Bevacizumab in Post-acute Sequelae of COVID-19 : Efficacy and Safety (Pilot Study)

Overview

The aim of this research is to evaluate an innovative treatment, Bevacizumab, in patients suffering from respiratory complications related to COVID-19. These complications, particularly difficulty breathing (dyspnea) and impaired lung function, are common in some individuals after infection. The study seeks to determine whether Bevacizumab can improve breathing capacity by acting on vascular mechanisms that may be responsible for these issues. A total of 21 patients with these persistent symptoms will be included in the study, with close medical monitoring to assess both the effectiveness of the treatment and its safety. This research aims to assess the effectiveness and safety of Bevacizumab, a medication known for its anti-angiogenic properties (which prevent the formation of new blood vessels), in patients experiencing persistent respiratory problems after COVID-19 infection. In other words, this research is based on the idea that inhibiting blood vessel formation with Bevacizumab may improve clinical outcomes in patients with severe forms of COVID-19 by reducing vascular complications associated with the infection. To answer this research question, 21 individuals with persistent respiratory symptoms (significant dyspnea) and reduced lung diffusing capacity (DLCO less than 75% of the predicted value) at least three months after their initial COVID-19 infection will be included. The study is being conducted at Hôpital Européen Georges Pompidou, in Paris. The total expected duration of the research is 31 months, and each patient's participation will last 7 months, which includes 2 months of treatment (five Bevacizumab injections) followed by five additional months of medical follow-up. In this research project, we will be evaluating Bevacizumab, an experimental drug in the context of Long COVID. Bevacizumab is a monoclonal antibody used to inhibit angiogenesis (the abnormal formation of new blood vessels). While commonly used in oncology, in this study, its use aims to improve lung function in patients suffering from persistent respiratory complications after COVID-19 infection. Bevacizumab will be administered as an intravenous infusion. The infusion lasts between 30 and 90 minutes. The dosage is 10 mg/kg every two weeks, for a total of five infusions over a two-month period. Additional follow-up visits will be conducted one month and five months after the end of treatment. Monitoring will include clinical examinations, laboratory tests, and lung function assessments.

Interventions

• Drug Bevacizumab Injection
  Participants will receive Bevacizumab at a dose of 10mg/kg via intravenous infusion. They will receive a total of 5 injections, administered every two weeks.

Primary outcome measures

• Rate of patients with 10% increase of impaired DLCO [Time frame: 3 months after the introduction of bevacizumab.]

Secondary outcome measures (7)

• Proportion of patients with recovery of clinical symptoms [Time frame: 1, 2, 3 and 7 months after the initiation of Bevacizumab.]
• Proportion of patients with recovery of psychological, cognitive, and autonomic functions [Time frame: 3 and 7 months after the initiation of Bevacizumab treatment.]
• Proportion of patients with improvement of other parameter than DLCO explored by Pulmonary Function Test [Time frame: 1, 2, 3 and 7-months after the initiation of Bevacizumab treatment.]
• Modification of DLCO [Time frame: 1 and 2 months after the initiation of Bevacizumab treatment.]
• Circulating angiogenic biomarkers levels [Time frame: 1, 2, 3 and 7 months after the initiation of Bevacizumab treatment.]
• Number of side effects related to bevacizumab [Time frame: From bevacizumab treatment initiation to the end of the follow-up at 7 months.]
• Number of patients with hospitalization or medical consultation [Time frame: From bevacizumab treatment initiation to the end of the follow-up at 7 months.]

Eligibility criteria

Inclusion criteria

• Patients over 18 years, under 90 years
• Social security affiliation
• Good understanding of the French language
• Written informed consent
• DOcumented COVID-19 infection (PCR or CT-scan) more than 3 months before inclusion
• Long COVID suspicion with dyspnea (mMRC > 2 at inclusion)
• DLCO < 75% of predicted value less than 3 months old on the day of screening or to be obtained before Day 1 older than 3 months

Exclusion criteria

• Acute COVID-19 infection
• Lung scintigraphy and thoracic CT angiography evaluation to rule out pulmonary embolism less than 3 months old on the day of screening or to be obtained before Day 1 if older than 3 months to exclude Sequelae of pulmonary embolism or lung emphysema in the setting of COPD
• Women of childbearing potential
• Myocardial infarction or stroke less than 3 months before screening
• Uncontrolled hypertension (> 140/90 at inclusion in the study)
• Proteinuria/creatinuria ratio > 1 g/mmol at baseline DFG < 30 ml/min
• History of malignant hypertension
• Previous osteonecrosis
• History of Aneurysm and artery dissections
• Active cancer
• Known hypersensitivity to bevacizumab or any ingredient in its formulation, including non-medicinal ingredients, or a component of the container
• Hypersensitivity to Chinese Hamster Ovary (CHO) cell product or other recombinant human or humanized antibodies
• History of radiotherapy
• History of bisphosphonates treatment
• Surgery in 28 days before inclusion
• Participation in another interventional study or being in the exclusion period at the end of a previous study
• Patient unable or unwilling to comply with the follow up schedule (at the investigator's discretion)
• Pregnant or breastfeeding women
• Vulnerable populations (patient under gardianship, curatorship, deprived of liberty)
• Patient on AME (State medical aid)

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Treatment

Study locations

France · 2 centers

• HEGP, clinical investigation center — Paris
• HEGP, department of Physiology — Paris

Publications

• Philippe A, Gunther S, Rancic J, Cavagna P, Renaud B, Gendron N, Mousseaux E, Hua-Huy T, Reverdito G, Planquette B, Sanchez O, Gaussem P, Salmon D, Diehl JL, Smadja DM. VEGF-A plasma levels are associated with impaired DLCO and radiological sequelae in long COVID patients. Angiogenesis. 2024 Feb;27(1):51-66. doi: 10.1007/s10456-023-09890-9. Epub 2023 Aug 1. PMID 37526809

Identifiers

NCT: NCT07089719 · APHP241020 · RECHMIE-23-0004 · 2024-520308-24-00

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗