Overview
Sponsor-declared trial summary
Long Covid
To evaluate the efficacy of study drugs in improving symptom severity in participants with Long Covid.
Key facts
- Sponsor
- Dr. Douglas D. Fraser
- Participant type
- Patients
- Age range
- 18-64 years
- Gender
- Male and Female
- Therapeutic area
- Diseases [C] - Virus Diseases [C02]
- Decision date (initial)
- 2026-02-25
- Transition trial
- No
- Low-intervention
- No
- Rare-disease indication
- No
- Vulnerable population
- No
External identifiers
- EU CT number
- 2025-522611-42-00
- ClinicalTrials.gov
- NCT06928272
Trial design
CTIS Part I — objectives, methods, condition coding
Main objective
Scope: Therapy, Safety, Efficacy
To evaluate the efficacy of study drugs in improving symptom severity in participants with Long Covid.
Secondary objectives 10
- To compare symptom burden of participants with Long Covid treated with study drugs versus placebo (e.g., overall well-being, anxiety, depression).
- To assess whether symptom burden worsens in participants with Long Covid treated with study drugs versus placebo, specifically when symptoms are reported across multiple scales.
- To compare the severity of post exertional malaise (PEM) in participants with Long Covid treated with study drugs versus placebo
- To measure specific pathophysiological biomarkers of study drugs versus placebo.
- To assess changes in exercise capacity over time of participants with Long Covid treated with study drugs versus placebo
- To evaluate the safety and tolerability of the study drugs in participants with Long Covid
- Analyze plasma proteomics to understand protein/pathway analyses and mechanisms of action for the study drugs
- Analyze plasma metabolomics to understand metabolic changes and the final consequences of the study drugs
- RNA sequencing to identify gene expression changes to understand response to study drugs
- Exome/single nucleotide polymorphisms to identify genetic variants to understand the metabolism/efficacy of the study drugs
Conditions and MedDRA coding
Long Covid
Study design 3 periods
| # | Title | Allocation | Blinding | Roles blinded | Arms |
|---|---|---|---|---|---|
| 1 | Phase One - Screening Period A 10 day period to assess eligibility criteria, collect baseline data, and perform initial safety labs. No investigational product administered.
|
Not Applicable | None | ||
| 2 | Phase One - Treatment Period 3-month treatment phase where eligible participants are randomly assigned to receive one of two study drugs or one of two placebos. Primary and secondary endpoints assessed.
|
Randomised Controlled | Double | [{"id":171187,"code":2,"name":"Investigator"},{"id":171186,"code":1,"name":"Subject"},{"id":171188,"code":3,"name":"Monitor"}] | Upadacitinib: One capsule (15mg) once daily Placebo for Upadacitinib: One capsule (0mg) once daily Pirfenidone: Days 1-7: one capsule (267mg) three times daily (801mg total) Days 8-14: two capsules (534mg) three times daily (1602mg total) Days 15+: three capsules (801mg) three times daily (2403mg total) Placebo for Pirfenidone: Days 1-7: one capsule, three times daily (0mg) Days 8-14: two capsules, three times daily (0mg) Days 15+: three capsules, three times daily (0mg) |
| 3 | Phase One - Follow-up Period Three-month safety follow-up after last dose of study medication to monitor adverse events and collect final labs
|
Randomised Controlled | Double | [{"id":171192,"code":2,"name":"Investigator"},{"id":171191,"code":1,"name":"Subject"},{"id":171190,"code":3,"name":"Monitor"}] | Upadacitinib: Study drug discontinued during follow-up period. Placebo for Upadacitinib: Study drug discontinued during follow-up period. Pirfenidone: Study drug discontinued during follow-up period. Placebo for Pirfenidone: Study drug discontinued during follow-up period. |
Eligibility criteria
Principal inclusion / exclusion criteria as submitted by sponsor
Inclusion criteria 6
- Adults ≥ 18 years of age and ≤ 65 years of age
- Previous Covid-19 (SARS-CoV-2 infection) within the past four years, as determined by the site investigator using the following certainty scale (based on available clinical history and/or serologic data): 3 – Confirmed Infection (PCR or n-Capsid Test): Prior positive nasopharyngeal or salivary PCR test for Covid-19 (documented proof and/or verbal confirmation by participant) or has positive nucleocapsid antibodies results. 2 – Probable Infection (Antigen Test): Participant verbally confirms a prior positive rapid antigen test without PCR confirmation. 1 – Possible Infection (Viral Syndrome and Epidemiological Link): Participant verbally confirms experiencing symptoms consistent with Covid-19 infection and has an epidemiological link (i.e., exposure to a confirmed case) without any positive testing.
- Persistent or new symptoms diagnosed as "Long Covid" as defined by the World Health Organization; "the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection (Covid-19), with these symptoms lasting for at least 2 months with no other explanation". This diagnosis may come from a healthcare professional experienced in Long Covid diagnosis, or the site investigator. These symptoms must be present for more days than not and must not have been present prior to the onset of SARS-CoV-2 (Covid-19) infection.
- At the time of screening, participants should be experiencing at least one of the following self-reported symptoms or symptom clusters. Participant has self-reported issues with: Fatigue Breathing Circulation Memory, thinking, and/or communication Muscles and/or joints These five symptoms or symptom clusters were selected based on unpublished data from the National Institutes for Health and Care Research (NIHR, United Kingdom) and their alignment with five validated SBQ scales. The selection was driven by their prevalence and their significant impact on quality of life as reported in symptom assessments.
- Participant has the ability and is willing to follow study procedures throughout the study
- Participant can provide informed consent
Exclusion criteria 40
- Participants who do not meet the criteria outlined above
- Participants who are unable to provide their informed consent
- Participants who are pregnant, lactating, or plan to become pregnant during the time of the study
- Persons of childbearing potential who are unwilling or unable to abstain from sex or to use at least one acceptable method of contraception from the time of screening through at least 30 days after the end of the study intervention period. Acceptable methods include barrier contraceptives (e.g., condoms or diaphragm) with spermicide, intrauterine devices (IUDs), hormonal contraceptives, oral contraceptive pills, and surgical sterilization. Participants unwilling to be counseled about the risks related to pregnancy or breastfeeding will also be excluded.
- Male participants must take precautions to avoid impregnating a female while participating in this study. If a male participant's partner can become pregnant, she must use an effective and reliable form of birth control, as listed above, during the study and for 30 days after the male participant's last dose of the investigational product. Additionally, male participants must agree to use a latex condom during sexual activity with partners who could become pregnant.
- eGFR <30 mL/min/1.73m2
- Moderate to severe liver dysfunction, defined as Bilirubin > 1.5 x ULN or AST or ALT > 2 x ULN
- Hemoglobin (Hbg) < 8.0 g/dL
- Absolute neutrophil count (ANC) below 1,000 cells/mm³, confirmed with repeat testing
- Absolute lymphocyte count (ALC) below 500 cells/mm³
- Alkaline phosphatase (ALP) levels equal to or greater than three times the upper limit of normal (ULN)
- Creatine phosphokinase (CPK) levels equal to or greater than three times the ULN
- Platelet count below 100,000 cells/mm³, confirmed with repeat testing
- Platelet count above 500,000 cells/mm³, confirmed with repeat testing
- Total fasting cholesterol levels of 280 mg/dL or higher, confirmed with repeat testing
- Fasting low-density lipoprotein (LDL) levels of 180 mg/dL or higher, confirmed with repeat testing
- A personal or family history of long QT syndrome or an electrocardiogram (ECG) during screening showing a corrected QT interval (QTc) of 500 milliseconds or greater, calculated using Fridericia's formula
- Participants with HIV diagnosis
- Participants with active hepatitis B or C diagnosis. Note: treated or cleared hepatitis C is not exclusionary.
- Active herpes zoster infection (visible skin lesions) within 3 months prior to screening, or any history of disseminated or complicated herpes zoster or herpes simplex infection (e.g., VZV encephalitis)
- Participants with active or latent tuberculosis
- Immunocompromised status, as determined by the investigator, that places the participant at an unacceptable risk for study participation
- Active malignancy or lymphoproliferative disorder that has not been in remission for at least five years. Localized non-melanoma skin cancers that have been definitively treated are not exclusionary.
- Positive SARS-CoV-2 test in the last 30 days or symptomatic with Covid-19 like illness
- Previous admission to an intensive care unit (ICU) for the treatment of acute COVID-19 infection
- Any history of deep venous thrombosis, pulmonary embolism, unstable angina, atrial fibrillation, ventricular fibrillation, or myocardial infarction or stroke
- History of sepsis or a significant viral, bacterial, fungal, or parasitic infection within 30 days prior to enrollment, as determined by the investigator.
- Use of one or more of the study drugs within 30 days prior to enrollment for the original indication or other purposes
- Known allergic reactions to the components of the study drugs
- Any prior exposure to JAK inhibitors
- Taking any of the listed medications on the prohibited medications list in Appendix A
- Intake or planned consumption of any of the following: Taurine, Curcumin, CoQ10, Creatine, Resveratrol, Fisetin, Nicotinamide mononucleotide (NMN), Nicotinamide adenine dinucleotide (NAD+), Quercetin, Glycine, Spermidine, Arginine alpha-ketoglutarate, Ergothioneine, Alpha Lipoic Acid, Carnitine, Benfotiamine, Carnosine, Crocin, N-acetylcysteine
- Covid vaccinations are prohibited within 30 days prior to enrollment
- Live vaccine within the 30 days before enrollment or plan to receive live vaccines during the study period
- Other vaccines, including influenza vaccine, are prohibited within 14 days of enrollment
- Major surgery within 30 days prior to enrollment or plans for major surgery during the study
- Any other co-existing medical condition or concomitant medication/therapy that might in the judgment of the study investigators, potentially impact the participant's safety or ability to adhere to the study protocol or interfere with the meaning of the clinical and research measurements as judged by the study investigators
- Participation in any clinical study within the last 30 days prior to enrollment
- Participants who participated in Phase One of this study (LC-Revitalize) are not eligible to participate in Phase Two
- Currently hospitalized and/or incarcerated
Endpoints
Primary and secondary outcome measures (English text)
Primary endpoints 1
- The aim of this study is to evaluate the efficacy of two repurposed drugs in reducing symptom severity in participants with Long Covid. The change in symptom score (transformed scale of 0-100) from baseline to both the interim and final analyses will be compared across one of the five validate subscales, relative to the placebo. This study will utilize five validated subscales: 1) Fatigue, 2) Breathing, 3) Memory, Thinking, and Communication, 4) Muscles and Joints, and 5) Circulation.
Secondary endpoints 8
- To compare symptom burden of participants with Long Covid treated with study drug versus placebo by measuring the change in total scores of the Patient Reported Outcome Measurement Information System (PROMIS)-29 questionnaire.
- To compare symptom burden of participants with Long Covid treated with study drug versus placebo by measuring the change in total scores of the Generalized Anxiety Disorder (GAD)-7 questionnaire from baseline to the interim and final analyses.
- To compare symptom burden of participants with Long Covid treated with study drug versus placebo by measuring the change in total scores of the Patient Health Questionnaire (PHQ)-9 from baseline to the interim and final analyses. The PHQ-9 questionnaire consists of 9 items related to the symptoms of depression. Each item is scored on a scale of 0-3 with higher scores indicating more severe symptoms.
- To assess whether symptom burden worsens in participants with Long Covid treated with study drugs versus placebo, specifically when symptoms are reported across multiple scales indicated by the total number of participants with increased SBQ subscale scores. The following SBQ subscales will be used during this study: 1) Fatigue, 2) Breathing, 3) Memory, thinking, and communication, 4) Muscles and joints, 5) Circulation.
- To measure specific pathophysiological biomarker of study drugs versus placebo indicated by the normalization of blood biomarkers after treatment in picograms per milliliter (pg/mL).
- To assess changes in exercise capacity over time of participants with Long Covid treated with study drugs versus placebo. The score is determined by the distance a participant walks in six minutes around the perimeter of a designated circuit.
- The frequency and severity of adverse events and laboratory abnormalities will be monitored to assess safety and tolerability. A lower incidence and severity will indicate that the drugs are safer and more tolerable.
- Plasma proteomics will be analyzed to assess protein differential expression and signaling pathway mechanisms related to the study drugs. Analyses will focus on the expression normalization of proteins/pathways associated with Long Covid. Plasma metabolomics will be analyzed to evaluate metabolic changes and the overall effects of the study drugs. Analyses will focus on the concentration normalization of metabolites linked to the pathophysiology of Long Covid.
Investigational products
Investigational medicinal products (IMPs), comparators, placebo, auxiliary
Test 2
Pirfenidon Accord 267 mg Filmtabletten
PRD10007276 · Product
- Active substance
- Pirfenidone
- Pharmaceutical form
- FILM-COATED TABLET
- Route of administration
- ORAL
- Max daily dose
- 2403 mg milligram(s)
- Max total dose
- 801 mg milligram(s)
- Max treatment duration
- 90 Day(s)
- Authorisation status
- Authorised
- ATC code
- L04AX05 — -
- Marketing authorisation
- 7005324.00.00
- MA holder
- ACCORD HEALTHCARE B.V.
- MA country
- Germany
- Paediatric formulation
- No
- Orphan designation
- No
- Modified vs. Marketing Authorisation
- Yes
- Modification description
- The product is over-encapsulated in rapid-release hard gelatin capsules to maintain blinding without affecting release. The remaining space within the capsule is filled with inert microcrystalline cellulose, which does not affect the release of the active drug.
RINVOQ 15 mg prolonged-release tablets
PRD7789003 · Product
- Active substance
- Upadacitinib
- Pharmaceutical form
- PROLONGED-RELEASE TABLET
- Route of administration
- ORAL
- Max daily dose
- 15 mg milligram(s)
- Max total dose
- 15 mg milligram(s)
- Max treatment duration
- 90 Day(s)
- Authorisation status
- Authorised
- ATC code
- L04AF03 — -
- Marketing authorisation
- EU/1/19/1404/002
- MA holder
- ABBVIE DEUTSCHLAND GMBH & CO. KG
- MA country
- EU
- Paediatric formulation
- No
- Orphan designation
- No
- Modified vs. Marketing Authorisation
- Yes
- Modification description
- The product is over-encapsulated in rapid-release hard gelatin capsules to maintain blinding without affecting release. The remaining space within the capsule is filled with inert microcrystalline cellulose, which does not affect the release of the active drug.
Placebo 4
N/A · Product
- Other product name
- N/A
- Pharmaceutical form
- N/A
- ATC code
- N/A — N/A
- Marketing authorisation
- N/A
- MA holder
- N/A
- MA country
- Iceland
- Paediatric formulation
- No
SUB12626MIG · Substance
- Active substance
- Cellulose, Microcrystalline
- Pharmaceutical form
- ORAL POWDER
- Route of administration
- ORAL
- Max daily dose
- 0 mg milligram(s)
- Max total dose
- 0 mg milligram(s)
- Max treatment duration
- 90 Day(s)
- Authorisation status
- Authorised
- ATC code
- - — -
- Marketing authorisation
- -
- Paediatric formulation
- No
- Orphan designation
- No
- Modified vs. Marketing Authorisation
- Yes
- Modification description
- The product is over-encapsulated in rapid-release hard gelatin capsules to maintain blinding without affecting release.
N/A · Product
- Other product name
- N/A
- Pharmaceutical form
- N/A
- ATC code
- N/A — N/A
- Marketing authorisation
- N/A
- MA holder
- N/A
- MA country
- Iceland
- Paediatric formulation
- No
SUB12626MIG · Substance
- Active substance
- Cellulose, Microcrystalline
- Pharmaceutical form
- ORAL POWDER
- Route of administration
- ORAL
- Max daily dose
- 0 mg milligram(s)
- Max total dose
- 0 mg milligram(s)
- Max treatment duration
- 90 Day(s)
- Authorisation status
- Authorised
- ATC code
- - — -
- Marketing authorisation
- -
- Paediatric formulation
- No
- Orphan designation
- No
- Modified vs. Marketing Authorisation
- Yes
- Modification description
- The product is over-encapsulated in rapid-release hard gelatin capsules to maintain blinding without affecting release.
Sponsors and contacts
Sponsor organisations, regulatory contacts, third parties
Dr. Douglas D. Fraser
- Sponsor organisation
- Dr. Douglas D. Fraser
- Address
- 800 Commissioners Rd E
- City
- London
- Postcode
- N6A 5W9
- Country
- Canada
Scientific contact point
- Organisation
- Dr. Douglas D. Fraser
- Contact name
- Douglas D. Fraser
Public contact point
- Organisation
- Dr. Douglas D. Fraser
- Contact name
- Stephanie Perkin
Third parties 1
| Organisation | City, country | Duties |
|---|---|---|
| Oximio Barl Canada Ltd. ORG-100055434
|
Dundas, Canada | Code 14 |
Locations
1 EU/EEA country · 1 investigational sites
By country
| Country | MS status | Planned subjects | Sites |
|---|---|---|---|
| Italy | Not authorised | 75 | 1 |
| Rest of world
United States, Canada, Brazil, Zambia, Uganda
|
— | 273 | — |
Investigational sites
Results and documents
Annex IV summary of results, Annex V layperson summary, and all documents registered in CTIS for this trial
Documents 16 files
Public protocol annexes, IB summaries, regulatory submissions and post-authorisation documents registered in CTIS.
| Type | Title | Version |
|---|---|---|
| Protocol (for publication) | D1 Core Protocol -Redacted- EU CT 2025-522611-42 | 4.1 |
| Protocol (for publication) | D1 Pirfenidone Specific Appendix Redacted EU CT 2025-522611-42 | 1.2 |
| Protocol (for publication) | D1 Upadacitinib Specific Appendix Redacted EU CT 2025-522611-42 | 1.1 |
| Recruitment arrangements (for publication) | K1_INMI - Consent and Recruitment Procedure | 1 |
| Subject information and informed consent form (for publication) | L1_ICF Female Partner Pregnancy EU CT 2025-522611-42 EN | 1.2 |
| Subject information and informed consent form (for publication) | L1_ICF Female Partner Pregnancy EU CT 2025-522611-42 IT | 1.2 |
| Subject information and informed consent form (for publication) | L1_ICF Genetic Analysis EU CT 2025-522611-42 EN | 1.1 |
| Subject information and informed consent form (for publication) | L1_ICF Genetic Analysis EU CT 2025-522611-42 IT | 1.1 |
| Subject information and informed consent form (for publication) | L1_ICF Main EU CT 2025-522611-42 EN | 3.0 |
| Subject information and informed consent form (for publication) | L1_ICF Main EU CT 2025-522611-42 IT | 3.0 |
| Subject information and informed consent form (for publication) | L1_SIS Preliminary Female Partner EU CT 2025-522611-42 EN | 1.2 |
| Subject information and informed consent form (for publication) | L1_SIS Preliminary Female Partner EU CT 2025-522611-42 IT | 1.2 |
| Summary of Product Characteristics (SmPC) (for publication) | E2 SmPC Pirfenidone | 03 |
| Summary of Product Characteristics (SmPC) (for publication) | E2 SmPC Upadacitinib | 1 |
| Synopsis of the protocol (for publication) | D1 Protocol Synopsis EU CT 2025-522611-42 | 1.0 |
| Synopsis of the protocol (for publication) | D1 Protocol Synopsis IT EU CT 2025-522611-42 | 1 |
Application history
1 submissions — initial application plus substantial / non-substantial modifications
| # | Type | Code | Submitted | Reference MS | Conclusion | Decision date |
|---|---|---|---|---|---|---|
| 1 | INITIAL | IN | 2025-10-20 | Italy | Not acceptable 2026-02-23
|
2026-02-25 |