- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04558424
RCT,Double Blind, Placebo to Evaluate the Effect of Zinc and Ascorbic Acid Supplementation in COVID-19 Positive Hospitalized Patients in BSMMU
Randomized, Double -Blind, Placebo Controlled, Trial to Evaluate the Effect of Zinc and Ascorbic Acid Supplementation in COVID-19 Positive Hospitalized Patients in BSMMU
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
In view of the emerging COVID-19 pandemic caused by SARS-coV-2 virus, the search for potential protective and therapeutic antiviral strategies is of particular and urgent interest. Despite the lack of clinical data, certain indications suggest that modulation of zinc status may be beneficial in COVID-19. The use of vitamin C could be effective in terms of mortality and outcomes in patients with covid-19 pneumonia. Zinc and vitamin C are the over the counter supplementation and other study shows the effect of this in respiratory tract infection. This type of study is not done in Bangladesh. So, this will give a baseline data for further study which will help the researcher.
C. Related with socio-economic development: Health economic analysis will be done by total duration of hospital stay in comparing with total cost during admission in hospital. Benefits of this analysis will consider the:
- Reduced the severity and symptoms which will decrease the risk of mortality among the patients.
- Duration of hospital stay will reduce the treatment cost and as well the price of this nutrients supplements is very low.
Costs are measured by the recorded number of patients and duration of hospital stay in both study groups. Number and duration will be recorded.
3. Work plan:
Methodology Types of study: Randomized double-blind placebo Controlled Trial Place of study: Department of pharmacology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka.
Study population:
Eligible participants for randomization are COVID-19 positive patients admitted in BSMMU
- Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
- Sexes Eligible for Study: All
- Accepts Healthy Volunteers: No Criteria
Inclusion Criteria:
- ≥ 18 years presenting symptoms who test positive for COVID-19
- Moderate to severe patients obtained consent
- Hypoxic respiratory failure (saturation <90% on air at rest or increasing oxygen requirement)
- Chest examination findings of bilateral crackles on auscultation or chest x-ray showing bilateral infiltrates
- C-Reactive Protein > 50mg/L
- women of childbearing potential who meet the above and have a negative pregnancy test.
Exclusion Criteria:
- Pregnant women: Current known pregnancy positive pregnancy test.
- Lactating women.
- Documented history of mental illnesses
- Multi-organ failure
- Severe ARDS (requiring ventilator support on presentation in the form of invasive or non-invasive ventilation)
- Septic Shock
- Drug allergy/intolerance Sampling technique: Patients who meet the inclusion criteria and who provide consent will be randomized by online graph pad software by using computer.
Sample size:
Sample size calculation P1 (1-P1) + P2 (1-P2) × (Zα+ Zβ)2 N = (P1- P2)2 Where, N= sample size P1 = control group response 50 % P2= treatment group response 20% Zα = Z value at a definite level of significance1.96 at 5% level of significance Zβ = Z value at a definite power 1.28 at 90 % power (when β is 0.10)
0.5 (1-0.5) + 0.2 (1- 0.2) × (1.96+ 1.28)2 N= (0.5-0.2)2
= 48 According to this formula sample size will be 48 in each group. We estimate that the drop-out rate will be 5%, total 50 patients will be in each group
Study variables
1. Demographic variables:
- Age
- Sex
- Ethnicity
- Past medical history - Hypertension, use of ACEI or ARB, DM, IHD, COPD, CKD, Obesity (BMI) and Cancer
- Presenting symptoms (dry cough, productive cough, fever, sore throat, myalgia, lethargy, headache, breathlessness, nausea, diarrhea and any other)
- Baseline observations on day of initiating treatment (Day 0): oxygen saturation (SpO2), fraction of inspired oxygen (FiO2), SpO2/FiO2 ratio, respiratory rate, body temperature, neutrophil-lymphocyte ratio, C-Reactive Protein & findings of bilateral infiltrates on chest-x-ray.
- Follow-up observations after randomization on Day 1,2,3,4 and 5 for SpO2/FiO2 ratio, respiratory rate, body temperature and C-Reactive Protein
- Length of stay (in days)
- Use of ventilator support (invasive or non-invasive ventilation)
- Side effects of drugs
- In-patient mortality
Methods:
Each patient will give informed consent and demographic data (age, sex) will be obtained and documented. All patients will receive standard routine medical care throughout the study. After collecting baseline data patients will be assigned to respective group randomly. A compliance sheet will be maintained for each patient. Regularity of drug intake will be ensured and recorded in the patient's compliance sheets by research assistant. Patients will be asked to report for any adverse effects of the medication given during the period of study. The study will follow the principle of the declaration of Helsinki and of the world medical assembly. The study will be conducted after the approval of the protocol by the institutional review board (IRB). Each patient will be assured that the present therapy would not provide harm, however in case of any untoward effect, assurance would be provided for proper medical treatment and care from the part of the researcher. Each patient had complete right to withdraw from the study at any time during the research.
Recruitment procedure for patients according to symptoms and who consent to participate in the study will be randomly allocated immediately after hospital admission to one of two groups; intervention (I), or placebo group (P).
Pre-designed case record form (CRF) will be used for collecting data, which will also contain the result of the study. The information collected in the CRF will be reviewed and inconsistencies will be investigated and clarified. Data from case record forms will be anonymized and stored securely in a secure online web-based portal. The study outline is presented in Figure 1.
Study procedure:
Randomization - After determining the sample size, patients will randomly be allocated into two groups to the patient's enrollment for the study. Randomization will be done by online graph pad software by using computer. the software automatically generated two distinct sets of numbers after giving necessary inputs (sample size, sets of number). The online graph pad calculator equally distributed the patients into two comparable groups. The randomization will conduct by a competent third group person, a professor of this University who has no relationship with this study.
Blinding - Immediately after randomization, random numbers of the two sets will assigned as patients code number. One set will be designated as intervention group and another group will placebo group. Two sets of code number that belongs to the intervention group and placebo group will be written with patient's id number. this total procedure will be conducted by the person unrelated to this research. Thus, the participants, caregiver, outcome assessor and the analyst, who require being blind for such study will effectively blind.
Allocation cancelation: In order to prevent selection bias, concealment of allocation will be done. Third person allocated two distinct sets of random numbers into intervention group and placebo group. The allocation code written in two different paper document and preserved in two separate pen drive which will sealed within two different envelop. The sealed enveloped will be preserved to another two distinguished professors. So, intervention allocation will not be known to any person involve in the research.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: elora sharmin, MD
- Phone Number: 01914499800
- Email: elora.sharmin@bsmmu.edu.bd
Study Contact Backup
- Name: Prof. Dr. Shohael Mahmud Arafat Prof. Dr. Shohael Mahmud Arafat, FCPS
Study Locations
-
-
-
Dhaka, Bangladesh
- Bangabandhu Sheikh Mujib Medical University
-
Contact:
- elora sharmin, MD
- Phone Number: 01914499800
- Email: elora.sharmin@bsmmu.edu.bd
-
Contact:
- Shohael Mahmud Arafat, FCPS
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- ≥ 18 years presenting symptoms who test positive for COVID-19
- Moderate to severe patients obtained consent
- Hypoxic respiratory failure (saturation <90% on air at rest or increasing oxygen requirement)
- Chest examination findings of bilateral crackles on auscultation or chest x-ray showing bilateral infiltrates
- C-Reactive Protein > 50mg/L
- women of childbearing potential who meet the above and have a negative pregnancy test.
Exclusion Criteria:
- Pregnant women: Current known pregnancy positive pregnancy test.
- Lactating women.
- Documented history of mental illnesses
- Multi-organ failure
- Severe ARDS (requiring ventilator support on presentation in the form of invasive or non-invasive ventilation)
- Septic Shock
- Drug allergy/intolerance
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Intervention group
This group will consist of 50 patients who will be treated with zinc and vitamin C at a dose of 220 mg and 1 gram orally daily for 10 days in addition to their standard treatment
|
This group will consist of 50 patients who will receive 220 mg zinc and 1gm ascorbic acid for 10 days in addition to their standard treatment.
|
Placebo Comparator: Placebo group
This group will consist of 50 patients who will receive placebo at a dose same dose for 10 days in addition to their standard treatment.
|
This group will consist of 50 patients who will receive 220 mg zinc and 1gm ascorbic acid for 10 days in addition to their standard treatment.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
symptoms reduction time frame
Time Frame: 28 days
|
Number of days to reach a 50 percent reduction in the cumulative 0-36 symptom score with each symptom evaluated on a 0-3 scale.
Assessed symptoms are Fever, Cough, Shortness of Breath, Fatigue, Muscle or body aches, Headache, New loss of taste, New loss of smell, Congestion or runny nose, Nausea, Vomiting, Diarrhea.
Each patient will have a composite score ranging from 0-36/day
|
28 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Symptom Resolution: Fever
Time Frame: 28 days
|
The number of days required to reach a score of 0 from the symptom category of fever based on a 0-3 scale: 0 = ≤98.6, 1 = >98.6-
100.6, 2 = > 100.6 - 102.6, 3 = >102.6
|
28 days
|
Symptom Resolution: Cough
Time Frame: 28 days
|
The number of days required to reach a score of 0 from the symptom category of cough based on a 0-3 scale: 0 = no cough, 1 = mild, 2 = moderate, 3 = severe
|
28 days
|
Symptom Resolution: Fatigue
Time Frame: 28 days
|
The number of days required to reach a score of 0 from the symptom category of shortness of breath based on a 0-3 scale: 0 = no shortness of breath, 1 = with moderate intensity exercise 2 = with walking on flat surface 3 = short of breath with getting dressed or daily activities
|
28 days
|
Symptom Resolution: Muscle/body aches
Time Frame: 28 days
|
The number of days required to reach a score of 0 from the symptom category of muscle/body aches based on a 0-3 scale: 1=mild muscle/body aches, 2=moderate muscle/body aches , 3=severe muscle/body aches.
|
28 days
|
Symptom Resolution: Headache
Time Frame: 28 days
|
The number of days required to reach a score of 0 from the symptom category of headache based on a 0-3 scale: 1=mild headache, 2=moderate headache, 3=severe headache.
|
28 days
|
Symptom Resolution: New loss of taste
Time Frame: 28 days
|
The number of days required to reach a score of 0 from the symptom category of new loss of taste based on a 0-3 scale: 1=mild loss of taste, 2=moderate loss of taste, 3=severe loss of taste.
|
28 days
|
Symptom Resolution: New loss of smell
Time Frame: 28 days
|
The number of days required to reach a score of 0 from the symptom category of new loss of smell based on a 0-3 scale: 1=mild loss of smell, 2=moderate loss of smell, 3=severe loss of smell.
|
28 days
|
Symptom Resolution: Congestion/ runny nose
Time Frame: 28 days
|
The number of days required to reach a score of 0 from the symptom category of congestion/runny nose on a 0-3 scale: 1=mild congestion/runny nose , 2=moderate congestion/runny nose , 3=severe congestion/runny nose .
|
28 days
|
Symptom Resolution: Nausea
Time Frame: 28 days
|
The number of days required to reach a score of 0 from the symptom category of nausea on a 0-3 scale: 1=mild nausea, 2=moderate nausea, 3=severe nausea.
|
28 days
|
Symptom Resolution: Vomiting
Time Frame: 28 days
|
The number of days required to reach a score of 0 from the symptom category of vomiting on a 0-3 scale: 1=mild vomiting, 2=moderate vomiting, 3=severe vomiting.
|
28 days
|
Symptom Resolution: Diarrhea
Time Frame: 28 days
|
The number of days required to reach a score of 0 from the symptom category of diarrhea on a 0-3 scale: 1=mild diarrhea, 2=moderate diarrhea, 3=severe diarrhea.
|
28 days
|
Day 5 Symptoms
Time Frame: 28 days
|
Total symptom composite score at day 5 of study supplementation: Symptom categories of fever based on a 0-3 scale: 0 = ≤98.6, 1 = >98.6-
100.6, 2 = > 100.6 - 102.6, 3 = >102; Cough on a 0-3 scale: 0 = no cough, 1 = mild, 2 = moderate, 3 = severe; Shortness of Breath on a 0-3: 0 = no shortness of breath, 1 = with moderate intensity exercise 2 = with walking on flat surface 3 = short of breath with getting dressed or daily activities; and Fatigue on a 0-3 scale: 0 = No fatigue/energetic, 1=mild fatigue, 2=moderate fatigue, 3=severe fatigue.
|
28 days
|
Severity of Symptoms
Time Frame: 28 days
|
Differences in severity of symptoms between study arms
|
28 days
|
Adjunctive Medications
Time Frame: 28 days
|
Differences in number of patients who were prescribed adjunctive medications for their diagnosis between study arms
|
28 days
|
Supplementation Side Effects
Time Frame: 28 days
|
Differences in number of patients in study arms who experienced side effects from the supplements.
|
28 days
|
Collaborators and Investigators
Investigators
- Principal Investigator: sharmin, bangabandhu sheikh mujib medical unuversity
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Coronavirus Infections
- Coronaviridae Infections
- Nidovirales Infections
- RNA Virus Infections
- Virus Diseases
- Infections
- Respiratory Tract Infections
- Respiratory Tract Diseases
- Pneumonia, Viral
- Pneumonia
- Lung Diseases
- COVID-19
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Protective Agents
- Micronutrients
- Vitamins
- Antioxidants
- Ascorbic Acid
Other Study ID Numbers
- BSMMU 2020
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- Statistical Analysis Plan (SAP)
- Informed Consent Form (ICF)
- Clinical Study Report (CSR)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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