Trial of Hydroxychloroquine In Covid-19 Kinetics

Overview

To test if the medication Hydroxychloroquine will decrease the amount of virus(as measured by PCR) , 7 days after initiation of therapy compared to control patients receiving placebo.

The study design is a randomized (5 days of medication v. 5 days of placebo) clinical trial initiated immediately after diagnosis in ambulatory health care workers at University of South Alabama Health, or in ambulatory USA patients. At 7 days after enrollment another nasopharyngeal swab will be taken to measure if the virus is still present. At 10 weeks we will measure immunity from Covid-19 using a single blood sample. It is a phase 2/3 clinical trial.

Full Title of Study: “A Randomized Phase 2/3 Trial of Hydroxychloroquine In Covid-19 Kinetics”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
  • Study Primary Completion Date: July 1, 2020

Detailed Description

Hydroxychloroquine (HCQ), which is a less toxic derivative of chloroquine (CQ), has been shown to be effective in inhibiting Covid-19 infection in vitro. The evidence from clinical research trials is sparse and has many flaws. Much of the Chinese experience with Chloroquine comes from a letter to the editor and a news briefing/conference held on February 15, 2020. The letter describes experience with more than 100 patients treated with CQ in multicenter clinical trials but the letter provides no quantitative data to back their claims. At least one non-randomized clinical trial has been performed in Europe. Covid-19 infected patients received 10 days of HCQ daily and underwent daily testing of viral loads from nasopharyngeal swabs. The subjects receiving HCQ were much more likely (P<0.02) to clear their viral load than subjects who did not receive HCQ. The study had many flaws, which make the conclusions less valuable than rigorously designed randomized clinical trial. This study is designed as a randomized, blinded trial to either confirm or refute the efficacy of HCQ in early treatment of Covid19 infection to ameliorate disease severity, and reduce viral load.

Interventions

  • Drug: Hydroxychloroquine
    • Hydroxychloroquine 800 mg initial dose then 6-8 hours later HCQ 600 mg, then 200 mg three times per day for 4 days.
  • Other: Placebo
    • Placebo take 4 tabs, then 6-8 hours later take 3 tabs, then take 1 tab three times per day for 4 days.

Arms, Groups and Cohorts

  • Experimental: Treatment
    • Subjects in this arm will receive the study drug
  • Placebo Comparator: Control
    • Subjects in this arm will take placebo for 6 days

Clinical Trial Outcome Measures

Primary Measures

  • Percentage of virus free subjects
    • Time Frame: 7 days after initiation of trial
    • Nasopharyngeal swab PCR measurement of viral load expressed as the % of negative PCR swabs
  • Disease severity
    • Time Frame: 6 days
    • Participants will self-report disease severity status as one of the following 5 options; no COVID19 illness (score of 1), COVID19 illness with no hospitalization (score of 2), or COVID19 illness with hospitalization (score of 3), or Covid 19 with care requiring hospitalization (score of 4), or Covid 19 with death (Score of 5) .

Secondary Measures

  • Incidence of hospitalization
    • Time Frame: 14 days
    • Number of subjects in each arm who are hospitalized for Covid 19 infection
  • Incidence of Death
    • Time Frame: 70 Days (10 weeks)
    • Number of subjects in each arm who die secondary to Covid-19 infection
  • Incidence of confirmed SARS-CoV-2 Detection
    • Time Frame: 14 days
    • Number of subjects in each arm who have confirmed Covid-19 infection
  • Incidence of all-cause study medication discontinuation or withdrawal
    • Time Frame: 14 days
    • Number of subjects in each arm who discontinue or withdraw medication use for any reason
  • Immunity to Covid-19
    • Time Frame: 70 days (10 weeks)
    • Blood tests to determine level of immunity in each subject

Participating in This Clinical Trial

Inclusion Criteria

  • Symptoms occurring within 3 days prior to patient presenting to USA Facility for PCR nasopharyngeal swab
  • Nasopharyngeal swab positive for Covid-19 infection and/or exposure and/or symptoms congruent with fever and cough
  • Male or Female age 19 to 89 years
  • Able to take oral medications
  • Patients not requiring hospitalization
  • Provision of informed consent

Exclusion Criteria

  • Known history of EKG QTc prolongation abnormality
  • Contraindication or allergy to hydroxychloroquine
  • Retinal eye disease
  • Known glucose-6 phosphate dehydrogenase (G-6-PD) deficiency
  • Known chronic kidney disease, stage 4 or 5 or receiving dialysis
  • Weight < 40 kg
  • Current use of: hydroxychloroquine or cardiac medicines of: flecainide, Tambocor; amiodarone, Cordarone, Pacerone; digoxin or Digox, Digitek, Lanoxin; procainamide or Procan, Procanbid, propafenone, Rythmal)
  • Known hepatic disease (cirrhosis, hepatitis)
  • Active treatment for cancer (chemotherapy, radiation, surgery within 3 months
  • On immunosuppressive drugs steroids, antirejection medications.
  • Recipient of solid organ transplant
  • Pregnancy/breastfeeding
  • Past medical history Porphyria (may exacerbate disease)
  • PMH Psoariasis (can worsen disease)
  • No access to internet or email
  • Current suicidal thoughts according to Columbia scale
  • In the screening process before signing consent, subjects will be asked if they are suicidal. If this response is yes, patients will be excluded from trial and directed to the National Suicide Prevention Lifeline: 1-800-273-8255.

Gender Eligibility: All

Minimum Age: 19 Years

Maximum Age: 85 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University of South Alabama
  • Provider of Information About this Clinical Study
    • Principal Investigator: William Richards, Professor and Chair Surgery – University of South Alabama
  • Overall Official(s)
    • William O Richards, MD, Principal Investigator, University of South Alabama College of Medicine

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