On Sept. 30, 2021, Trevena announced data from 30 patients enrolled in the proof-of-concept study of TRV027, the Company’s novel AT1 receptor selective agonist, in hospitalized COVID-19 patients. The results showed that TRV027 was well-tolerated and provided initial evidence of its potential to improve biomarker and clinical endpoints associated with COVID-19 disease severity and progression.  The study was led and funded by Imperial College London, with additional support through the British Heart Foundation Imperial Centre for Research Excellence Award.

The primary endpoint was mean change from baseline D-dimer levels at three days. D-dimer is a biomarker used to monitor the risk of abnormal clotting throughout the vascular system. In patients with COVID-19, elevations in circulating D-dimer are also known to be an accurate predictor of critical disease progression and death. Among TRV027 treated patients, 70% (7 of 10) experienced a reduction in circulating D-dimer, compared to 27% (3 of 11) of patients on placebo. TRV027 was associated with a 92% probability of a potential beneficial treatment effect, based on a Bayesian model analysis recommended by the study’s Data Monitoring and Safety Committee (DMSC).

Notably, a post-hoc analysis indicated that patients receiving TRV027 experienced a 12 day reduction in average length of hospital stay compared to placebo (11.4 vs. 23.3 days), with a median reduction of 4 days (8 vs. 12).

In March 2021, the study’s DMSC reviewed this data and unanimously found no safety or efficacy concerns, and it supported advancing TRV027 to a larger, more extensive study with clinical efficacy outcomes. As a result, the DMSC recommended closing enrollment at the interim analysis (~30 patients) prior to reaching the full study population number necessary to detect statistically significant treatment differences. The DMSC also recommended use of a Bayesian analysis on the primary endpoint to take full advantage of the accumulated data.

TRV027 is now being evaluated in two larger efficacy studies: ACTIV-4 Host Tissue led by Vanderbilt University Medical Center / NIH in the U.S. (ClinicalTrials.gov Identifier: NCT04924660), with data expected as early as mid-2022, and REMAP-CAP in the U.K. These two global, multi-site, multi-arm COVID-19 platform trials are expected to generate extensive scientific data in up to 600 patients on the potential clinical impact of TRV027 to prevent critical illness progression, multiorgan failure, and mortality in hospitalized patients with COVID-19 infection.