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COVID-19 Treatment in South Africa

Primary Purpose

COVID-19

Status
Completed
Phase
Phase 2
Locations
South Africa
Study Type
Interventional
Intervention
Standard of care (Paracetamol)
Artesunate-amodiaquine
Pyronaridine-artesunate
Favipiravir plus Nitazoxanide
Sofosbuvir/daclatasvir
Sponsored by
Shin Poong Pharmaceutical Co. Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for COVID-19 focused on measuring COVID-19, Pyramax, Pyronaridine, Artesunate, Chloroquine, Zinc, Amodiaquine, Favipiravir, Nitazoxanide, Sofosbuvir, Daclatasvir

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Age from 18 to 65 years of age, inclusive, at the time of signing the informed consent.
  2. Willing and able to provide informed consent.
  3. Women of reproductive potential must be using a highly effective method of contraception for at least 28 days prior to enrolment and must be able and willing to continue its use throughout the duration of the study.
  4. Men must agree to use condoms when engaging in heterosexual sex during the study and for the period up to 91 days after the last dose of study medication. Men who are not randomized to a treatment arm including favipiravir (or another arm identified as having teratogenic potential through semen) will no longer need to adhere to this after randomization.
  5. Laboratory confirmed SARS-CoV-2 infection, and any of the following self-reported symptoms within 72 hours prior to randomization: fever or chills, cough, myalgia, sore throat, shortness of breath, or new onset of anosmia or ageusia.
  6. Body weight ≥45 kg.
  7. Access to reliable video conference, telephone, direct/text messaging, or other device permitting real-time, reliable information transfer.

Exclusion Criteria:

  1. Pregnant or lactating women.
  2. Known hypersensitivity or specific contraindications to the use of any of the active drugs in the treatment arms, or similar compounds.
  3. Signs of respiratory distress prior to randomization, including:

    • respiratory rate >24 breaths/min
    • SpO2 <95% in room air.
  4. Resting pulse rate ≥120 beats/min.
  5. High likelihood of hospitalization in the opinion of the attending clinician.
  6. QTcF >470 msec for females, or >450 msec for males, at screening.
  7. Serum potassium <3.5 mmol/L at screening.
  8. History of clinically significant cardiovascular disease (including arrhythmias, QT-interval prolongation, torsades de pointes (TdP), history of coronary artery disease with graft or stent procedures/surgery, cardiac failure [class 2 or higher using the New York Heart Association functional classification]).
  9. Known chronic kidney disease (Stage IV or receiving dialysis).
  10. Known cirrhosis (Child-Pugh Class B or greater).
  11. Known macular degeneration, or other known retinal diseases, or 4-aminoquinolone-induced visual impairment.
  12. Currently receiving, or recently received (within 60 days prior to randomization) treatment with any of the drugs in the treatment arms.
  13. Currently receiving, or recently received (within 30 days prior to randomization) treatment with any antimalarial drugs.
  14. Currently on treatment with drugs with known arrhythmogenic potential, or those known to induce significant QT-interval prolongation or TdP, as detailed in Appendix 6.
  15. Currently on treatment for tuberculosis (or on treatment with rifampicin for any other indication), or on treatment with a protease inhibitor-based antiretroviral regimen, or efavirenz, or carbamazepine.
  16. Inability/unlikely to be in the study area for the duration of the 28 day follow-up period.
  17. Any surgical or medical condition which might significantly alter the absorption, distribution, metabolism, or excretion of drugs, or which may jeopardize the safety of the volunteer or the objectives of the study. The Investigator should make this determination in consideration of the volunteer's medical history.
  18. Personnel (e.g. investigator, sub-investigator, research assistant, pharmacist, study coordinator or anyone mentioned in the delegation log) directly involved in the conduct of the study.
  19. Participant is judged by the Investigator to be at significant risk of failing to comply with the provisions of the protocol as to cause harm to self or seriously interfere with the validity of the study results.

Sites / Locations

  • Ezintsha, Wits Reproductive Health & HIV Institute University of the Witwatersrand

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm Type

Placebo Comparator

Experimental

Experimental

Experimental

Experimental

Arm Label

Arm A

Arm B

Arm C

Arm D

Arm E

Arm Description

Paracetamol (SOC)

SOC plus Artesunate-Amodiaquine

SOC plus Pyronaridine-Artesunate

SOC plus Favipiravir plus Nitazoxanide

SOC plus Sofosbuvir/daclatasvir

Outcomes

Primary Outcome Measures

Incidence of SARS-CoV-2 clearance
Defined as the proportion of participants with a negative nasal swab

Secondary Outcome Measures

Incidence of SARS-CoV-2 clearance
Defined as the proportion of participants with a negative nasal swab
Time to clearance of nasal SARS-CoV-2
Defined as a negative swab
Median quantity of SARS-CoV-2
Detected from mid-nasal swabs by PCR
Proportion of days with fever after randomization
Number of days with fever
Proportion of days with respiratory symptoms after randomization
Number of days with respiratory symptoms
FLU-PRO© Plus
FLU-PRO© Plus questionnaire scores and FLU-PRO© Plus Global Additional Daily Diary Items *The Influenza Patient-Reported Outcome instrument (FLU-PRO© Plus)
Serious adverse events
Serious adverse events
Adverse events resulting in treatment discontinuation
Adverse events
Adverse events considered related to the investigational products
Related adverse events
LRTI
Resting SpO2<93% sustained for 2 readings 2 hours apart AND presence of subjective dyspnea or cough in participants with access to SpO2
Maximum score on WHO Ordinal Scale for Clinical Improvement during study participation
score 0(Uninfected)~ score 8(Dead)
Cumulative incidence of hospitalization
frequency of patients requiring time in hospital
Days of hospitalization
length of hospital stay
Cumulative incidence of mortality
incidence of death

Full Information

First Posted
August 26, 2020
Last Updated
September 16, 2021
Sponsor
Shin Poong Pharmaceutical Co. Ltd.
Collaborators
Medicines for Malaria Venture
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1. Study Identification

Unique Protocol Identification Number
NCT04532931
Brief Title
COVID-19 Treatment in South Africa
Official Title
Phase 2, Exploratory, Single Center, Randomized, Open Label, Adaptive Clinical Trial to Compare Safety and Efficacy of Four Different Experimental Drug Regimens to Standard of Care for the Treatment of Symptomatic Outpatients With COVID-19
Study Type
Interventional

2. Study Status

Record Verification Date
September 2021
Overall Recruitment Status
Completed
Study Start Date
September 3, 2020 (Actual)
Primary Completion Date
August 5, 2021 (Actual)
Study Completion Date
August 23, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Shin Poong Pharmaceutical Co. Ltd.
Collaborators
Medicines for Malaria Venture

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
This exploratory study is a randomized, single center, open label study of four different experimental treatment arms versus standard of care for the treatment of SARS-CoV-2 infection in symptomatic outpatients with mild disease at the time of enrollment.
Detailed Description
This phase 2, exploratory study will be an adaptive, randomized, open label, trial for treatment of individuals in an outpatient settings with mild SARS-CoV-2 infection. The primary outcome is focused on the evaluation of efficacy of the proposed experimental drugs in reducing upper respiratory viral shedding, defined as viral clearance (i.e., negative swab) on Day 7. Key secondary outcomes focus on other measures of viral shedding, safety evaluation, progression to LRTI (defined by resting blood oxygen saturation level [SpO2] <93% sustained for two readings two hours apart and presence of subjective dyspnoea or cough), disease severity, clinical resolution rate, and cumulative incidence of hospitalization or mortality at Day 28.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
COVID-19
Keywords
COVID-19, Pyramax, Pyronaridine, Artesunate, Chloroquine, Zinc, Amodiaquine, Favipiravir, Nitazoxanide, Sofosbuvir, Daclatasvir

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
192 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm A
Arm Type
Placebo Comparator
Arm Description
Paracetamol (SOC)
Arm Title
Arm B
Arm Type
Experimental
Arm Description
SOC plus Artesunate-Amodiaquine
Arm Title
Arm C
Arm Type
Experimental
Arm Description
SOC plus Pyronaridine-Artesunate
Arm Title
Arm D
Arm Type
Experimental
Arm Description
SOC plus Favipiravir plus Nitazoxanide
Arm Title
Arm E
Arm Type
Experimental
Arm Description
SOC plus Sofosbuvir/daclatasvir
Intervention Type
Other
Intervention Name(s)
Standard of care (Paracetamol)
Intervention Description
SOC - 2 tablets (1000 mg) to be taken 6-hourly as needed
Intervention Type
Drug
Intervention Name(s)
Artesunate-amodiaquine
Intervention Description
SOC plus artesunate-amodiaquine (ASAQ) - 2 tablets (200/540 mg artesunate/amodiaquine) daily for 3 days
Intervention Type
Drug
Intervention Name(s)
Pyronaridine-artesunate
Intervention Description
SOC plus pyronaridine-artesunate (PA) Weight 45 to <65 kg: 3 tablets (540/180 mg pyronaridine/artesunate) daily for 3 days Weight ≥65 kg: 4 tablets (720/240 mg pyronaridine/artesunate) daily for 3 days
Intervention Type
Drug
Intervention Name(s)
Favipiravir plus Nitazoxanide
Intervention Description
SOC plus favipiravir plus nitazoxanide (FPV-NTZ) Favipiravir: 1600 mg 12-hourly for 1 day then 600 mg 12-hourly for 6 days Nitazoxanide: 2 tablets (1000 mg) 12-hourly for 7 days
Intervention Type
Drug
Intervention Name(s)
Sofosbuvir/daclatasvir
Intervention Description
SOC plus sofosbuvir/daclatasvir (SOF/DCV) 1 tablet (400 mg/60 mg sofosbuvir/daclatasvir) daily for 7 days
Primary Outcome Measure Information:
Title
Incidence of SARS-CoV-2 clearance
Description
Defined as the proportion of participants with a negative nasal swab
Time Frame
Day 7
Secondary Outcome Measure Information:
Title
Incidence of SARS-CoV-2 clearance
Description
Defined as the proportion of participants with a negative nasal swab
Time Frame
Day 10, 14, 21, 28
Title
Time to clearance of nasal SARS-CoV-2
Description
Defined as a negative swab
Time Frame
Day 0, 3, 7, 10, 14, 21, 28
Title
Median quantity of SARS-CoV-2
Description
Detected from mid-nasal swabs by PCR
Time Frame
Day 14
Title
Proportion of days with fever after randomization
Description
Number of days with fever
Time Frame
Day 28
Title
Proportion of days with respiratory symptoms after randomization
Description
Number of days with respiratory symptoms
Time Frame
Day 28
Title
FLU-PRO© Plus
Description
FLU-PRO© Plus questionnaire scores and FLU-PRO© Plus Global Additional Daily Diary Items *The Influenza Patient-Reported Outcome instrument (FLU-PRO© Plus)
Time Frame
14 days
Title
Serious adverse events
Description
Serious adverse events
Time Frame
Day 28
Title
Adverse events resulting in treatment discontinuation
Description
Adverse events
Time Frame
Day 28
Title
Adverse events considered related to the investigational products
Description
Related adverse events
Time Frame
Day 28
Title
LRTI
Description
Resting SpO2<93% sustained for 2 readings 2 hours apart AND presence of subjective dyspnea or cough in participants with access to SpO2
Time Frame
Day 28
Title
Maximum score on WHO Ordinal Scale for Clinical Improvement during study participation
Description
score 0(Uninfected)~ score 8(Dead)
Time Frame
Day 28
Title
Cumulative incidence of hospitalization
Description
frequency of patients requiring time in hospital
Time Frame
Day 28
Title
Days of hospitalization
Description
length of hospital stay
Time Frame
Day 28
Title
Cumulative incidence of mortality
Description
incidence of death
Time Frame
Day 28 or later if participant is hospitalized at the time of Day 28

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age from 18 to 65 years of age, inclusive, at the time of signing the informed consent. Willing and able to provide informed consent. Women of reproductive potential must be using a highly effective method of contraception for at least 28 days prior to enrolment and must be able and willing to continue its use throughout the duration of the study. Men must agree to use condoms when engaging in heterosexual sex during the study and for the period up to 91 days after the last dose of study medication. Men who are not randomized to a treatment arm including favipiravir (or another arm identified as having teratogenic potential through semen) will no longer need to adhere to this after randomization. Laboratory confirmed SARS-CoV-2 infection, and any of the following self-reported symptoms within 72 hours prior to randomization: fever or chills, cough, myalgia, sore throat, shortness of breath, or new onset of anosmia or ageusia. Body weight ≥45 kg. Access to reliable video conference, telephone, direct/text messaging, or other device permitting real-time, reliable information transfer. Exclusion Criteria: Pregnant or lactating women. Known hypersensitivity or specific contraindications to the use of any of the active drugs in the treatment arms, or similar compounds. Signs of respiratory distress prior to randomization, including: respiratory rate >24 breaths/min SpO2 <95% in room air. Resting pulse rate ≥120 beats/min. High likelihood of hospitalization in the opinion of the attending clinician. QTcF >470 msec for females, or >450 msec for males, at screening. Serum potassium <3.5 mmol/L at screening. History of clinically significant cardiovascular disease (including arrhythmias, QT-interval prolongation, torsades de pointes (TdP), history of coronary artery disease with graft or stent procedures/surgery, cardiac failure [class 2 or higher using the New York Heart Association functional classification]). Known chronic kidney disease (Stage IV or receiving dialysis). Known cirrhosis (Child-Pugh Class B or greater). Known macular degeneration, or other known retinal diseases, or 4-aminoquinolone-induced visual impairment. Currently receiving, or recently received (within 60 days prior to randomization) treatment with any of the drugs in the treatment arms. Currently receiving, or recently received (within 30 days prior to randomization) treatment with any antimalarial drugs. Currently on treatment with drugs with known arrhythmogenic potential, or those known to induce significant QT-interval prolongation or TdP, as detailed in Appendix 6. Currently on treatment for tuberculosis (or on treatment with rifampicin for any other indication), or on treatment with a protease inhibitor-based antiretroviral regimen, or efavirenz, or carbamazepine. Inability/unlikely to be in the study area for the duration of the 28 day follow-up period. Any surgical or medical condition which might significantly alter the absorption, distribution, metabolism, or excretion of drugs, or which may jeopardize the safety of the volunteer or the objectives of the study. The Investigator should make this determination in consideration of the volunteer's medical history. Personnel (e.g. investigator, sub-investigator, research assistant, pharmacist, study coordinator or anyone mentioned in the delegation log) directly involved in the conduct of the study. Participant is judged by the Investigator to be at significant risk of failing to comply with the provisions of the protocol as to cause harm to self or seriously interfere with the validity of the study results.
Facility Information:
Facility Name
Ezintsha, Wits Reproductive Health & HIV Institute University of the Witwatersrand
City
Johannesburg
Country
South Africa

12. IPD Sharing Statement

Plan to Share IPD
No

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COVID-19 Treatment in South Africa

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