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Efficacy of oral 20-hydroxyecdysone (BIO101), a MAS receptor activator, in adults with severe COVID-19 (COVA): a randomized, placebo-controlled, phase 2/3 trial.


ABSTRACT:

Background

SARS-CoV-2 binding to ACE2 is potentially associated with severe pneumonia due to COVID-19. The aim of the study was to test whether Mas-receptor activation by 20-hydroxyecdysone (BIO101) could restore the Renin-Angiotensin System equilibrium and limit the frequency of respiratory failure and mortality in adults hospitalized with severe COVID-19.

Methods

Double-blind, randomized, placebo-controlled phase 2/3 trial. Randomization: 1:1 oral BIO101 (350 mg BID) or placebo, up to 28 days or until an endpoint was reached. Primary endpoint: mortality or respiratory failure requiring high-flow oxygen, mechanical ventilation, or extra-corporeal membrane oxygenation. Key secondary endpoint: hospital discharge following recovery (ClinicalTrials.gov Number, NCT04472728).

Findings

Due to low recruitment the planned sample size of 310 was not reached and 238 patients were randomized between August 26, 2020 and March 8, 2022. In the modified ITT population (233 patients; 126 BIO101 and 107 placebo), respiratory failure or early death by day 28 was 11.4% lower in the BIO101 (13.5%) than in the placebo (24.3%) group, (p = 0.0426). At day 28, proportions of patients discharged following recovery were 80.1%, and 70.9% in the BIO101 and placebo group respectively, (adjusted difference 11.0%, 95% CI [-0.4%, 22.4%], p = 0.0586). Hazard Ratio for time to death over 90 days: 0.554 (95% CI [0.285, 1.077]), a 44.6% mortality reduction in the BIO101 group (not statistically significant). Treatment emergent adverse events of respiratory failure were more frequent in the placebo group.

Interpretation

BIO101 significantly reduced the risk of death or respiratory failure supporting its use in adults hospitalized with severe respiratory symptoms due to COVID-19.

Funding

Biophytis.

SUBMITTER: Lobo SM 

PROVIDER: S-EPMC10965409 | biostudies-literature | 2024 Feb

REPOSITORIES: biostudies-literature

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Publications

Efficacy of oral 20-hydroxyecdysone (BIO101), a MAS receptor activator, in adults with severe COVID-19 (COVA): a randomized, placebo-controlled, phase 2/3 trial.

Lobo Suzana Margareth SM   Plantefève Gaétan G   Nair Girish G   Joaquim Cavalcante Adilson A   Franzin de Moraes Nara N   Nunes Estevao E   Barnum Otis O   Berdun Stadnik Claudio Marcel CM   Lima Maria Patelli MP   Lins Muriel M   Hajjar Ludhmila Abrahao LA   Lipinski Christopher C   Islam Shaheen S   Ramos Fabiano F   Simon Tiago T   Martinot Jean-Benoît JB   Guimard Thomas T   Desclaux Arnaud A   Lioger Bertrand B   Neuenschwander Fernando Carvalho FC   DeSouza Paolino Bruno B   Amin Alpesh A   Acosta Samuel Amil SA   Dilling Daniel Forde DF   Cartagena Edgardo E   Snyder Brian B   Devaud Edouard E   Barreto Berselli Marinho Ana Karolina AK   Tanni Suzana S   Milhomem Beato Patricia Medeiros PM   De Wit Stephan S   Selvan Vani V   Gray Jeffrey J   Fernandez Ricardo R   Pourcher Valérie V   Maddox Lee L   Kay Richard R   Azbekyan Anait A   Chabane Mounia M   Tourette Cendrine C   Esmeraldino Luis Everton LE   Dilda Pierre J PJ   Lafont René R   Mariani Jean J   Camelo Serge S   Rabut Sandrine S   Agus Samuel S   Veillet Stanislas S   Dioh Waly W   van Maanen Rob R   Morelot-Panzini Capucine C  

EClinicalMedicine 20240103


<h4>Background</h4>SARS-CoV-2 binding to ACE2 is potentially associated with severe pneumonia due to COVID-19. The aim of the study was to test whether Mas-receptor activation by 20-hydroxyecdysone (BIO101) could restore the Renin-Angiotensin System equilibrium and limit the frequency of respiratory failure and mortality in adults hospitalized with severe COVID-19.<h4>Methods</h4>Double-blind, randomized, placebo-controlled phase 2/3 trial. Randomization: 1:1 oral BIO101 (350 mg BID) or placebo,  ...[more]

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