Adaptive COVID-19 Treatment Trial 2 (ACTT-2)


Trial ID: NCT04401579


ACTT-2 will evaluate the combination of baricitinib and remdesivir compared to remdesivir alone. Subjects will be assessed daily while hospitalized. If the subjects are discharged from the hospital, they will have a study visit at Days 15, 22, and 29. For discharged subjects, it is preferred that the Day 15 and 29 visits are in person to obtain safety laboratory tests and oropharyngeal (OP) swab and blood (serum only) samples for secondary research as well as clinical outcome data. However, infection control or other restrictions may limit the ability of the subject to return to the clinic. In this case, these visits may be conducted by phone, and only clinical data will be obtained. The Day 22 visit does not have laboratory tests or collection of samples and is conducted by phone. The primary outcome is time to recovery by Day 29.

Official Title

A Multicenter, Adaptive, Randomized Blinded Controlled Trial of the Safety and Efficacy of Investigational Therapeutics for the Treatment of COVID-19 in Hospitalized Adults (ACTT-2)

Stanford Investigator(s)

Evelyn Bin Ling
Evelyn Bin Ling

Clinical Assistant Professor, Medicine

Nidhi Rohatgi, MD MS
Nidhi Rohatgi, MD MS

Clinical Professor, Medicine Clinical Professor (By courtesy), Neurosurgery


Inclusion Criteria:

   1. Admitted to a hospital with symptoms suggestive of COVID-19.

   2. Subject (or legally authorized representative) provides informed consent prior to
   initiation of any study procedures.

   3. Subject (or legally authorized representative) understands and agrees to comply with
   planned study procedures.

   4. Male or non-pregnant female adult > / = 18 years of age at time of enrollment.

   5. Has laboratory-confirmed SARS-CoV-2 infection as determined by polymerase chain
   reaction (PCR) or other commercial or public health assay in any specimen, as
   documented by either of the following:

      - PCR positive in sample collected < 72 hours prior to randomization; OR

      - PCR positive in sample collected >/= 72 hours prior to randomization, documented
      inability to obtain a repeat sample (e.g. due to lack of testing supplies,
      limited testing capacity, results taking >24 hours, etc.) AND progressive disease
      suggestive of ongoing SARS-CoV-2 infection.

   6. Illness of any duration, and at least one of the following:

      - Radiographic infiltrates by imaging (chest x-ray, CT scan, etc.), OR

      - SpO2 < / = 94% on room air, OR

      - Requiring supplemental oxygen, OR

      - Requiring mechanical ventilation or extracorporeal membrane oxygenation (ECMO).

   7. Women of childbearing potential must agree to either abstinence or use at least one
   primary form of contraception not including hormonal contraception from the time of
   screening through Day 29.

   8. Agrees to not participate in another clinical trial for the treatment of COVID-19
   through Day 29.

Exclusion Criteria:

   1. Alanine Transaminase (ALT) or Aspartate Transaminase (AST) > 5 times the upper limit
   of normal.

   2. Estimated glomerular filtration rate (eGFR) < 30 ml/min or patient is receiving
   hemodialysis or hemofiltration at time of screening.

   3. Neutropenia (absolute neutrophil count <1000 cells/microliter) (<1.0 x 103/microliter
   or <1.0 GI/L).

   4. Lymphopenia (absolute lymphocyte count <200 cells/microliter) (<0.20 x 103/microliter
   or <0.20 GI/L)

   5. Pregnancy or breast feeding.

   6. Anticipated discharge from the hospital or transfer to another hospital which is not a
   study site within 72 hours.

   7. Allergy to any study medication.

   8. Received three or more doses of remdesivir, including the loading dose, outside of the
   study under the EUA (or similar mechanism) for COVID-19.

   9. Received convalescent plasma or intravenous immunoglobulin [IVIg]) for COVID-19, the
   current illness for which they are being enrolled.

10. Received small molecule tyrosine kinase inhibitors (e.g. baricitinib, imatibib,
   genfinitib), in the 1 week prior to screening

11. Received monoclonal antibodies targeting cytokines (e.g., TNF inhibitors,
   anti-interleukin-1 [IL-1], anti-IL-6 [tocilizumab or sarilumab]), or T-cells (e.g.,
   abatacept) in the 4 weeks prior to screening.

12. Received monoclonal antibodies targeting B-cell (e.g., rituximab, and including any
   targeting multiple cell lines including B-cells) in the 3 months prior to screening.

13. Received other immunosuppressants in the 4 weeks prior to screening and in the
   judgement of the investigator, the risk of immunosuppression with baricitinib is
   larger than the risk of COVID-19.

14. Received >/= 20 mg/day of prednisone or equivalent for >/=14 consecutive days in the 4
   weeks prior to screening.

15. Use of probenecid that cannot be discontinued at study enrollment.

16. Have diagnosis of current active tuberculosis (TB) or, if known, latent TB treated for
   less than 4 weeks with appropriate anti-tuberculosis therapy per local guidelines (by
   history only, no screening required).

17. Suspected serious, active bacterial, fungal, viral, or other infection (besides
   COVID-19) that in the opinion of the investigator could constitute a risk when taking
   investigational product.

18. Have received any live vaccine (that is, live attenuated) within 4 weeks before
   screening, or intend to receive a live vaccine (or live attenuated) during the study.
   Note: Use of non-live (inactivated) vaccinations is allowed for all subjects.

19. Have a history of VTE (deep vein thrombosis [DVT] or pulmonary embolism [PE]) within
   12 weeks prior to screening or have a history of recurrent (>1) VTE (DVT/PE).

20. Immunocompromised patients, patients with a chronic medical condition, or those taking
   a medication that cannot be discontinued at enrollment, who, in the judgment of PI,
   are at increased risk for serious infections or other safety concerns given the study


other: Placebo

drug: Remdesivir

drug: Baricitinib


Contact Information

Stanford University
School of Medicine
300 Pasteur Drive
Stanford, CA 94305