Maraviroc in Patients With Moderate and Severe COVID-19

This pilot study seeks to establish that selective blockade of the CCR5/CCL5 axis as well as the potential anti-viral properties of Maraviroc may reduce disease severity. This proof-of-concept effort seeks to correlate differences in clinical outcomes to differential cytokine expression in the setting of CCR5 antagonism in patients infected with SARS-CoV-2. Maraviroc is FDA-approved for the treatment of CCR5-tropic HIV-1 and has a well-documented safety and tolerability record in previous trials in immunocompromised HIV patients. Maraviroc was not shown to have significant effect on the QT segment, can be delivered via oral formulation, and can be delivered safely to both patients with end-stage renal disease and dependence on hemodialysis12. For these reasons, Maraviroc is an ideal candidate to study as a potential therapy for hospitalized patients with moderate-to-severe COVID-19.

The primary objective is to establish whether Maraviroc, used at its approved dosage for HIV, is safe, tolerable, and effective in hospitalized patients with SARS-CoV-2. The secondary objective is to investigate the relationship between reduction of inflammatory markers (such as IL-6, CCL5, etc.) and clinical outcomes, including avoidance of respiratory decompensation and death.

This is a single-center, single-arm, open-label trial. Sixteen hospitalized patients will be enrolled. Screening data will be reviewed to determine subject eligibility. Subjects who meet all inclusion criteria and none of the exclusion criteria will be approached for consent prior to entering the study. Each subject will receive 7 days of Maraviroc twice daily. Each subject will have blood samples checked at time of enrollment (Day 0), Day 3, Day 7, and Day 15 or time of live discharge (whichever comes first) of the study. The total duration of subject participation will be five weeks. The total duration of the study is expected to be 16 weeks.

• Maraviroc (Drug): Maraviroc will be administered for seven days. Biomarkers of disease will be checked at time of enrollment, during and at the conclusion of therapy. The cytokine panel will consist of CCL5, IL-6, and Chitinase 3-like 1(Chi3l1).

Primary outcomes

• Rate of Completion [7 days]: Rate of subjects who complete the 7-day course of Maraviroc (or shorter if discharged from hospital prior to 7 days) without discontinuation for serious adverse event or death.
• Clinical Improvement at Day 7 [7 days]: Percent of patients at Day 7 from enrollment achieving reduction of two points on a seven-category ordinal scale (defined below). Ordinal scale: 1, not hospitalized with resumption of normal activities; 2, not hospitalized, but unable to resume normal activities OR hospitalized pending disposition, not requiring COVID-related care; 3, hospitalized, not requiring supplemental oxygen; 4, hospitalized, requiring supplemental oxygen; 5, hospitalized, requiring nasal high-flow oxygen therapy, noninvasive mechanical ventilation, or both; 6, hospitalized, requiring ECMO, invasive mechanical ventilation, or both; and, 7, death.

Secondary outcomes

• Mortality [28 days]: 7-, 14- and 28-day all-cause-mortality
• Median Time to >= 2 Point Improvement in Clinical Score. [28 Days]: If no clinical improvement of >=2 points met by day 28, patient outcome censored

Sex: All, ages: 18 Years to 99 Years

Inclusion Criteria:

* Male or female ≥ 18 years of age at time of screening
* Documentation of a SARS-CoV-2 diagnosis as evidenced by positive SARS-CoV-2 PCR within twelve days at time of screening
* Chest radiography consistent with multi-focal pneumonia or air-space disease
* Written informed consent obtained from subject and ability for subject to comply with the requirements of the study.
* Subject able to safely swallow pills or receive Maraviroc through a nasogastric or orogastric tube.

Exclusion Criteria:

* Subjects who are pregnant, breastfeeding, or unwilling to practice birth control during participation in the study.
* Subjects with the presence of a condition or abnormality that in the opinion of the Investigator would compromise the safety of the patient or the quality of the data. This includes, but is not limited to, recent myocardial infarction in past 6 months, neurological, psychiatric, endocrine, or neoplastic diseases that are judged to interfere with participation in the study.
* Subjects with known diagnosis of human immunodeficiency virus infection (HIV)
* Subjects enrolled in another clinical trial (including one for COVID-19) that excludes participation in other trials or includes a potent CYP3A inhibitor or inducer (e.g. lopinavir-ritonavir).
* Subjects with ESRD or severe renal failure who are taking potent (moderate or strong) CYP3A inhibitors or inducers

Participant flow

Outcome results

• Rate of Completion (Primary), Count of participants, Participants: Maraviroc Treatment 7
• Clinical Improvement at Day 7 (Primary), Count of participants, Participants: Maraviroc Group 3
• Mortality (Secondary), Count of participants, Participants: Maraviroc Treatment 0
• Median Time to >= 2 Point Improvement in Clinical Score. (Secondary), Median, Days: Maraviroc Treatment 8 (5 to 28)

Adverse events

Time frame: Adverse event data was collected over 35 days from day of enrollement.

Serious adverse events by term

Other adverse events by term

• Study Protocol and Statistical Analysis Plan (PDF, 2020-11-06)

• Philip A Chan, MD, Principal investigator, Warren Alpert Medical School and School of Public Health, Brown University