteria:
  • The following exclusion criteria differ from the master protocol criteria:
  • 1. Randomized in another trial evaluating fostamatinib in the prior 30 days
  • Study arm exclusion criteria measured within 24 hours prior to randomization:
  • AST or ALT ≥ 5 × upper limit of normal (ULN) or ALT or AST ≥ 3 × ULN and total bilirubin ≥ 2 × ULN
  • SBP > 160 mmHg or DBP > 100 mmHg at the time of screening and randomization
  • ANC < 1000/mL
  • Patient is anticipated to require a strong CYP3A inhibitor (Atazanavir, Certinib, Clarithromycin, Cobicistat and cobicistat-containing coformulations, Idelalisib,Indinavir, Itraconazole, Ketoconazole, Levoketoconazole, Lonafarnib, Lopinavir, Mifeprostone, Mibefradil, Nefazodone, Nelfinavir, Ombitasvir-paritaprevir-ritonavir plus dasabuvir, Posaconazole, Ribociclib Ritonavir, Saquinavir, Telithromycin, Troleandomycin, Tucatinib, Voriconazole) from randomization to 21 days post-randomization. For a full list of CYP3A4 substrates, please reference this regularly updated list: https://drug-interactions.medicine.iu.edu/MainTable.aspx.
  • Patient unable to participate or declines participation in the fostamatinib arm.

Trial locations and contacts

21 sites in 5 countries.

21 sites in 5 countries

Spain9 sites
  • Hospital General Universitario de Elche

    Alicante

  • Hospital Clinic Barcelona

    Barcelona, Villarroel

  • Hospital del Mar

    Barcelona

  • Hospital Universitario Vall d'Hebron

    Barcelona

  • Hospital Clinico San Carlos

    Madrid

  • Hospital Universitario Fundacion Alcorcon

    Madrid

  • Hospital Universitario Ramón y Cajal

    Madrid

  • Universidad de Valladolid - Hospital Universitario Río Hortega

    Valladolid

  • Hospital Clinico Universitario Lozano Blesa

    Zaragoza

Other trials in Spain

Italy4 sites
  • Ente Ospedaliero Ospedali Galliera

    Genova

  • San Paolo Hospital - ASST Santi Paolo e Carlo

    Milan

  • San Raffaele Turro Hospital

    Milan

  • University of Milan

    Milan

Other trials in Italy

Brazil3 sites
  • Hospital de Clínicas de Porto Alegre

    Porto Alegre

  • Hospital Federal dos Servidores do Estado

    Rio de Janeiro

  • Instituto Nacional de Infectologia Evandro Chagas

    Rio de Janeiro

Other trials in Brazil

South Africa3 sites
  • Worthwhile Clinical Trials (WWCT Lakeview Hospital)

    Benoni

  • Clinical HIV Research Unit - Helen Joseph Hospital (WITS CHRU)

    Johannesburg

  • Global Clinical Trials (Pty) Ltd

    Pretoria

Other trials in South Africa

Germany2 sites
  • University Hospital Bonn

    Bonn

  • University of Frankfurt

    Frankfurt

Other trials in Germany

About this study

Official title: International Sites: CONNECTS Master Protocol for Clinical Trials Targeting Macro-, Micro-immuno-thrombosis, Vascular Hyperinflammation, and Hypercoagulability and Renin-angiotensin-aldosterone System (RAAS) in Hospitalized Patients With COVID-19 (ACTIV-4 Host Tissue)

The overarching goal of the Master Protocol is to find effective strategies for inpatient management of patients with COVID-19. Therapeutic goals for patients hospitalized for COVID-19 include hastening recovery and preventing progression to critical illness, multiorgan failure, or death. Our objective is to determine whether modulating the host tissue response improves clinical outcomes among patients with COVID-19.

Read the detailed description

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has resulted in a global pandemic. The clinical spectrum of COVID-19 infection is broad, encompassing asymptomatic infection, mild upper respiratory tract illness, and severe viral pneumonia with respiratory failure and death. Between 13 and 40% of patients become hospitalized, up to 30% of those hospitalized require admission for intensive care, and there is a 13% inpatient mortality rate. The reasons for hospitalization include respiratory support, as well as support for failure of other organs, including the heart and kidneys. The risk of thrombotic complications is increased, even when compared to other viral respiratory illnesses, such as influenza. While 82% of hospitalized patients with COVID-19 are ultimately discharged alive, median length of stay is 10-13 days.

Early work in treating COVID-19 has focused on preventing worsening of the initial clinical presentation to prevent hospitalization and disease progression to organ failure and death. Studies conducted under this Master Host Tissue Protocol are expected to extend our knowledge of how to manage patients who are hospitalized for COVID-19 illness. Our objective is to determine whether modulating the host tissue response improves clinical outcomes among patients with COVID-19. This Master Protocol is a randomized, placebo-controlled trial of agents targeting the host response in COVID-19 in hospitalized patients with hypoxemia. The Master Host Tissue Protocol is designed to be flexible in the number of study arms, the use of a single placebo group, and the stopping and adding of new therapies. Our primary outcome is oxygen free days through day 28. This is defined as days alive and without supplemental oxygen use during the first 28 days following randomization. Patients who die on or before day 28 are assigned -1 oxygen free days.

Being tested
Fostamatinib, Placebo
Medical subject headings
COVID-19, Coronavirus Infections

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • FostamatinibDrug

    Fostamatinib100-150mg orally twice daily for 14 days or 28 doses. Study medication will be continued as an outpatient if the patient is discharged prior to completing 28 doses.

  • PlaceboDrug

    Orange film-coated, plain bioconvex tablets orally twice daily for 14 days or 28 doses for fostamatinib. Study medication will be continued as an outpatient if the patient is discharged prior to completing 28 doses.

Study groups in NCT05593770
Study groupRoleWhat they receive
FostamatinibExperimentalAn investigational oral spleen tyrosine kinase inhibitor.
Receives: Drug: Fostamatinib
PlaceboPlacebo comparatorOrange film-coated, plain, bioconvex tablets for fostamatinib. For the purposes of interim and final analyses, the route and frequency of placebo will be ignored, and all placebo participants will be pooled together as a single group. In comparing an active drug versus placebo, only those placebo participants that were eligible for the active drug will be included.
Receives: Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Oxygen Free Days Through Day 28

    This is defined as days alive and without supplemental oxygen use during the first 28 days following randomization. Patients who die on or before day 28 are assigned -1 oxygen free days. Patients will be considered to be receiving supplemental oxygen therapy when they are receiving any of the following: supplemental oxygen by nasal cannula, supplemental oxygen by face mask, high flow nasal cannula (HFNC), non-invasive ventilation (NIV), invasive mechanical ventilation (IMV), or extracorporeal membrane oxygenation (ECMO).

    Measured: Day 1 to Day 28

Secondary outcomes (13)
  1. In-hospital Mortality

    Number of patients who die during hospitalization

    Measured: Day 1 to hospital discharge or Day 90 whichever comes first

  2. Alive and Oxygen Free at Day 14

    Number of patients oxygen free at day 14. Patients will be considered to be receiving supplemental oxygen therapy when they are receiving any of the following: supplemental oxygen by nasal cannula, supplemental oxygen by face mask, high flow nasal cannula (HFNC), non-invasive ventilation (NIV), invasive mechanical ventilation (IMV), or extracorporeal membrane oxygenation (ECMO).

    Measured: Day 1 to Day 14

  3. Alive and Oxygen Free at Day 28

    Number of patients oxygen free at day 28. Patients will be considered to be receiving supplemental oxygen therapy when they are receiving any of the following: supplemental oxygen by nasal cannula, supplemental oxygen by face mask, high flow nasal cannula (HFNC), non-invasive ventilation (NIV), invasive mechanical ventilation (IMV), or extracorporeal membrane oxygenation (ECMO)

    Measured: Day 1 to Day 28

  4. Alive and Free of New Invasive Mechanical Ventilation at Day 28

    Number of patients alive free of new invasive mechanical ventilation at day 28

    Measured: Day 1 to Day 28

  5. 28-day Mortality

    Number of patients who have died at Day 28

    Measured: Day 28

  6. 60-day Mortality

    Number of patients who have died at Day 60

    Measured: Day 60

  7. 90-day Mortality

    Number of participants mortality at Day 90

    Measured: Day 90

  8. Clinical Status Assessed Using World Health Organization (WHO) 8-point Ordinal Scale at Day 14

    Number of participants who fell within the ordinal scale per the below criteria. A higher score indicates a worse outcome.

    1. Ambulatory - Not hospitalized and no limitation of activities
    2. Ambulatory - Not hospitalized with limitation of activities or home oxygen use
    3. Hospitalized Mild Disease - Hospitalized, no oxygen therapy
    4. Hospitalized Mild Disease - Hospitalized, oxygen by mask or nasal prongs
    5. Hospitalized Severe Disease - Non-invasive ventilation or high-flow nasal cannula
    6. Hospitalized Severe Disease -Invasive mechanical ventilation
    7. Hospitalized Severe Disease - Invasive mechanical ventilation plus additional organ support with- vasopressors, RRT, or ECMO
    8. Dead

    Measured: Day 14

  9. Clinical Status Assessed Using WHO 8-point Ordinal Scale at Day 28

    The number of participants who fell within the ordinal scale per the below criteria. A higher score means a worse outcome

    1. Ambulatory - Not hospitalized and no limitation of activities
    2. Ambulatory - Not hospitalized with limitation of activities or home oxygen use
    3. Hospitalized Mild Disease - Hospitalized, no oxygen therapy
    4. Hospitalized Mild Disease - Hospitalized, oxygen by mask or nasal prongs
    5. Hospitalized Severe Disease - Non-invasive ventilation or high-flow nasal cannula
    6. Hospitalized Severe Disease -Invasive mechanical ventilation
    7. Hospitalized Severe Disease - Invasive mechanical ventilation plus additional organ support with- vasopressors, RRT, or ECMO
    8. Dead

    Measured: Day 28

  10. Clinical Status Assessed Using WHO 8-point Ordinal Scale at Day 60

    Number of participants who fell within the ordinal scale per the below criteria. A higher score means a worse outcome

    1. Ambulatory - Not hospitalized and no limitation of activities
    2. Ambulatory - Not hospitalized with limitation of activities or home oxygen use
    3. Hospitalized Mild Disease - Hospitalized, no oxygen therapy
    4. Hospitalized Mild Disease - Hospitalized, oxygen by mask or nasal prongs
    5. Hospitalized Severe Disease - Non-invasive ventilation or high-flow nasal cannula
    6. Hospitalized Severe Disease -Invasive mechanical ventilation
    7. Hospitalized Severe Disease - Invasive mechanical ventilation plus additional organ support with- vasopressors, RRT, or ECMO
    8. Dead

    Measured: Day 60

  11. Hospital-free Days Through Day 28

    Days alive and not hospitalized during the first 28 days following randomization. Patients who die on or before day 28 are assigned a value -1.

    Measured: Day 1 to Day 28

  12. Ventilator-free Days Through Day 28

    Days alive and not receiving mechanical ventilation during the first 28 days following randomization. Patients who die on or before day 28 are assigned a value -1.

    Measured: Day 1 to Day 28

  13. Respiratory Failure-free Days Through Day 28

    Days alive and not in respiratory failure during the first 28 days following randomization. A respiratory failure-free day is defined as a day alive without the use of HFNC, NIV, IMV, or (ECMO). Patients who die on or before day 28 are assigned a value -1.

    Measured: Day 1 to Day 28

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted25 Oct 2022
  2. Study start27 Oct 2022
  3. Primary completion14 Dec 2023
  4. Study completion14 Dec 2023

Why it stopped: Following a meeting of the DSMB on 20th September 2023, the recommendation was made to the sponsor on 26th September 2023 that the Fostamatinib arm of the trial ceases enrolment and study medication is discontinued immediately.

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2/3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Participants will be randomly allocated in a two-step process: 1) The participant will first be randomized in an m:1 ratio to receive an active study drug or placebo, where m represents the number of study drug arms for which the participant is eligible. 2) The participant will then be randomly assigned with equal probability to one of the study drug arms. Participants will receive the corresponding study drug or matching placebo.
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
28 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05593770
Sponsor's protocol ID
ACTIV-4
Acronym
NECTAR
Status last verified
Apr 2025
First submitted
21 Oct 2022
Last updated
2 May 2025
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2/3 study testing Fostamatinib in people with COVID-19 and SARS-CoV2 Infection, run by NEAT ID Foundation at 21 sites in 5 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 12 inclusion and 18 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 2 May 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 21 sites in Spain, Italy, Brazil, South Africa, Germany. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this combined phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 5 Nov 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Oxygen Free Days Through Day 28 (time frame: Day 1 to Day 28). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 May 2025.

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