A Platform Protocol for Evaluation of Interventions for Autonomic Dysfunction in Post-Acute Sequelae of SARS-CoV-2 Infection

Overview

About this study

This protocol is a prospective, multi-center, multi-arm, randomized, controlled platform trial evaluating various interventions for use in the treatment of autonomic dysfunction symptoms, including cardiovascular complications and postural orthostatic tachycardia syndrome (POTS), in PASC participants. The interventions tested will include non-pharmacologic care and pharmacologic therapies with study drugs.

The hypothesis is that some of the autonomic dysfunction symptoms are immune-mediated, so immunotherapy and other applicable therapies will result in improvement in autonomic symptoms.

Participation eligibility

Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Guidelines differ from study to study, and identify who can or cannot participate. There is no guarantee that every individual who qualifies and wants to participate in a trial will be enrolled. Contact the study team to discuss study eligibility and potential participation.

Inclusion Criteria:

  • ≥ 18 years of age at the time of enrollment.
  • Previous suspected, probable, or confirmed SARS-CoV-2 infection, as defined by the Pan American Health Organization.
  • Enrollment of participants with suspected or probable SARS-CoV-2 infection will only be allowed if they occurred before May 1, 2021 and be limited to no more than 10% of the total sample size per Study Drug Appendix. Refer to the Manual of Procedures (MOP) for details.
  • Suspected case of SARS-CoV-2 infection.
  • Three options, A through C:  
    • Meets the clinical OR epidemiological criteria:
      • Clinical criteria: Acute onset of fever AND cough (influenza-like illness) OR Acute onset of ANY THREE OR MORE of the following signs or symptoms: fever, cough, general, weakness/fatigue, headache, myalgia, sore throat, coryza, dyspnea, nausea, diarrhea, anorexia;
      • Epidemiological criteria: Contact of a probable or confirmed case or linked to a COVID-19 cluster; or
    • Presents with acute respiratory infection with history of fever or measured fever of ≥ 38°C; and cough; with onset within the last 10 days; and who requires hospitalization); or
    • Presents with no clinical signs or symptoms, NOR meeting epidemiologic criteria with a positive professional use or self-test SARS-CoV-2 antigen-Rapid Diagnostic Test. Probable case of SARS-CoV-2 infection, defined as meets clinical criteria above AND is a contact of a probable or confirmed case or is linked to a COVID-19 cluster.
    • Confirmed case of SARS-CoV-2 infection - Two options, A through B: RECOVER-AUTO Version 1.0
  • A person with a positive nucleic acid amplification test, regardless of clinical criteria OR epidemiological criteria; or
  • Meeting clinical criteria AND/OR epidemiological criteria (See suspect case A). With a positive professional use or self-test SARS-CoV-2 Antigen-Rapid Diagnostic Test.
  • Moderate, self-identified autonomic symptoms (defined as COMPASS-31 > 25) following a SARSCoV-2 infection that has persisted for at least 12 weeks and is still present at the time of consent.
  • OHQ/OIQ, question 1 score > 2.

Exclusion Criteria:

  • Known pregnancy, breastfeeding, or contemplating pregnancy during the study period.
  • Known active acute SARS-CoV-2 infection ≤ 4 weeks from enrollment.
  • Known renal failure (eGFR <20ml/1.73 m²).
  • Known atrial fibrillation or significant cardiac arrhythmia.
  • Known cardiovascular conditions such as heart failure (Class 3-4), severe valvular disease, symptomatic ischemic coronary artery disease, revascularization for PAD/CAD within the past 6 months.
  • Clinically significant atherosclerotic disease, defined as history of stroke or myocardial infarction or revascularization 6 months prior to enrollment and/or current symptomatic angina.
  • Existing uncontrolled hypertension.
  • History of significant hypercoagulability disorders.
  • Active or recent thrombosis.
  • Inability to comply with the protocol.
  • Less than 2 weeks since discontinuation/weaning of beta blockers and calcium channel blockers. 
  • Any condition that the investigator believes makes it inappropriate to treat with study intervention, including severe debility.
  • History of POTS or significant dysautonomia before COVID-19 index infection.
  • Currently receiving/using intervention from another clinical trial, such as another RECOVER trial.

Note: Other protocol defined Inclusion/Exclusion Criteria may apply.

Eligibility last updated 10/25/23. Questions regarding updates should be directed to the study team contact.

Participating Mayo Clinic locations

Study statuses change often. Please contact the study team for the most up-to-date information regarding possible participation.

Mayo Clinic Location Status Contact

Rochester, Minn.

Mayo Clinic principal investigator

Kamal Shouman, M.D.

Open for enrollment

Contact information:

Sherry Klingerman CCRP

(507) 284-0451

klingerman.sherry@mayo.edu

More information

Publications

Publications are currently not available
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CLS-20568794

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