Hydroxychloroquine for the Treatment of Mild COVID-19 Disease (COMIHY)

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ClinicalTrials.gov Identifier: NCT04340544

Recruitment Status : Terminated (It appeared to be impossible for the study centres to recruit the targeted number of patients, due to reduced incidence and reduced acceptance to IMP)

First Posted : April 9, 2020

Last Update Posted : November 2, 2020

Sponsor:

Collaborators:

Robert Bosch Medical Center

Universitätsklinikum Hamburg-Eppendorf

Bernhard Nocht Institute for Tropical Medicine

Information provided by (Responsible Party):

University Hospital Tuebingen

Study Description

Brief Summary:

The current outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is a global health emergency with a case fatality rate so far approximately 4% and a growing number of confirmed cases (>57.000) in Germany. There is no data available on the efficacy of antiviral agents for the treatment of COVID-19. In-vitro data show that hydroxychloroquine can inhibit SARS-CoV-2 [1] replication and anecdotal reports from Chinese COVID-19 patients [2, 3] suggest that chloroquine is a good candidate for treatment. No data have been published and reported evidence is based on non-controlled use of hydroxychloroquine.

The aim of this placebo-controlled trial is to assess the effect of hydroxychloroquine on duration of symptoms in mild COVID-19 patients and time of virus shedding as an important tool to reduce the risk of further community transmissions. This data will inform practice for the design of larger trials on clinical efficacy of hydroxychloroquine in the treatment and post- and preexposure prophylaxis of COVID-19 and as a tool for reduction of community transmission.

Condition or disease	Intervention/treatment	Phase
COVID-19	Drug: Hydroxychloroquine Drug: Placebo	Phase 2

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Detailed Description:

The study is a double-blinded randomized placebo controlled multicentric trial. The trial is expected to be conducted from April to January 2021. The duration for each individual subject includes 7 days study treatment and 21±2 days of follow-up after the last study treatment administration time. Adult male and female patients with positive COVID-19 diagnosis and fulfilling the outlined eligibility criteria will be enrolled into the study. Trial population will consist of both genders. Gender distribution in the trial is supposed to reflect the distribution in the real patient's population, there will be no prior defined quantitative ratio between females and males.

All consenting and eligible adult patients with virologically confirmed COVID-19 will be recruited and randomly and double-blindly (patient and investigators) allocated in a 1:1 ratio to either IMP or placebo. Each patient will be given a first dose of 600mg IMP (hydroxychloroquine or placebo) at the day of inclusion at the study site. This amount corresponds to 3 capsules. From the 2nd day on, each patient will take 600mg once a day until day 7 (6 more doses of 600mg) at home and will document it in an online form or, when not possible, in a diary.

IMP will be given to the patients orally. To mask the IMP versus placebo the original tables will be encapsulated in a film coated tablet. After this step IMP and placebo will not be distinguishable. Only the pharmacy and an independent party are aware of group allocation.

Treatment phase:

Day 1:

After randomization and treatment allocation medical history, concomitant as well as previous (up to 2 weeks) medication and baseline characteristics of the patients will be captured and a physical examination will be performed. The patients will receive the full amount of study medication (drug or placebo) from a trained study nurse together with a diary. They will be instructed how and when to fill in the diary concerning drug intake, clinical signs and symptoms and, if applicable, any adverse events and changes in concomitant medication. The first assessment of clinical signs and symptoms and a throat swab including blood sample collection will be done under supervision of a study nurse. The patients will then take the first dose of the allocated treatment and document the intake in the diary. This will also take place under the supervision of a study nurse. Patients will then be discharged to home isolation.

Day 2 to Day 7:

On each of the following 6 days during home isolation the patients will take the study medication and document the intake and the clinical signs and symptoms in their online or paper diary. In case of any adverse events or changes in concomitant medication, the patients will document this in their diary as well. The patients will be asked to contact the investigator in case their clinical condition is getting worse. Home visits will be performed in case of clinically significant symptoms.

Day 8 to Day 13:

On each day, the patients are in home isolation and document the clinical signs and symptoms in their diary. In case of any adverse events or changes in concomitant medication, the patients will document this in their diary as well. The patients will be asked to contact the investigator in case their clinical condition is getting worse. As before, home visits will be performed when indicated.

Day 14±1:

Patients will go to the study site and bring their diary and any unused study medication (if applicable). Physical examination will be performed. The patients will document their clinical signs and symptoms, a throat swab and a blood sample will be taken under the supervision of a study nurse. They will be motivated to continue their diary for the follow-up phase with instruction how to use it.

Day 15 to Day 27:

On each day, the patients will document the clinical signs and symptoms in their diary. In case of any adverse events or changes in concomitant medication, the patients will document this in their diary as well. The patients will be asked to contact the investigator in case their clinical condition is getting worse.

Day 28±2:

Patients will go to the study site and bring their follow-up diary. Physical examination will be performed. The patients will document their clinical signs and symptoms. Blood and throat swab will be taken in a subset of patients under the supervision of a study nurse. Their study participation will then be terminated.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	17 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose:	Treatment
Official Title:	Hydroxychloroquine for the Treatment of Mild COVID-19 Disease
Actual Study Start Date :	April 22, 2020
Actual Primary Completion Date :	October 12, 2020
Actual Study Completion Date :	October 12, 2020

Resource links provided by the National Library of Medicine

Drug Information available for: Hydroxychloroquine Hydroxychloroquine sulfate

U.S. FDA Resources

Arms and Interventions

Arm	Intervention/treatment
Experimental: Hydroxychloroquine Hydroxychloroquine 600mg daily for 7 days	Drug: Hydroxychloroquine Hydroxychloroquine Sulfate is an anti-malarial and anti-rheumatic drug and seems to be a potential candidate for the treatment of COVID-19 since it is able to block virus infection by increasing the endosomal pH, required for virus/cell fusion, it affects the activation of p38 mitogen-activated protein kinase (MAPK), involved in the replication of HCoV-229E and can interfere with the terminal glycosylation of ACE2, thus inhibiting SARS-CoV-2 infection.
Placebo Comparator: Placebo Equivalent number of placebo capsules	Drug: Placebo Placebo capsules

Arm

Intervention/treatment

Experimental: Hydroxychloroquine

Hydroxychloroquine 600mg daily for 7 days

Drug: Hydroxychloroquine

Hydroxychloroquine Sulfate is an anti-malarial and anti-rheumatic drug and seems to be a potential candidate for the treatment of COVID-19 since it is able to block virus infection by increasing the endosomal pH, required for virus/cell fusion, it affects the activation of p38 mitogen-activated protein kinase (MAPK), involved in the replication of HCoV-229E and can interfere with the terminal glycosylation of ACE2, thus inhibiting SARS-CoV-2 infection.

Placebo Comparator: Placebo

Equivalent number of placebo capsules

Drug: Placebo

Placebo capsules

Outcome Measures

Primary Outcome Measures :

Difference in time to resolution of clinical signs and symptoms of mild COVID-19 treated with hydroxychloroquine or placebo as assessed by daily self-assessment [ Time Frame: 28±2 days ]

Secondary Outcome Measures :

Difference between hydroxychloroquine- and placebotreated patients on an ordinal outcome scale until Day 28 (death, admission to intensive care, hospitalization, continuing disease, recovered) [ Time Frame: 28±2 days ]
All-cause mortality within 28 days [ Time Frame: 28±2 days ]

Other Outcome Measures:

Proportion of patients with negative COVID-19 PCR test at day 14 in per protocol population as per throat swab [ Time Frame: 28±2 days ]
Change in COVID-19 virus load from baseline to day 14 [ Time Frame: 28±2 days ]

Eligibility Criteria

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:	18 Years to 99 Years (Adult, Older Adult)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Must be ≥18 years at the time of signing the informed consent
Understand and voluntarily sign an informed consent document prior to any study related assessments/procedures
Able to adhere to the study visit schedule and other protocol requirements
Mild COVID-19 with outpatient management as decided by the treating physician
Early warning score for 2019-nCoV infected patients ≤ 5
Females of childbearing potential (FCBP1) must agree
to utilize two reliable forms of contraception simultaneously or practice complete abstinence from heterosexual contact for at least 28 days before starting study drug, while participating in the study (including dose interruptions), and for at least 28 days after study treatment discontinuation and must agree to regular pregnancy testing during this timeframe
to abstain from breastfeeding during study participation and 28 days after study drug discontinuation
All subjects must agree to refrain from donating blood while on study drug and for 28 days after discontinuation from this study treatment
All subjects must agree not to share medication

Exclusion Criteria:

Requirement for oxygen administration
Shortness of breath in resting position
Creatinin > 2.0 mg/dl
Women during pregnancy and lactation
Participation in other clinical trials or observation period of competing trials
Active or clinically significant cardiac disease including congestive heart failure (New York Heart Association Class III or higher)
History or current evidence of clinically significant cardiac arrhythmia except atrial fibrillation or paroxysmal supraventricular tachycardia
Use of concomitant medications that prolong the QT/QTc interval
Physician decision that involvement in the study is not in the patient´s best interest

Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04340544

Locations

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Germany
Institute for Tropical Medicine
Tübingen, Germany, 72074

Sponsors and Collaborators

University Hospital Tuebingen

Robert Bosch Medical Center

Universitätsklinikum Hamburg-Eppendorf

Bernhard Nocht Institute for Tropical Medicine

More Information

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Responsible Party:	University Hospital Tuebingen
ClinicalTrials.gov Identifier:	NCT04340544
Other Study ID Numbers:	COMIHY
First Posted:	April 9, 2020 Key Record Dates
Last Update Posted:	November 2, 2020
Last Verified:	April 2020

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

Additional relevant MeSH terms:

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Hydroxychloroquine Antimalarials Antiprotozoal Agents Antiparasitic Agents	Anti-Infective Agents Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Antirheumatic Agents

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