Novel Agents for Treatment of High-risk COVID-19 Positive Patients

Randomized, Multi-arm Phase II Trial of Novel Agents for Treatment of High-risk COVID-19 Positive Patients

This is a multi-arm, phase II trial for rapid efficacy and toxicity assessment of multiple therapies immediately after COVID19 positive testing in high-risk individuals. Therapies include stand-alone or combination treatment with hydroxychloroquine, azithromycin, ivermectin, or camostat mesilate, artemesia annua. The hypothesis of this study is that the addition of agents that inhibit viral entry or replication of SARS-CoV-2 virus replication in will be devoid of additional moderate to severe toxicities, will prevent clinical deterioration, and will improve viral clearance in high risk individuals.

Study Overview

• Status: Terminated
• Conditions: COVID; Sars-CoV2
• Intervention / Treatment: Drug: Ivermectin; Drug: Camostat Mesilate; Dietary supplement: Artemesia annua; Drug: Artesunate

Detailed Description

Coronavirus Disease 2019 (COVID-19) is a highly contagious disease, caused by a novel enveloped RNA beta-coronavirus, also known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The first case of this unprecedented outbreak "pneumonia of unknown etiology" was reported in Wuhan City, Hubei Province, China on December 8th, 2019 and reported to the World Health Organization (WHO) on December 31st, 2019. WHO declared a COVID-19 global emergency on January 30, 2020, and then categorized the outbreak as a pandemic on March 11, 2020. As of April 22, 2020, more than 2,628,894 confirmed cases of COVID-19 worldwide and 182,740 people globally have died from COVID-19 since it emerged in China, according to the data from Johns Hopkins University.

While the majority of patients with COVID-19 develop mild or uncomplicated illness, approximately 20-30% of hospitalized patients have required intensive care support and 5% of those have multi-organ failure or shock. The case fatality rate ranges from 1 to 4% and it is higher among those with pre-existing comorbid conditions such as cardiovascular disease, diabetes mellitus, obesity, chronic respiratory disease, hypertension and cancer. The vast majority of patients present with fever (83-99%), cough (59-82%), fatigue (44-70%), anorexia (40-84%), shortness of breath (31-40%), sputum production (28-33%), myalgias (11-35%). Less than 10% of patients will present with headache, confusion, rhinorrhea, sore throat, hemoptysis, vomiting, or diarrhea. Anosmia or ageusia proceeding the onset of respiratory symptoms has been anecdotally reported.

To date, treatments for COVID-19 in high risks individuals remain experimental and therapeutic strategies to deal with the infection are at best supportive, with prevention aimed at reducing transmission in the community as the best weapon. No proven therapies have been demonstrated to prevent the progression of COVID-19 to severe illness and this is a critical unmet need for high-risk individuals and warrants study. Recently, the Infectious Disease Society of America has made recommendations for the treatment of patients with COVID-19, focusing on inpatient care, and recommending randomized trials where possible as the best step to improve treatment outcomes and to increase our understanding of this coronavirus pandemic. Discoveries in this area may inform clinicians on effective treatment for low-risk individuals who progress to severe illness, as well.

• Study Type: Interventional
• Enrollment (Actual): 13
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Kentucky
    • Lexington, Kentucky, United States, 40532
      • University of Kentucky Markey Cancer Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 97 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria

• Age ≥18 years
• Laboratory-confirmed SARS-CoV-2 infection within the past 7 days or the presence of symptoms or physical examination signs providing high probability of COVID-19 disease
• Patients must have adequate organ and marrow function measured within the last 6 months

• Subjects must have at least one of the following high-risk features for clinical deterioration:

  • Hypertension
  • Diabetes Mellitus
  • Moderate to severe Chronic Obstructive Pulmonary Disease, Emphysema, Cystic Fibrosis, or Asthma
  • Cancer patients who have received any immunosuppressive drugs within a year from enrollment
  • Sickle Cell disease or thalessemia
  • Age > or = 50
  • BMI > or = 30
  • Living in a nursing home or long-term facility
  • Underlying serious heart condition as determined by the treating physician
  • Immunocompromised subject as defined by the treating physician or COVID-19 Telehealth Treatment Team

Exclusion Criteria

• Severe or life threating COVID
• Weight less than 45 kg.
• Pregnant or breast-feeding females
• Subjects on dialysis or with creatinine clearance < 45 ml/min
• Existing DMID Toxicity Scale for Determining Severity of Adverse Events grade 3 or greater hepatic failure
• Previously documented moderate or severe retinopathy or macular degeneration
• Uncontrolled Seizure disorder
• Prolonged QT, defined as QTc ≥470 milliseconds for men and as QTc ≥480 for women using Bazett's formula
• Known allergy to artesunate, artemisia annua, hydroxychloroquine, macrolides, 4-aminoquinolines, camostat mesilate, or other agents to be used in the trial.
• Currently receiving any study medications for other indications
• Concurrent use of medication that would cause drug-drug interactions
• Patients with psychiatric illness/social situations that would limit compliance

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Arm C: Ivermectin; Ivermectin	Drug: Ivermectin; Ivermectin: Days 1-2: Weight < 75kg: 4 tabs (12 mg total daily dose) Days 1-2: Weight > 75kg: 5 tabs (15 mg total daily dose)
Experimental: Arm D: Camostat Mesilate; Camostat Mesilate	Drug: Camostat Mesilate; Days 1-14: 2 tab TID after a meal (600 mg total daily dose)
Experimental: Arm E: Artemesia annua; Artemesia annua tea or coffee	Dietary supplement: Artemesia annua; Days 1-14: tea or coffee pod TID (1350 mg total daily dose)
Experimental: Arm F: Artesunate; Artesunate	Drug: Artesunate; Days 1-14:

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clinical Deterioration	Number of patients experiencing clinical deterioration. Clinical deterioration is defined as a less than a 2-point change from the initial COVID 7-Point Ordinal Outcomes Scale within 14 days from the study start. This scale ranges from 1-7. Lower scores indicate worse outcomes (death); higher scores indicate fewer symptoms and better outcomes.	14 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Viral Load	The change in (clearance of) viral RNA will be measured by PCR testing at days 1, 14, 28, and 40 days.	40 days
Rate of Organ Failure	Number of patients that experienced severe respiratory or other organ failure.	28 days
Progression to ICU Care or Ventilation	Percentage of patients requiring ICU admission or ventilation.	28 days
Number of Participants Who Had a Change in Clinical Status Measured by Decrease in COVID 7-point Ordinal Scale	Number of participants who died or had greater than a 2-point decrease in COVID 7-Point Ordinal Outcomes Scale from Day to Day 14. COVID 7-point ordinal outcomes scale: Death; Hospitalized on invasive mechanical ventilation or ECMO; Hospitalized on non-invasive ventilation or high flow nasal cannula; Hospitalized on supplemental oxygen; Hospitalized not on supplemental oxygen; Not hospitalized with limitation in activity (continued symptoms); Not hospitalized without limitation in activity (no symptoms)	14 days
Mortality	Percentage of patients who have died by day 14.	14 days
Rate of Severe Adverse Events	Percentage of patients experiencing severe adverse events, defined as grade 3 non-hematologic or greater by DMID Toxicity Scale for Determining Severity of Adverse Events.	14 days
Number of Patients That Required Oxygen Supplementation	Number of patients that required oxygen supplementation during study treatment Days 1-28	28 days
Number of Patients That Required Mechanical Ventilation	Number of patients that required mechanical ventilation during the study period. Days 1-28	28 days
Number of Patients Who Required Vasopressors	Number of patients who required vasopressor treatment Days 1 to 28	28 days
Number of Patients Who Required ICU Services	Number of patients who required ICU services during study treatment Days 1-28.	28 days
Number of Patients That Required Hospitalization	Number of patients that required hospitalization during study treatment	28 days
Heart Function	Proportion of patients with significant changes in ECG findings, including heart rate, ECG intervals (PR, QTcB, QTcF), conduction changes, or abnormalities including severe QTc prolongation of > 500 ms.	28 days

Collaborators and Investigators

• Sponsor: Susanne Arnold
• Investigators: Principal Investigator: Susanne Arnold, MD, University of Kentucky

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2020
• Primary Completion (Actual): December 21, 2020
• Study Completion (Actual): January 12, 2022

Study Registration Dates

• First Submitted: May 1, 2020
• First Submitted That Met QC Criteria: May 1, 2020
• First Posted (Actual): May 5, 2020

Study Record Updates

• Last Update Posted (Actual): January 20, 2022
• Last Update Submitted That Met QC Criteria: January 18, 2022
• Last Verified: January 1, 2022

More Information

Terms related to this study

• Keywords: high-risk
• Additional Relevant MeSH Terms: Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Antiviral Agents; Enzyme Inhibitors; Antineoplastic Agents; Protease Inhibitors; Serine Proteinase Inhibitors; Antiprotozoal Agents; Antiparasitic Agents; Trypsin Inhibitors; Antimalarials; Anthelmintics; Schistosomicides; Antiplatyhelmintic Agents; Artesunate; Ivermectin; Camostat
• Other Study ID Numbers: MCC-20-COVID-01-PMC

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: Yes