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Hydroxychloroquine and Lopinavir/ Ritonavir to Improve the Health of People With COVID-19: "The Hope Coalition - 1"

Primary Purpose

COVID-19, Coronavirus Infection, Virus Disease

Status
Unknown status
Phase
Phase 3
Locations
Brazil
Study Type
Interventional
Intervention
Hydroxychloroquine Sulfate Tablets
Lopinavir/ Ritonavir Oral Tablet
Hydroxychloroquine Sulfate Tablets plus Lopinavir/ Ritonavir Oral Tablets
Placebo
Sponsored by
Cardresearch
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for COVID-19

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Patients with RT-PCR diagnosis of COVID-19 or a clinical condition compatible with COVID-19 and respiratory symptoms, presenting:

A. Persistent dry cough associated with axillary temperature > 37.7 Celsius;

OR

B. Recent onset of Flu-like Respiratory Symptoms associated with dry cough

OR

C. Tomographic image compatible with COVID 19 infection;

2. Men and women aged > 50 years OR: Patients over 18 years of age with at least one of the following criteria

  • Diabetes requiring oral medication or insulin.
  • Arterial hypertension requiring at least 01 oral medication for treatment
  • Known cardiovascular diseases (CHF of any etiology, documented Coronary Artery Disease, Clinically overt heart disease)
  • Symptomatic chronic lung disease and/ or medically controlled
  • Patients with a history of transplantation
  • Patient with stage IV chronic kidney disease or on dialysis.
  • Patients on current Immunosuppression and/or using corticosteroid therapy (equivalent to at least 10 mg of oral prednisone per day)
  • Willingness to comply with study related procedures

    3. Ability to provide informed consent before any protocol-related procedures.

Exclusion Criteria:

  1. RT-PCR exam for COVID-19 negative during the screening visit.
  2. Patients with an acute respiratory condition compatible with COVID-19 being hospitalized;
  3. Patients with an acute respiratory condition and with moderate to high probability of not being a COVID infection 19;
  4. Dyspnea secondary to other acute and chronic respiratory causes or infections (eg, decompensated Chronic Obstructive Pulmonary Disease, acute bronchitis, pneumonia, primary pulmonary arterial hypertension);
  5. Severe respiratory clinical condition, presenting at least ONE of the criteria below:

    1. Respiratory Rate> 28 / min;
    2. Arterial Oxygen Saturation < 92% with nasal oxygen therapy at 10 l/ min;
    3. PaO2 / FIO2 <300 mmHg

4. History of Cardiac Arrhythmia or Long QT Syndrome; 5. Use of Medications that are known to prolong QTc: Citalopram, Venlafaxine, Bupropion and with no possibility of suspension during the period of investigational medical product administration. 6. Inability to take oral medications; 7. Patients on continuous use of Amiodarone and / or PGE5 Inhibitors (Ex .: Sildenafil and similar). 8. Use of Digoxin, Cyclosporine, Cimetidine, Tamoxifen. 9. Use of anticonvulsants, antifungals, immunosuppressants other than corticotherapy. 10. Use of Hydroxychloroquine for other indications 11. Use of chemoprophylaxis for malaria. 12. Psoriasis in a form other than cutaneous 13. Porphyria 14. Use of protease inhibitors, ritonavir or Cobicistat 15. Clinical history of Liver Cirrhosis or Child-Pugh C classification; 16. Patients with a history of degenerative retinal diseases (patients with retinal diseases due to diabetes and hypertension can participate in the research); 17. Patient with a clinically relevant history of hearing loss; 18. Patients with known severe degenerative neurological diseases and / or severe mental illness; 19. Inability of the patient or representative to give consent or adhere to the procedures proposed in the protocol; 20. Known hypersensitivity and / or intolerance to Hydroxychloroquine. 21. Hypersensitivity and / or intolerance Lopinavir / Ritonavir

-

Sites / Locations

  • CARDRESEARCH - Cardiologia Assistencial e de PesquisaRecruiting
  • Pontificia Universidade Catolica de Minas Gerais
  • Fundo Municipal de Saúde de BetimRecruiting
  • Universidade Federal de Ouro Preto

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Active Comparator

Active Comparator

Active Comparator

Placebo Comparator

Arm Label

Hydroxychloroquine Sulfate

Lopinavir/ Ritonavir

Hydroxychloroquine plus Lopinavir/ Ritonavir

Placebo

Arm Description

Hydroxychloroquine 400 mg. Loading oral dose of 800 mg followed by orally dose of 400 mg/ day for the following 10 days

Lopinavir Ritonavir 200/ 50 mg Loading oral dose of 800/ 200 mg twice a day on day 1 followed by 400/100 mg orally twice a day for the following 9 days

Hydroxychloroquine 400 mg. Loading oral dose of 800 mg followed by orally dose of 400 mg/ day for the following 10 days Plus Lopinavir Ritonavir 200/ 50 mg Loading oral dose of 800/ 200 mg twice a day on day 1 followed by 400/100 mg orally twice a day for the following 9 days

Placebo Twice a day from day 1 through day 10.

Outcomes

Primary Outcome Measures

Proportion of participants who were hospitalized for progression of COVID-19 disease
Hospitalization is defined as at least 24 hours of acute care in a hospital or similar acute care facility (emergency settings, temporary emergency facilities created for acute care of COVID-19 pandemic)
Proportion of participants who died due to COVID-19 progression and/ or complications

Secondary Outcome Measures

Proportion of participants with viral load change on 03, 07, 10 and 14 after randomization
Viral load change on 03, 07, 10 and 14 after randomization (200 patients per arm)
Time to clinical improvement
Proportion of participants with clinical improvement, defined as normalization of temperature, Respiratory rate, SaO2, and cough relief (> 50% compared to baseline measured on a visual analog scale) in the last 72 hours.
Time to clinical failure
Proportion of participants with clinical improvement, defined as as time to need for hospitalization due to dyspnea, death, need for mechanical ventilation, shock and need for vasoactive amines;
Hospitalization for any cause
Proportion of participants with hospitalization for any cause
Proportion of participants who died due to pulmonary complications
Proportion of participants who died due to cardiovascular complications
Proportion of participants who presented with adverse events
Evaluation of adverse events evaluated as associated to any of study arms
Time to improvement on respiratory scale symptoms
Proportion of participants who presented sustained improvement on respiratory scale defined as at least 48 hours of improvement.
proportion of non-adherent participants to any of study drugs

Full Information

First Posted
May 23, 2020
Last Updated
January 25, 2021
Sponsor
Cardresearch
Collaborators
Cardresearch - Cardiologia Assistencial e de Pesquisa LTDA, Cytel Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT04403100
Brief Title
Hydroxychloroquine and Lopinavir/ Ritonavir to Improve the Health of People With COVID-19: "The Hope Coalition - 1"
Official Title
Hydroxychloroquine and Lopinavir/ Ritonavir for Hospitalization and Mortality Reduction in Patients With COVID-19 and Mild Disease Symptoms: "The Hope Coalition"
Study Type
Interventional

2. Study Status

Record Verification Date
January 2021
Overall Recruitment Status
Unknown status
Study Start Date
June 3, 2020 (Actual)
Primary Completion Date
February 1, 2021 (Anticipated)
Study Completion Date
February 1, 2021 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Cardresearch
Collaborators
Cardresearch - Cardiologia Assistencial e de Pesquisa LTDA, Cytel Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The COVID-19 pandemic has been characterized by high morbidity and mortality, especially in certain subgroups of patients. To date, no treatment has been shown to be effective in controlling this disease in hospitalized patients with moderate and / or severe cases of this disease. Hydroxychloroquine and lopinavir / ritonavir have been shown to inhibit SARS-CoV viral replication in experimental severe acute respiratory symptoms models and have similar activity against SARS-CoV2. Although widely used in studies of critically ill patients, to date, no study has demonstrated its role on the treatment of high-risk, newly diagnosed patients with COVID-19 and mild symptoms.
Detailed Description
In December 2019 a series of viral pneumonia cases were reported in the city of Wuhan, China. A new subtype of coronavirus has been identified as the causative agent of this condition. On February 11, 43,103 cases had already been described and on this day the World Health Organization (WHO) named this disease as COVID-19. With. The disease had spread out to several countries on different continents and on March 11, WHO declared a state of worldwide pandemic. Today (April 25, 2020) there are 2,719,897 cases and 187,705 deaths documented, with a global case-fatality ratio of 6.9%. To date, no treatment has been identified as effective in combating this disease which has been identified as with high mortality, therefore there are no specific therapeutic options. So far, efforts have been focused on the treatment of patients hospitalized with dyspnea and, although several promising drugs are being evaluated, none has demonstrated effectiveness in reducing morbidity and mortality at this stage of the disease, suggesting that perhaps the best time to use medications either before the onset of severe symptoms of respiratory distress. Thus, we propose the use of two drugs which experimentally have shown activity against SARS-CoV2 and being used in severely ill patients with COVID-19. Our hypothesis is that perhaps using such drugs before onset of complications will allow better outcomes on this patient population.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
COVID-19, Coronavirus Infection, Virus Disease, Acute Respiratory Infection, SARS-CoV Infection

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Factorial Assignment
Model Description
Patients will be randomly allocated to one of four treatment arms in a 1:1:1:1 ratio: Lopinavir / Ritonavir Hydroxychloroquine Lopinavir / Ritonavir + Hydroxychloroquine Placebo. We will use a centralized random allocation schedule, generated by computer and implemented using an online remote access system. Randomization will be stratified by participating basic health unit.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
The investigational medical product will be packaged in similar bottles by a third party who will keep the allocation confidential until the end of the study. The bottles will be sealed and identified as "Research Product A, B and C" and with different colored labels. They will be randomly allocated among the participants. The research subjects, medical assistance, administrative and health staff will not have access to the contents of the bottles. The Arm Lopinavir/ ritonavir plus hydroxychloroquine will receive two of such bottles. At the end of the study, after the statistical analysis and DMSB meeting, it will then be requested from third party documentation on content of each bottle and then have arms identified.
Allocation
Randomized
Enrollment
1968 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Hydroxychloroquine Sulfate
Arm Type
Active Comparator
Arm Description
Hydroxychloroquine 400 mg. Loading oral dose of 800 mg followed by orally dose of 400 mg/ day for the following 10 days
Arm Title
Lopinavir/ Ritonavir
Arm Type
Active Comparator
Arm Description
Lopinavir Ritonavir 200/ 50 mg Loading oral dose of 800/ 200 mg twice a day on day 1 followed by 400/100 mg orally twice a day for the following 9 days
Arm Title
Hydroxychloroquine plus Lopinavir/ Ritonavir
Arm Type
Active Comparator
Arm Description
Hydroxychloroquine 400 mg. Loading oral dose of 800 mg followed by orally dose of 400 mg/ day for the following 10 days Plus Lopinavir Ritonavir 200/ 50 mg Loading oral dose of 800/ 200 mg twice a day on day 1 followed by 400/100 mg orally twice a day for the following 9 days
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo Twice a day from day 1 through day 10.
Intervention Type
Drug
Intervention Name(s)
Hydroxychloroquine Sulfate Tablets
Intervention Description
Tablets of 400 mg: Loading dose of 02 tablets followed by one tablet of 400 mg orally on the following 09 days
Intervention Type
Drug
Intervention Name(s)
Lopinavir/ Ritonavir Oral Tablet
Intervention Description
tablets of 200/ 50 mg; Loading dose of 04 tablets twice a day on day 1 followed by two tablets twice a day on the following 09 days
Intervention Type
Drug
Intervention Name(s)
Hydroxychloroquine Sulfate Tablets plus Lopinavir/ Ritonavir Oral Tablets
Intervention Description
Hydroxychloroquine Oral Tablet 400 mg: Loading dose of 02 tablets followed by one tablet of 400 mg orally on the following 09 days plus Lopinavir/ Ritonavir Oral Tablet of 200/ 50 mg: Loading dose of 04 tablets twice a day on day 1 followed by two tablets twice a day on the following 09 days
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo tablets - 01 tablet twice daily from day 01 through day 10.
Primary Outcome Measure Information:
Title
Proportion of participants who were hospitalized for progression of COVID-19 disease
Description
Hospitalization is defined as at least 24 hours of acute care in a hospital or similar acute care facility (emergency settings, temporary emergency facilities created for acute care of COVID-19 pandemic)
Time Frame
Measuring during 28-day period since randomization (Intention to treat analysis)
Title
Proportion of participants who died due to COVID-19 progression and/ or complications
Time Frame
Measuring during 28-day period since randomization (Intention to treat analysis)
Secondary Outcome Measure Information:
Title
Proportion of participants with viral load change on 03, 07, 10 and 14 after randomization
Description
Viral load change on 03, 07, 10 and 14 after randomization (200 patients per arm)
Time Frame
Measuring during 14-day period since randomization
Title
Time to clinical improvement
Description
Proportion of participants with clinical improvement, defined as normalization of temperature, Respiratory rate, SaO2, and cough relief (> 50% compared to baseline measured on a visual analog scale) in the last 72 hours.
Time Frame
Measuring during 28-day period since randomization
Title
Time to clinical failure
Description
Proportion of participants with clinical improvement, defined as as time to need for hospitalization due to dyspnea, death, need for mechanical ventilation, shock and need for vasoactive amines;
Time Frame
Measuring during 28-day period since randomization
Title
Hospitalization for any cause
Description
Proportion of participants with hospitalization for any cause
Time Frame
Measuring during 28-day period since randomization
Title
Proportion of participants who died due to pulmonary complications
Time Frame
Measuring during 28-day period since randomization
Title
Proportion of participants who died due to cardiovascular complications
Time Frame
Measuring during 28-day period since randomization
Title
Proportion of participants who presented with adverse events
Description
Evaluation of adverse events evaluated as associated to any of study arms
Time Frame
Measuring during 28-day period since randomization
Title
Time to improvement on respiratory scale symptoms
Description
Proportion of participants who presented sustained improvement on respiratory scale defined as at least 48 hours of improvement.
Time Frame
Measuring during 28-day period since randomization
Title
proportion of non-adherent participants to any of study drugs
Time Frame
Measuring during 10-day period since randomization

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients with RT-PCR diagnosis of COVID-19 or a clinical condition compatible with COVID-19 and respiratory symptoms, presenting: A. Persistent dry cough associated with axillary temperature > 37.7 Celsius; OR B. Recent onset of Flu-like Respiratory Symptoms associated with dry cough OR C. Tomographic image compatible with COVID 19 infection; 2. Men and women aged > 50 years OR: Patients over 18 years of age with at least one of the following criteria Diabetes requiring oral medication or insulin. Arterial hypertension requiring at least 01 oral medication for treatment Known cardiovascular diseases (CHF of any etiology, documented Coronary Artery Disease, Clinically overt heart disease) Symptomatic chronic lung disease and/ or medically controlled Patients with a history of transplantation Patient with stage IV chronic kidney disease or on dialysis. Patients on current Immunosuppression and/or using corticosteroid therapy (equivalent to at least 10 mg of oral prednisone per day) Willingness to comply with study related procedures 3. Ability to provide informed consent before any protocol-related procedures. Exclusion Criteria: RT-PCR exam for COVID-19 negative during the screening visit. Patients with an acute respiratory condition compatible with COVID-19 being hospitalized; Patients with an acute respiratory condition and with moderate to high probability of not being a COVID infection 19; Dyspnea secondary to other acute and chronic respiratory causes or infections (eg, decompensated Chronic Obstructive Pulmonary Disease, acute bronchitis, pneumonia, primary pulmonary arterial hypertension); Severe respiratory clinical condition, presenting at least ONE of the criteria below: Respiratory Rate> 28 / min; Arterial Oxygen Saturation < 92% with nasal oxygen therapy at 10 l/ min; PaO2 / FIO2 <300 mmHg 4. History of Cardiac Arrhythmia or Long QT Syndrome; 5. Use of Medications that are known to prolong QTc: Citalopram, Venlafaxine, Bupropion and with no possibility of suspension during the period of investigational medical product administration. 6. Inability to take oral medications; 7. Patients on continuous use of Amiodarone and / or PGE5 Inhibitors (Ex .: Sildenafil and similar). 8. Use of Digoxin, Cyclosporine, Cimetidine, Tamoxifen. 9. Use of anticonvulsants, antifungals, immunosuppressants other than corticotherapy. 10. Use of Hydroxychloroquine for other indications 11. Use of chemoprophylaxis for malaria. 12. Psoriasis in a form other than cutaneous 13. Porphyria 14. Use of protease inhibitors, ritonavir or Cobicistat 15. Clinical history of Liver Cirrhosis or Child-Pugh C classification; 16. Patients with a history of degenerative retinal diseases (patients with retinal diseases due to diabetes and hypertension can participate in the research); 17. Patient with a clinically relevant history of hearing loss; 18. Patients with known severe degenerative neurological diseases and / or severe mental illness; 19. Inability of the patient or representative to give consent or adhere to the procedures proposed in the protocol; 20. Known hypersensitivity and / or intolerance to Hydroxychloroquine. 21. Hypersensitivity and / or intolerance Lopinavir / Ritonavir -
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Gilmar Reis, MD, PhD
Phone
+5531332416574
Email
greisbh@uol.com.br
First Name & Middle Initial & Last Name or Official Title & Degree
Rosemary Oliveira, SC
Phone
+5531992636703
Email
roliveira@cardresearch.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gilmar Reis, MD, PhD
Organizational Affiliation
Cardresearch - Cardiologia Assistencial e de Pesquisa LTDA
Official's Role
Principal Investigator
Facility Information:
Facility Name
CARDRESEARCH - Cardiologia Assistencial e de Pesquisa
City
Belo Horizonte
State/Province
Minas Gerais
ZIP/Postal Code
30150240
Country
Brazil
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Izabel Silva, SC
Phone
553132416574
Email
coordpesq@cardresearch.org
First Name & Middle Initial & Last Name & Degree
Gilmar Reis, MD,PhD
Facility Name
Pontificia Universidade Catolica de Minas Gerais
City
Belo Horizonte
State/Province
Minas Gerais
ZIP/Postal Code
30535901
Country
Brazil
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Eduardo Silva, MD, PhD
Email
duduaugusto1@gmail.com
First Name & Middle Initial & Last Name & Degree
Eduardo Silva, MD, PhD
Facility Name
Fundo Municipal de Saúde de Betim
City
Betim
State/Province
Minas Gerais
ZIP/Postal Code
32600412
Country
Brazil
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Daniela Silva, MD, PhD
Phone
5531984923130
Email
daninhamed@yahoo.com.br
First Name & Middle Initial & Last Name & Degree
Daniela Silva, MD, PhD
Facility Name
Universidade Federal de Ouro Preto
City
Ouro Preto
State/Province
Minas Gerais
ZIP/Postal Code
35400000
Country
Brazil
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Leonardo Savassi, MD, PhD
Email
leosavassi@gmail.com
First Name & Middle Initial & Last Name & Degree
Leonardo Savassi, MD, PhD

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
33885775
Citation
Reis G, Moreira Silva EADS, Medeiros Silva DC, Thabane L, Singh G, Park JJH, Forrest JI, Harari O, Quirino Dos Santos CV, Guimaraes de Almeida APF, Figueiredo Neto AD, Savassi LCM, Milagres AC, Teixeira MM, Simplicio MIC, Ribeiro LB, Oliveira R, Mills EJ; TOGETHER Investigators. Effect of Early Treatment With Hydroxychloroquine or Lopinavir and Ritonavir on Risk of Hospitalization Among Patients With COVID-19: The TOGETHER Randomized Clinical Trial. JAMA Netw Open. 2021 Apr 1;4(4):e216468. doi: 10.1001/jamanetworkopen.2021.6468. Erratum In: JAMA Netw Open. 2021 Sep 1;4(9):e2130442.
Results Reference
derived

Learn more about this trial

Hydroxychloroquine and Lopinavir/ Ritonavir to Improve the Health of People With COVID-19: "The Hope Coalition - 1"

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