The Potential of Camostat in COVID-19 (COV-AAT)

The Potential of Oral Camostat in Early COVID-19 Disease in an Ambulatory Setting to Reduce Viral Load and Disease Burden

The investigators are conducting a pilot trial where they will study safety, efficacy and compliance in a cohort of ambulatory patients in the Ghent region with confirmed COVID-19 infection, in both an early stage of disease, defined as less than 5 days of symptoms and who at presentation do not meet any criteria for hospitalisation as well as asymptomatic individuals with a PCR CT value below 30.

The primary endpoint is to assess the efficacy of the drug in terms of change from day 0 to day 5 in respiratory (oropharyngeal swab RT-PCR) log10 viral load.

The aim of the study is to assess whether Camostat, a serine protease inhibitor available in an oral formulation has the potential to be studied as an antiviral drug in a large scale ambulatory setting to prevent transmission by decreasing viral load, to prevent symptoms after exposure (PEP) in asymptomatic individuals or to prevent disease progression in the occurrence of early symptomatology.

Study Overview

• Status: Terminated
• Conditions: Covid19
• Intervention / Treatment: Drug: Camostat; Drug: Camostat; Drug: Placebo; Drug: Placebo

Detailed Description

Core study After eligibility assessment participants will be randomized and will receive the study drugs. We will define D1 as the first dose of the medication which can be the morning, midday or evening dose. They will be treated for 5 consecutive days.

In patients with a positive PCR at D5 (CT value with threshold below 30) and/or presence of clinical symptoms after exclusion of hospitalization criteria (flowchart emergency department appendix 4), the treatment will be extended up to D10 at the same dosage in both treatment arms for 5 consecutive days: D6 and D10).

Follow-up will be as follows:

• D1->D14 (D28): The study participants will be asked to fill in daily questionnaires assessing symptoms (cfr daily self-score). They will receive a kit enabling to monitor heart rate (HR), respiratory rate (RR), temperature and oxygen saturation 3 times per day (every 4-8 hours, preferentially at the timing of medication intake at D1 to D5 or D10).
• Compliance and tolerance will be assessed during the treatment period, D0->D5 (or D0->D10 if the treatment is prolonged).
• During the study D1-D28: If indicated in the opinion of the investigator, a physical exam and biochemistry will be performed through a consultation at the clinic. This can be requested at any time during the study based on clinical symptoms or signs.
• Consultation at D0, D5, (D10) and D28 at our COVID consultation facility. This will be done by a study nurse and/or a study physician.

• Study Type: Interventional
• Enrollment (Actual): 108
• Phase: Phase 2

Contacts and Locations

Study Locations

• Belgium
  • Gent, Belgium, 9000
    • Ghent University Hospital, Algemene Inwendige Ziekten

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 100 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria

• Aged ≥18
• Willing to participate and fill out a daily symptom diary
• Willing to take the parameters such as blood oxygenation and temperature
• Willing to attend follow-up visits both by phone as at the clinic
• Capable of understanding the commitment in the trial
• Signed informed consent
• Signs and symptoms suggestive of COVID disease in absence of hospitalization criteria as defined by the flowchart used at the emergency department of our institution (appendix 4), present for maximum 5 days and confirmed by PCR.
• OR documented COVID-19 infection by PCR with CT value below the threshold of 30 in asymptomatic individuals.
• For women of childbearing potential*: they should be willing to use highly effective method of contraception during treatment and until the end of study defined as having a failure rate of less than 1% per year when used consistently and correctly.

Such methods include:

• combined (estrogen and progestogen containing) hormonal contraception
• associated with inhibition of ovulation: oral, intravaginal or transdermal
• progestogen-only hormonal contraception associated with inhibition of ovulation: oral, injectable or implantable
• intrauterine device (IUD) and intrauterine hormone-releasing system ( IUS)
• bilateral tubal occlusion
• vasectomised partner

• sexual abstinence

  • For men of reproductive potential**: condom should be used as contraception during treatment and until the end of study when having a partner of childbearing potential

    • a woman is considered of childbearing potential (WOCBP), i.e. fertile, following menarche and until becoming post-menopausal unless permanently sterile. Permanent sterilisation methods include hysterectomy, bilateral salpingectomy and bilateral oophorectomy. A postmenopausal state is defined as no menses for 12 months without an alternative medical cause. A high follicle stimulating hormone (FSH) level in the postmenopausal range may be used to confirm a post-menopausal state in women not using hormonal contraception or hormonal replacement therapy. However in the absence of 12 months of amenorrhea, a single FSH measurement is insufficient.

      • a man is considered fertile after puberty unless permanently sterile by bilateral orchidectomy.

Exclusion Criteria

• Inability to make a decision to participate
• Pregnant or breast feeding
• Inability to take oral medication
• Inability to provide informed written consent
• Known hypersensitivity towards Camostat or other Serine protease inhibitors
• Any condition that, in the Investigator's opinion, prevents adequate compliance with study therapy.
• Any COVID infection at risk for hospitalisation as described in the emergency department flowchart (cfr appendix 4)
• With regard to exclusion of women of child-bearing potential, women who tell us they know they are pregnant are excluded. All women of child-bearing potential who test positive for pregnancy by urine test at first visit are excluded.
• Severe chronic pancreatitis requiring suction of gastric juice, fasting or abstention from drinking
• Postoperative reflux oesophagitis due to reflux or gastric juice
• Postoperative reflux oesophagitis (if improvement of symptoms is not observed).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Camostat; camostat 100mg 3 tablets 3x/day D1->D5 (+ possible extension D6->D10)	Drug: Camostat; Standard of care (SOC) + Camostat mesilate (Foipan) 100mg 3 tablets 3 times a day for 5 consecutive days (D1->D5); Drug: Camostat; Standard of care (SOC) + Camostat mesilate (Foipan) 100mg 3 tablets 3 times a day for 5 consecutive days (D6->D10);
Placebo Comparator: Placebo; Placebo 3 tablets 3x/day D1->D5 (+ possible extension D6->D10)	Drug: Placebo; SOC + placebo 500 mg 3 tablets 3 times a day for five consecutive days (D1->D5).; Drug: Placebo; SOC + placebo 500 mg 3 tablets 3 times a day for five consecutive days (D6->D10).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Efficacy in Terms of Viral Load or Surrogate After 5 Days of Treatment	The primary endpoint is to assess the efficacy of the drug in terms of change from day 0 to day 5 in respiratory (oropharyngeal swab RT-PCR) surrogate market CT value. Higher values equate to better outcomes.	5 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Patients With Clinical Improvement (in at Least 1 Point on the 5-point Likert Scale) of 5 Most Self-reported Symptoms	Symptoms were daily measured by means of a self-report questionnaire. The top 5 self-reported symptoms during the whole study period were determined. Time to clinical improvement of these 5 most self-reported symptoms were compared between the camostat and placebo group. Additionally, potential risk factors are studied in order to influence clinical improvement.	28 days
Neutralizing Antibodies (NAbs) at Visit 28	The 50% neutralizing antibody titer (NT50) was compared between the camostat and placebo group	28 days

Collaborators and Investigators

• Sponsor: University Hospital, Ghent
• Investigators: Principal Investigator: Steven Callens, UZ Gent

Publications and helpful links

General Publications

• Tobback E, Degroote S, Buysse S, Delesie L, Van Dooren L, Vanherrewege S, Barbezange C, Hutse V, Romano M, Thomas I, Padalko E, Callens S, De Scheerder MA. Efficacy and safety of camostat mesylate in early COVID-19 disease in an ambulatory setting: a randomized placebo-controlled phase II trial. Int J Infect Dis. 2022 Sep;122:628-635. doi: 10.1016/j.ijid.2022.06.054. Epub 2022 Jul 5.

Study record dates

Study Major Dates

• Study Start (Actual): November 4, 2020
• Primary Completion (Actual): July 12, 2022
• Study Completion (Actual): July 12, 2022

Study Registration Dates

• First Submitted: November 5, 2020
• First Submitted That Met QC Criteria: November 10, 2020
• First Posted (Actual): November 12, 2020

Study Record Updates

• Last Update Posted (Actual): August 9, 2024
• Last Update Submitted That Met QC Criteria: August 1, 2024
• Last Verified: August 1, 2024

More Information

Terms related to this study

• Keywords: antiviral
• 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; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Protease Inhibitors; Serine Proteinase Inhibitors; Anticoagulants; Trypsin Inhibitors; Camostat; Gabexate
• Other Study ID Numbers: BC-7707

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: No
• Studies a U.S. FDA-regulated device product: No