ACTIV-6: COVID-19 Study of Repurposed Medications

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ClinicalTrials.gov Identifier: NCT04885530

Recruitment Status : Recruiting

First Posted : May 13, 2021

Last Update Posted : June 30, 2022

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Sponsor:

Collaborators:

National Center for Advancing Translational Science (NCATS)

Vanderbilt University Medical Center

Information provided by (Responsible Party):

Susanna Naggie, MD, Duke University

Tracking Information

First Submitted Date ^ICMJE

April 30, 2021

First Posted Date ^ICMJE

May 13, 2021

Last Update Posted Date

June 30, 2022

Actual Study Start Date ^ICMJE

June 8, 2021

Estimated Primary Completion Date

March 2023 (Final data collection date for primary outcome measure)

Current Primary Outcome Measures ^ICMJE

Number of hospitalizations as measured by patient reports. [ Time Frame: Up to 28 days ]
Number of deaths as measured by patient reports [ Time Frame: Up to 28 days ]
Number of symptoms as measured by patient reports [ Time Frame: Up to 28 days ]

Original Primary Outcome Measures ^ICMJE

Number of hospitalizations as measured by patient reports. [ Time Frame: Up to 14 days ]
Number of deaths as measured by patient reports [ Time Frame: Up to 14 days ]
Number of symptoms as measured by patient reports [ Time Frame: Up to 14 days ]

Change History

Current Secondary Outcome Measures ^ICMJE

Change in COVID Clinical Progression Scale [ Time Frame: Up to 28 days ]
COVID Clinical Progression Scale is a scale of 0 to 8, with 0 being "No clinical or virological evidence of infection" to 8 being "death".
Number of hospitalizations as measured by patient reports [ Time Frame: Up to 28 days ]
Number of deaths as measured by patient reports [ Time Frame: Up to 28 days ]
Number of Symptom Resolutions as measured by patient reports [ Time Frame: Up to 28 days ]
Symptom resolution, defined as first of at least three consecutive days without symptoms
Change in Quality of Life (QOL) as measured by the PROMIS-29 [ Time Frame: Baseline, Day 7, 14, 28, and 90 ]
The PROMIS-29 consists of seven health domains with four 5-level items associated with each and a pain intensity assessment using a 0-10 numeric rank. The seven health domains include physical function, fatigue, pain interference, depressive symptoms, anxiety, ability to participate in social roles and activities, and sleep disturbance.
Composite score of hospitalizations, urgent care visits, and emergency room visits as measured by patient reports [ Time Frame: Up to 28 days ]

Original Secondary Outcome Measures ^ICMJE

Change in COVID Clinical Progression Scale [ Time Frame: Up to 28 days ]
COVID Clinical Progression Scale is a scale of 0 to 8, with 0 being "No clinical or virological evidence of infection" to 8 being "death".
Number of hospitalizations as measured by patient reports [ Time Frame: Up to 28 days ]
Number of deaths as measured by patient reports [ Time Frame: Up to 28 days ]
Number of Symptom Resolutions as measured by patient reports [ Time Frame: Up to 28 days ]
Symptom resolution, defined as first of at least three consecutive days without symptoms
Change in Quality of Life (QOL) as measured by the PROMIS-29 [ Time Frame: Baseline, Day 7, 14, 28, and 29 ]
The PROMIS-29 consists of seven health domains with four 5-level items associated with each and a pain intensity assessment using a 0-10 numeric rank. The seven health domains include physical function, fatigue, pain interference, depressive symptoms, anxiety, ability to participate in social roles and activities, and sleep disturbance.
Composite score of hospitalizations, urgent care visits, and emergency room visits as measured by patient reports [ Time Frame: Up to 28 days ]

Current Other Pre-specified Outcome Measures

Not Provided

Original Other Pre-specified Outcome Measures

Not Provided

Descriptive Information

Brief Title ^ICMJE

ACTIV-6: COVID-19 Study of Repurposed Medications

Official Title ^ICMJE

ACTIV-6: COVID-19 Outpatient Randomized Trial to Evaluate Efficacy of Repurposed Medications

Brief Summary

The purpose of this study is to evaluate the effectiveness of repurposed medications (study drug(s) in reducing symptoms of non-hospitalized participants with mild to moderate COVID-19. Participants will receive either study drug or placebo. They will self-report any new or worsening symptoms or medical events they may experience while taking study drug or placebo. This study is intended to be all remote with no in person visits, unless the study team feels it is in the best interest of a participant to see them in person.

Detailed Description

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel betacoronavirus that first emerged in December 2019 and has since caused a global pandemic unseen in almost a century with respect to the number of cases and overall mortality. The clinical disease related to SARS-CoV-2 is referred to as Coronavirus Disease 2019 (COVID-19). Over 2020, advances were made for treatment of COVID-19 and several vaccinations have received emergency use authorization for prevention of SARS-CoV-2 infections. However, the pandemic continues to evolve with new variants and surges of infections in different regions of the world, requiring an ongoing evidence-generating platform, in particular for the treatment of COVID-19 infection in the outpatient setting.

This proposed platform protocol can serve as an evidence generating system for prioritized drugs repurposed from other indications with an established safety record and preliminary evidence of clinical efficacy for the treatment of COVID-19. The ultimate goal is to evaluate if repurposed medications can make participants feel better faster and reduce death and hospitalization.

This platform protocol is designed to be flexible so that it is suitable for a wide range of settings within healthcare systems and in community settings where it can be integrated into routine COVID-19 testing programs and subsequent treatment plans. This platform protocol will enroll participants in an outpatient setting with a confirmed polymerase chain reaction (PCR) or antigen test for SARS-CoV-2.

Participants will be randomized to study drugs or placebo based on the arms that are actively enrolling at the time of randomization. Study drugs may be added or removed according to adaptive design and/or emerging evidence. When there are multiple study drugs available, randomization will occur based on appropriateness of each drug for the participant as determined by the study protocol and investigator and participant equipoise. Each participant will be required to randomize to at least one study drug versus placebo. The probability of placebo to treatment will remain the same regardless of eligibility decisions.

Eligible participants will be randomized (1:1), in a blinded fashion, to either the study drug arm or placebo arm in addition to standard of care. As additional study drugs are added, the randomization will be altered to leverage placebo data across arms. Participants will receive a complete supply study drug or placebo with the quantity depending on the study drug/placebo to which they are randomized.

All study visits are designed to be remote. However, screening and enrollment may occur in-person at sites and unplanned study visits may occur in-person or remotely, as deemed appropriate by the site investigator for safety purposes. Participants will be asked to complete questionnaires and report safety events during the study. Participants will be prompted by the online system to report safety events and these will be reviewed and confirmed via medical records and site staff, as necessary.

Study Type ^ICMJE

Interventional

Study Phase ^ICMJE

Phase 3

Study Design ^ICMJE

Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description:

Double-Blind, Placebo-Controlled, Randomized Trial

Masking: Double (Participant, Care Provider)
Masking Description:

The participant and study teams will know which study drug the participant is allocated to, but will be blinded to study drug versus placebo because they will be matching.

Primary Purpose: Treatment

Condition ^ICMJE

Covid19

Intervention ^ICMJE

Drug: Ivermectin
Each participant will receive a sufficient quantity of 7-mg tablets to be taken as directed based on their weight. The tablets are white, round, biconvex tablets with "123" over the scoring on one side. All packaging will be labeled to indicate that the product is for investigational use.

Other Name: Ivermectin Tablets
Drug: Fluvoxamine
Fluvoxamine is a round golden 50 mg tablet that is scored on both sides - one side has "APO" and the other side has "F50" with a partial bisect. All packaging will be labeled to indicate that the product is for investigational use, administered at a dose of 50 mg, twice daily for 10 days.

Other Name: Fluvoxamine Maleate Tablets
Drug: Fluticasone
Fluticasone furoate is an inhaled powder drug product composed of fluticasone furoate. It is a synthetic trifluorinated corticosteroid that is insoluble in water. Fluticasone furoate is a white powder and will be provided in a two tone grey inhaler with a mouthpiece cover and separate foil blister strips. The inhaler will be packaged in a moisture-protective foil tray with a desiccant and a peelable lid.All packaging will be labeled to indicate that the product is for investigational use. Participants will self-administer 200 µg (1 blister) of fluticasone furoate once daily for 14 days.

Other Name: Fluticasone Furoate
Other: Placebo
Each study arm will contain a placebo comparator. Placebo will look similar to study drug and will be administered via the same route of administration and dose. However, placebo will be an inactive substance, containing no study drug.

Study Arms ^ICMJE

Experimental: Arm A - Ivermectin 400
Ivermectin - 7-mg tablets

Participant will be instructed to take a pre-specified number of tablets for 3 consecutive days based on their weight for a daily dose of approximately 300-400 µg/kg.

Intervention: Drug: Ivermectin
Placebo Comparator: Arm A - Placebo
Placebo -7mg tablets

Participant will be instructed to take a pre-specified number of tablets for 3 consecutive days based on their weight for a daily dose of approximately 300-400 µg/kg.

Intervention: Other: Placebo
Experimental: Arm B - Fluvoxamine
Fluvoxamine will be self-administered orally by each participant at a dose of 50 mg twice a day for 10 days.

Intervention: Drug: Fluvoxamine
Placebo Comparator: Arm B- Placebo
Placebo will be self-administered orally by each participant at a dose of 50 mg twice a day for 10 days.

Intervention: Other: Placebo
Experimental: Arm C - Fluticasone
Fluticasone is a self-administered inhaled drug. Participants will self-administer 200 µg (1 blister) of fluticasone once daily for 14 days. After inhaler activation, the powder within the blister is exposed and the participant inhales the study drug through the mouthpiece.

Intervention: Drug: Fluticasone
Placebo Comparator: Arm C - Placebo
Placebo is a self-administered inhaled drug. Participants will self-administer 200 µg (1 blister) of placebo once daily for 14 days. After inhaler activation, the powder within the blister is exposed and the participant inhales the placebo through the mouthpiece.

Intervention: Other: Placebo
Experimental: Arm D - Ivermectin 600
Ivermectin - 7-mg tablets

Participant will be instructed to take a pre-specified number of tablets for 6 consecutive days based on their weight for a daily dose of approximately 400-600 µg/kg.

Intervention: Drug: Ivermectin
Placebo Comparator: Arm D - Placebo
Placebo -7mg tablets

Participant will be instructed to take a pre-specified number of tablets for 6 consecutive days based on their weight for a daily dose of approximately 400-600 µg/kg.

Intervention: Other: Placebo

Publications *

Dodds MG, Doyle EB, Reiersen AM, Brown F, Rayner CR. Fluvoxamine for the treatment of COVID-19. Lancet Glob Health. 2022 Mar;10(3):e332. doi: 10.1016/S2214-109X(22)00006-7.

* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.

Recruitment Information

Recruitment Status ^ICMJE

Recruiting

Estimated Enrollment ^ICMJE

15000

Original Estimated Enrollment ^ICMJE

Same as current

Estimated Study Completion Date ^ICMJE

March 2023

Estimated Primary Completion Date

March 2023 (Final data collection date for primary outcome measure)

Eligibility Criteria ^ICMJE

Inclusion Criteria:

Completed Informed Consent
Age ≥ 30 years old
Confirmed SARS-CoV-2 infection by any authorized or approved polymerase chain reaction (PCR) or antigen test collected within 10 days of screening
Two or more current symptoms of acute infection for ≤7 days. Symptoms include the following: fatigue, dyspnea, fever, cough, nausea, vomiting, diarrhea, body aches, chills, headache, sore throat, nasal symptoms, new loss of sense of taste or smell

Exclusion Criteria:

Prior diagnosis of COVID-19 infection (> 10 days from screening)
Current or recent (within 10 days of screening) hospitalization
Known allergy/sensitivity or any hypersensitivity to components of the study drug or placebo
Known contraindication(s) to study drug including prohibited concomitant medications

Sex/Gender ^ICMJE

Sexes Eligible for Study:

All

Ages ^ICMJE

30 Years and older (Adult, Older Adult)

Accepts Healthy Volunteers ^ICMJE

Contacts ^ICMJE

Contact: Sybil Wilson	1-833-385-1880	sybil.wilson@duke.edu
Contact: Allison DeLong	919-668-6855	allison.delong@duke.edu

Listed Location Countries ^ICMJE

United States

Removed Location Countries

Administrative Information

NCT Number ^ICMJE

NCT04885530

Other Study ID Numbers ^ICMJE

Pro00107921
3U24TR001608-05W1 ( U.S. NIH Grant/Contract )

Has Data Monitoring Committee

Yes

U.S. FDA-regulated Product

Studies a U.S. FDA-regulated Drug Product:	Yes
Studies a U.S. FDA-regulated Device Product:	No

IPD Sharing Statement ^ICMJE

Plan to Share IPD:	Yes
Plan Description:	We will share this data after it has been de-identified. We will share data beginning around 6 months after publication and for up to 36 months afterward. Access will only be shared with those who have obtained prior IRB approval to be able to access this data.
Supporting Materials:	Statistical Analysis Plan (SAP)
Supporting Materials:	Clinical Study Report (CSR)
Time Frame:	Up to 36 months after publication
Access Criteria:	Interested investigators will need to seek prior IRB approval before access to any data is granted.