The main purpose of this study is to evaluate the activity of low dose oral selinexor (KPT-330) and to evaluate the clinical recovery, the viral load, length of hospitalization and the rate of morbidity and mortality in participants with severe COVID-19 compared to placebo. The study had 2 arms and evaluated selinexor 20 mg + standard of care (SoC) and placebo + SoC. As the treatment for COVID-19 is rapidly evolving, the SoC varied over time and across regions of the world.
Drug: Selinexor
Participants will receive 20 mg of selinexor.
Other Name: Array
Other: Placebo
Participants will receive 20 mg of placebo matched to selinexor.
Inclusion Criteria:
- Confirmed laboratory diagnosis of SARS-CoV2 by standard FDA-approved reverse
transcription polymerase chain reaction (RT-PCR) assay or equivalent FDA-approved
testing (local labs).
- Currently hospitalized.
- Informed consent provided as above (it is recommended that participants are dosed with
study drug within 12 hours of consent).
- Has symptoms of severe COVID-19 as demonstrated by:
- At least one of the following: fever, cough, sore throat, malaise, headache,
muscle pain, shortness of breath at rest or with exertion, confusion, or symptoms
of severe lower respiratory symptoms including dyspnea at rest or respiratory
distress.
- Clinical signs indicative of lower respiratory infection with COVID-19, with at
least one of the following: SaO2 <92% on room air in last 12 hours or requires >
4 liters per minute (LPM) oxygen by nasal canula, non-rebreather/Ventimask or
high flow nasal canula in order maintain SaO2 ≥92%, PaO2/FiO2 <300 millimeter per
mercury (mm/hg).
- Elevated C-reactive protein (CRP) > 2 x upper limit of normal (ULN).
- Concurrent anti-viral and/or anti-inflammatory agents (e.g., biologics,
hydroxychloroquine) are permitted. If in the physician's judgment, it is in the best
interest of the participant to use anti-viral or anti-inflammatory treatments, these
treatments are to be documented in the participant's chart and entered in the
electronic case report form.
- Female participants of childbearing potential must have a negative serum pregnancy
test at Screening. Female participants of childbearing potential and fertile male
participants must use highly effective methods of contraception throughout the study
and for 3 months following the last dose of study treatment.
Exclusion Criteria:
- Evidence of critical COVID-19 based on:
- Respiratory failure (defined by endotracheal intubation and mechanical
ventilation, oxygen delivered by noninvasive positive pressure ventilation, or
clinical diagnosis of respiratory failure in setting of resource limitations)
- Septic shock (defined by Systolic blood pressure [BP] < 90 mm Hg, or Diastolic BP
< 60 mm Hg)
- Multiple organ dysfunction/failure
- In the opinion of the investigator, unlikely to survive for at least 48 hours from
screening or anticipate mechanical ventilation within 48 hours.
- Inadequate hematologic parameters as indicated by the following labs:
- Participants with severe neutropenia (ANC <1000 x 10^9/L) or
- Thrombocytopenia (e.g., platelets <100,000 per microliter of blood)
- Inadequate renal and liver function as indicated by the following labs:
- Creatinine clearance (CrCL) <20 mL/min using the formula of Cockcroft and Gault
- Aspartate transaminase (AST) or alanine transaminase (ALT) > 5 x ULN
- Hyponatremia defined as sodium < 135 milliequivalents per liter (mEq/L).
- Unable to take oral medication when informed consent is obtained.
- Participants with a legal guardian or who are incarcerated.
- Treatment with strong CYP3A inhibitors or inducers.
- Pregnant and breastfeeding women.
UCLA
Los Angeles, California, United States
Kaiser Permanente Oakland
Oakland, California, United States
UC Davis Health
Sacramento, California, United States
Kaiser Permanente Sacramento
Sacramento, California, United States
Kaiser Permanente San Francisco
San Francisco, California, United States
Miami Cancer Institute at Baptist Health
Miami, Florida, United States
Emory University
Atlanta, Georgia, United States
Advocate Christ Medical Center
Oak Lawn, Illinois, United States
University of Kansas Medical Center
Kansas City, Kansas, United States
Norton Healthcare
Louisville, Kentucky, United States
Boston Medical Center
Boston, Massachusetts, United States
Karmanos
Detroit, Michigan, United States
Michigan Center of Medical Research
Farmington Hills, Michigan, United States
Michigan Center of Medical Research
Royal Oak, Michigan, United States
Columbia University
New York, New York, United States
Weill Cornell Medical College
New York, New York, United States
Levine Cancer Institute-Atrium Health University City
Charlotte, North Carolina, United States
Lehigh Valley Hospital
Allentown, Pennsylvania, United States
Baylor Scott & White Dallas
Dallas, Texas, United States
MultiCare Institute for Research & Innovation (Puget Sound)
Tacoma, Washington, United States
Hospital Hietzing, 2. Medical department - Center for Diagnosis and Therapy of Rheumatic Diseases
Vienna, Austria
CHU Bordeaux
Bordeaux, France
CHU Lyon
Lyon, France
CHU Nantes
Nantes, France
Hadassah MC
Jerusalem, Israel
Hasharon Medical Center
Petah Tiqva, Israel
Sheba Medical Center
Tel HaShomer, Israel
Hospital Universitari Vall d'Hebron
Barcelona, Spain
Servicio de Medicina Interna, Hospital Universitario de Salamanca, Universidad de Salamanca
Salamanca, Spain
Princess Royal University Hospital
Kent, United Kingdom
Kings College Hospital
London, United Kingdom
The Royal Marsden Hospital
London, United Kingdom
University Hospitals Plymouth NHS Trust
Plymouth, United Kingdom
Dayana Michel
Study Director
Karyopharm Therapeutics Inc