ACTG initiates novel clinical trial to evaluate multiple therapeutics for COVID-19

Reviewed by Emily Henderson, B.Sc.Aug 4 2020

The AIDS Clinical Trials Group (ACTG), the world's largest and longest established HIV research network, today announced the initiation of the ACTIV-2 Outpatient Monoclonal Antibodies and Other Therapies Trial, which will be conducted by the ACTG. ACTIV-2 includes both phase 2 and phase 3 evaluations of multiple promising investigational agents for treating early COVID-19 in a single trial. There is currently no approved vaccine or therapeutic to prevent or treat COVID-19.

ACTIV-2 will evaluate the safety and efficacy of investigational agents to treat adults who have COVID-19 illness but do not require hospitalization. The study will also enable researchers to assess the correlation between changes in viral shedding and clinical outcomes, leading to a better understanding of whether effective medications can reduce or halt the transmission of SARS-CoV-2 (the virus that causes COVID-19) to others. ACTIV-2 is a randomized, blinded, controlled adaptive platform that allows promising investigational agents to be added and removed over the course of the study, in order to efficiently test a variety of new agents against placebo within the same trial infrastructure.

Early treatment of COVID-19 will be vital to help us prevent advanced illness, hospitalization, and transmission of SARS-CoV-2. ACTIV-2 is designed to help us rapidly identify treatments that have the potential to radically alter the current pandemic landscape. Individuals who have recently been diagnosed with COVID-19 and are not hospitalized have the opportunity to make a huge contribution by participating in this study."

Judith Currier, M.D., M.Sc., ACTG Chair, University of California, Los Angeles

ACTIV-2 has been launched at 25 U.S.-based ACTG sites and will expand to include approximately 100 total sites (ACTG and non-ACTG), in both the United States and around the world. The study is sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), which also funds the ACTG. ACTIV-2 is part of NIH's Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV), a public-private partnership program to create a coordinated research strategy that prioritizes and speeds development of the most promising treatments and vaccines. It is also receiving support from Operation Warp Speed, the U.S. government's multi-agency effort to accelerate the development, manufacturing, and distribution of COVID-19 vaccines, therapeutics, and diagnostics.

In phase 2 of ACTIV-2, investigational agents will be studied to determine their safety, antiviral activity, and ability to reduce the duration of COVID-19 symptoms over 28 days. These agents will be selected based on the presence of in vitro data demonstrating activity against SARS-CoV-2 and phase 1 pharmacokinetics and safety data. In phase 2, 110 participants will receive the investigational agent and be compared to 110 participants randomized to receive placebo. If an agent demonstrates positive results and meets study-defined criteria for further evaluation, it will advance from phase 2 to phase 3. The phase 3 studies will evaluate the ability of each investigational agent to prevent hospitalization and death in non-hospitalized adults with COVID-19; 1,000 participants will receive the investigational agent (inclusive of the 110 participants from phase 2) and be compared to 1,000 participants randomized to placebo.

To qualify for the study, participants must have tested positive for SARS-CoV-2 infection in the outpatient setting within seven days and started experiencing symptoms within 10 days of enrolling into the study. At least half of participants will have factors that put them at "high risk" of progressing to severe COVID-19, including being age 55 or older and having one of the following conditions: chronic lung, kidney, or liver disease; obesity; hypertension; cardiovascular disease; diabetes; or moderate to severe asthma. The ACTG is committed to enrolling individuals most impacted by COVID-19 and will work closely with community partners to make participation in the trial available to those who are often underrepresented in clinical research.

The trial is being led by protocol chair Davey Smith, M.D., University of California, San Diego, along with Kara W. Chew M.D., M.S., University of California, Los Angeles (UCLA), David Alain Wohl, M.D., University of North Carolina (UNC), and Eric S. Daar, M.D., UCLA. It is supported by ACTG Chair Judith Currier, M.D., M.Sc., UCLA and ACTG Co-Chair Joseph J. Eron, M.D., UNC.

"We have learned a lot about COVID-19 in the past few months - while people may start off with just a few minor symptoms, they can rapidly become very ill, and this is true of both young and older people," said Dr. Smith. "We desperately need a treatment that can prevent people from progressing to advance disease and requiring hospitalization. We are hopeful that ACTIV-2 will identify some of those treatments, which we believe will have a profound impact on the health of people who acquire COVID-19."

The first investigational agent to be evaluated by ACTIV-2 is LY3819253, an experimental monoclonal antibody treatment made by Lilly Research Laboratories in partnership with AbCellera Biologics. AbCellera and the Vaccine Research Center at NIAID identified the antibody from a blood sample of one of the first people in the United States to recover from COVID-19.