Official Title
The CRISIS2 Study: A Phase 2, Randomized, Double Blind, Placebo-controlled, Multi-center Study Assessing the Safety and Anti-coronavirus Response of Suppression of Host Nucleotide Synthesis in Out-patient Adults With SARS-CoV-2
Brief Summary

This study will assess the efficacy and safety of DHODHi (brequinar) as an antiviral via 5 days of treatment of participants with positive COVID-19 and at least one symptom of COVI019 in an out-patient setting. The study is multi-center, randomized, and placebo-controlled.

Detailed Description

Brequinar is a potent DHODH inhibitor that has been previously studied in more than 1,000
cancer, psoriasis, and organ transplant patients. Brequinar has been found to have potent in
vitro antiviral activity against many RNA viruses including SARS-CoV-2. The antiviral
activity of brequinar against SARS-CoV-2 is likely due to DHODH inhibition and shows
nanomolar potency and a high selectivity index in inhibiting viral replication in in vitro
studies.

The CRISIS2 trial will study out-patients (non-hospitalized patients) who have a positive
SARS-CoV-2 test and are symptomatic. Subjects will be randomized to receive standard of care
(SOC) + 5 days of brequinar or SOC + 5 days of placebo. The purpose of this study is to
determine if the in vitro antiviral activity of brequinar can be duplicated in patients
infected with SARS-CoV-2 by measuring the effect of brequinar on viral shedding. Importantly,
the safety and tolerability of brequinar will also be determined in these patients. The
results of this proof-of-concept study will inform future studies that will help determine if
brequinar is a safe and effective drug for the treatment of SARS-CoV-2 infection.

This will be a phase II randomized, placebo-controlled, double blind, multi-center study with
approximately 100 subjects. All subjects will receive standard of care (SOC) per
institutional guidelines for treatment of patients with COVID-19 infection. In addition to
SOC, the subjects will self-administer one capsule once daily for 5 days.

Subjects will have a Screening Visit followed as soon as possible with Study Day 1. Study
visits (virtual or in person) will take place at Screening and on specified days. The visits
that include bloodwork must be conducted at the study site or arrangements made for sample
collection at the subject's home or other appropriate location. Other visits/visit activities
for that visit may be conducted remotely using telemedicine or other remote technique.
Subjects are to self-collect a viral load sample, obtain their respiratory rate, heart rate,
body temperature and SpO2, and complete a symptom assessment checklist on specified days.

Completed
Covid-19 Infection

Drug: Brequinar

Dihydroorotate dehydrogenase inhibitor (DHODHi)

Drug: Placebo

Placebo capsules

Eligibility Criteria

Inclusion Criteria:

1. Willing and able to provide informed consent for the trial, written, electronic,
verbal or other method deemed acceptable by the institution and IRB.

2. 18 years of age or older.

3. Laboratory-confirmed SARS-CoV-2 infection as determined by real time polymerase chain
reaction (RT-PCR) or other FDA-approved commercial or public health assay.

4. Out-patient (never hospitalized as an in-patient for COVID-19 or was evaluated/treated
for COVID-19 only in the Emergency Room with a stay of < 24 hours)

5. The effects of brequinar on the developing human fetus are unknown. For this reason,
women of child-bearing potential and men must agree to use adequate contraception
(hormonal or barrier method of birth control; abstinence) prior to study entry and for
the duration of study participation. Should a woman become pregnant or suspect she is
pregnant while she or her partner is participating in this study, she should inform
her treating physician immediately. Men and women treated or enrolled on this protocol
must also agree to use adequate contraception for the duration of study participation,
and for 90 days after completion of brequinar administration.

6. Male subjects must agree to refrain from sperm donation and female subjects must agree
to refrain from ovum donation from initial study drug administration until 90 days
after the last dose of brequinar.

7. Must have at least one COVID-19 symptom including but not limited to fever, cough,
sore throat, malaise, headache, muscle pain, gastrointestinal symptoms, shortness of
breath, dyspnea, anosmia, dysgeusia, or other symptom commonly associated with
COVID-19 in the opinion of the investigator. Symptom onset must be ≤7 days prior to
first dose. Subject must have one or more symptoms at first dose.

8. Able to swallow capsules.

Exclusion Criteria:

1. Any physical examination findings and/or history of any illness that, in the opinion
of the study investigator, might confound the results of the study or pose an
additional risk to the patient

2. Nursing women or women of childbearing potential (WOCBP) with a positive pregnancy
test

3. Treatment with another DHODH inhibitor (e.g., leflunomide, teriflunomide) or other
agents known to cause bone marrow suppression leading to thrombocytopenia

4. Platelets ≤150,000 cell/mm3

5. Hemoglobin < 10 gm/dL

6. Absolute neutrophil count < 1500 cells/mm3

7. Renal dysfunction, i.e., creatinine clearance < 30 mL/min

8. AST or ALT > 2 x ULN, or total bilirubin > ULN. Gilbert's Syndrome is allowed.

9. Bleeding disorders or blood loss requiring transfusion in the six weeks preceding
enrollment

10. Ongoing gastrointestinal ulcer, or gastrointestinal bleeding within 6 weeks of
randomization.

11. Chronic hepatitis B infection, active hepatitis C infection, active liver disease
and/or cirrhosis per subject report.

12. Heart failure, current uncontrolled cardiovascular disease, including unstable angina,
uncontrolled arrhythmias, major adverse cardiac event within 6 months (e.g. stroke,
myocardial infarction, hospitalization due to heart failure, or revascularization
procedure).

Eligibility Gender
All
Eligibility Age
Minimum: 18 Years ~ Maximum: N/A
Countries
United States
Locations

Central Alabama Research
Homewood, Alabama, United States

Ark Clinical Research
Long Beach, California, United States

Doral Medical Research
Doral, Florida, United States

South Jersey Infectious Disease
Somers Point, New Jersey, United States

Monroe Biomedical Research
Monroe, North Carolina, United States

Wilmington Health
Wilmington, North Carolina, United States

Remington-Davis, Inc.
Columbus, Ohio, United States

Toledo Institute of Clinical Research
Toledo, Ohio, United States

VitaLink - Gaffney
Gaffney, South Carolina, United States

Self Regional Healthcare Research Center - Self Medical Group
Greenwood, South Carolina, United States

VitaLink Research
Spartanburg, South Carolina, United States

Clinical Trials Center of Middle Tennessee
Franklin, Tennessee, United States

Centex Studies, Inc. - McAllen
McAllen, Texas, United States

Synexus Clinical Research US, Inc. - Olympus Family Medicine
Salt Lake City, Utah, United States

Clear Creek Bio, Inc.
NCT Number
MeSH Terms
COVID-19
Brequinar