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A Randomised, Multi-centre, Double-blind, Phase 3 Study to Observe the Effectiveness, Safety and Tolerability of Molnupiravir Compared to Placebo Administered Orally to High-risk Adult Outpatients With Mild COVID-19 Receiving Local Standard of Care in South Africa (CoTeT)

Primary Purpose

COVID-19

Status
Recruiting
Phase
Phase 3
Locations
South Africa
Study Type
Interventional
Intervention
Molnupiravir 200 mg
Sponsored by
University of Witwatersrand, South Africa
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for COVID-19

Eligibility Criteria

50 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Able and willing to provide written or electronic informed consent prior to any study-specific procedure.
  2. Age ≥50 at the time of signing the informed consent form.
  3. Women of reproductive potential must have a negative pregnancy test at screening and be using a highly effective method of contraception. Highly effective methods of contraception
  4. A male participant must wear a condom when engaging in any activity that allows for passage of ejaculate to another while taking the investigational product. Male participants should also be advised of the benefit for a female partner to use a highly effective method of contraception as condom may break or leak.
  5. Self-reported symptoms of COVID-19 with onset no more than five days prior to screening informed consent including at least one of, fever or chills, cough, sore throat, rhinorrhoea or rhinitis or sinusitis, shortness of breath, headache, myalgia, new onset anosmia or ageusia, nausea, diarrhoea, or extreme fatigue, or other symptoms recognized in local and international guidelines as typical of mild COVID-19.
  6. SARS-CoV-2 infection confirmed through a positive LumiraDx rapid antigen test on the day of screening or a positive RT-PCR within two days prior to screening.
  7. Participant is at high risk for progression to severe COVID-19, this defined as either:

    1. Age ≥50 with at least one of the following background or medical conditions: diabetes mellitus, obesity (BMI 30 kg/m2), hypertension, HIV, active or previous TB.
    2. Age ≥65
  8. Participant agrees to comply with study procedures, including the completion of a daily diary for 10 days from the time of enrolment, and to be available for study contacts and visits.

    -

Exclusion Criteria:

  1. Pregnant or breastfeeding women, or women planning/desiring to become pregnant during the 28 days following enrolment into the study.
  2. Duration of self-reported symptoms of COVID-19 for more than five days prior to screening.
  3. Signs of respiratory distress or severe disease prior to enrolment, including:
  4. Inability/unlikely to be in the study area for the duration of the 28-day follow-up period.
  5. Inability to tolerate oral medications.
  6. 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 patient or the objectives of the study. The Investigator should make this determination in consideration of the volunteer's medical history.
  7. The volunteer is assessed to be clinically unstable in the Investigator's opinion.
  8. Participation in another investigational study involving an investigational product within 30 days, or 5 half-lives, whichever is longer, prior to screening.
  9. 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.
  10. Any physical, mental, or social condition, drug/alcohol use, history of illness or laboratory abnormality that, in the Investigator's judgment, might jeopardise the safety of the patient in the context of this study, or might interfere with study procedures or the ability of the subject to adhere to and complete the study. The Investigator should make this determination in consideration of the volunteer's medical history.

Sites / Locations

  • Nelson Mandela Academic Clinical Research Unit (NeMACRU)Recruiting
  • Sunnyside Office ParkRecruiting
  • Nelson R. Mandela School of Medicine 3rd Floor, K-RITH Tower BuildingRecruiting
  • The Aurum Institute: Gavin J Churchyard Legacy Centre Klerksdorp Clinical Research CentreRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Monulpiravir

Placebo

Arm Description

Eligible participants will be randomised in a 1:1 manner to receive either molnupiravir 800 mg orally approximately 12-hourly for five days or a placebo for the equivalent amount of time.

Eligible participants will be randomised in a 1:1 manner to receive either molnupiravir 800 mg orally approximately 12-hourly for five days or a placebo for the equivalent amount of time.

Outcomes

Primary Outcome Measures

To evaluate the effectiveness of molnupiravir compared to placebo in preventing severe disease progression in adults with mild COVID-19
Combination of incidence of COVID-19-related hospitalisation (24 hours of care in a hospital or similar acute care facility) and COVID-19-related mortality to Day 29
To evaluate the safety of molnupiravir in adults with mild COVID-19
Adverse events (including serious adverse events and adverse drug reactions)
To evaluate the safety of molnupiravir in adults with mild COVID-19
Self-assessed vital signs to Day 10

Secondary Outcome Measures

To facilitate same-day COVID-19 diagnosis and treatment initiation in adults with mild COVID-19 and comorbid conditions
Proportion of enrolled patients for whom diagnosis and same day treatment initiation was facilitated through use of a LumiraDx™ rapid antigen test
To assess the tolerability of molnupiravir in adults with mild COVID-19
Severity of adverse events
To assess the tolerability of molnupiravir in adults with mild COVID-19
Adverse event-related study drug discontinuations
To describe time to symptom resolution in adults with mild COVID-19 treated with molnupiravir compared to placebo
Time to sustained resolution of symptoms as reported in the Flu-PRO© Plus
To evaluate maximum COVID-19 disease severity in adults treated with molnupiravir compared to placebo
Maximum score on the WHO Clinical Progression Scale from Day 1 to Day 29
To evaluate the relationship between effectiveness of molnupiravir and time between onset of symptoms and initiation of treatment
Number of days from symptom onset to initiation of treatment
To evaluate the relationship between effectiveness of molnupiravir and time between onset of symptoms and initiation of treatment
Incidence of hospitalisation (24 hours of care in a hospital or similar acute care facility) and/or death to Day 29 in patients with co-morbid conditions
To evaluate the relationship between effectiveness of molnupiravir and time between onset of symptoms and initiation of treatment
Time to sustained resolution of symptoms as reported in the Flu-PRO Plus
To evaluate the relationship between effectiveness of molnupiravir and time between onset of symptoms and initiation of treatment
Maximum score on the WHO Clinical Progression Scale from Day 1 to Day 29. On a scale of 0 to 10 (0 being uninfected and 10 being worse/death)
To describe adherence to a 5-day course of molnupiravir in adults with mild COVID-19
Proportion of patients completing the course of molnupiravir as prescribed
To describe the utilisation of health care services by adults with mild COVID-19 treated with molnupiravir compared to placebo
Rate of hospital, emergency facility, clinic, health care practitioner or home visits to Day 29
To report the incidence and outcome of pregnancies in female participants who received molnupiravir
Incidence of pregnancy in female participants to Day 29
To report the incidence and outcome of pregnancies in female participants who received molnupiravir
20-week gestational age ultrasound findings
To report the incidence and outcome of pregnancies in female participants who received molnupiravir
Pregnancy complications
To report the incidence and outcome of pregnancies in female participants who received molnupiravir
Pregnancy outcome
To report the incidence and outcome of pregnancies in female participants who received molnupiravir
Infant wellbeing to three months of age

Full Information

First Posted
July 13, 2022
Last Updated
August 12, 2022
Sponsor
University of Witwatersrand, South Africa
Collaborators
Bill and Melinda Gates Foundation
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1. Study Identification

Unique Protocol Identification Number
NCT05459532
Brief Title
A Randomised, Multi-centre, Double-blind, Phase 3 Study to Observe the Effectiveness, Safety and Tolerability of Molnupiravir Compared to Placebo Administered Orally to High-risk Adult Outpatients With Mild COVID-19 Receiving Local Standard of Care in South Africa
Acronym
CoTeT
Official Title
This is a Multi-centre, Double-blind, Phase 3 Study to Observe the Effectiveness, Safety, and Tolerability of Molnupiravir 800 mg Administered 12-hourly for Five Days to Adult Patients With Mild COVID-19 at the Time of Enrolment Who Are at Risk of Progression to Severe Disease, Compared to a Placebo. Patients With Recent Onset of COVID-19 Symptoms Will be Screened to Assess Eligibility for Enrolment. Confirmation of SARS-CoV-2 Infection Will be Performed Through Rapid Antigen Detection Using the LumiraDx Point of Care Diagnostic Platform.
Study Type
Interventional

2. Study Status

Record Verification Date
August 2022
Overall Recruitment Status
Recruiting
Study Start Date
August 12, 2022 (Actual)
Primary Completion Date
July 2024 (Anticipated)
Study Completion Date
July 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Witwatersrand, South Africa
Collaborators
Bill and Melinda Gates Foundation

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 is a multi-centre, double-blind, phase 3 study to observe the effectiveness, safety, and tolerability of molnupiravir 800 mg administered 12-hourly for five days in adult patients with mild COVID-19 at the time of enrolment, who are at risk of progression to severe disease, compared to a placebo.
Detailed Description
This is a multi-centre, double-blind, phase 3 study to observe the effectiveness, safety, and tolerability of molnupiravir 800 mg administered 12-hourly for five days in adult patients with mild COVID-19 at the time of enrolment, who are at risk of progression to severe disease, compared to a placebo. Patients with recent onset of COVID-19 symptoms will be screened to assess eligibility for enrolment. Confirmation of SARS-CoV-2 infection will be performed through rapid antigen detection using the LumiraDx point of care diagnostic platform. Approximately 4000 eligible patients will be enrolled and will be randomised in a 1:1 manner to start treatment with either molnupiravir or a placebo on the same day. Patients will record their symptoms (through a self-administered questionnaire) and self-observed vital signs daily for 10 days from the time of enrolment and will be contacted by study team personnel on Days 3, 6 and 10 to monitor their well-being. Adverse event and concomitant medication data will be collected. A final end-of-study follow-up visit will be conducted on Day 29. An independent Data and Safety Monitoring Board (DSMB) will be convened for this study with expertise in COVID-19 or respiratory viruses, and emerging epidemics. The purpose of the DSMB is to monitor the study for safety and operational futility. In addition to the usual, regular, required reporting to SAHPRA, the investigator anticipates that additional reporting will be required by the Clinical Trials Committee, noting the severity of the 3rd and 4th waves, the level of ''breakthrough'' infections in the context of high background comorbidities, and the urgent interest in this class of drugs.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
COVID-19

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
Molnupiravir is a broad-spectrum antiviral that is an orally bioavailable prodrug of the nucleoside analogue NHC. NHC distributes into cells where it is phosphorylated to form the pharmacologically active NHC-TP. NHC-TP acts by a mechanism known as viral error catastrophe. NHC-TP incorporation into viral RNA by the viral RNA polymerase, results in an accumulation of errors in the viral genome leading to inhibition of replication.
Masking
ParticipantCare ProviderInvestigator
Masking Description
Double-Blinded
Allocation
Randomized
Enrollment
4000 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Monulpiravir
Arm Type
Experimental
Arm Description
Eligible participants will be randomised in a 1:1 manner to receive either molnupiravir 800 mg orally approximately 12-hourly for five days or a placebo for the equivalent amount of time.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Eligible participants will be randomised in a 1:1 manner to receive either molnupiravir 800 mg orally approximately 12-hourly for five days or a placebo for the equivalent amount of time.
Intervention Type
Drug
Intervention Name(s)
Molnupiravir 200 mg
Intervention Description
The drug is orally bioavailable (and is indicated for treatment of mild to moderate COVID-19 in adults with a positive SARS-COV-2 diagnostic test and who have at least one risk factor for developing severe illness. The recommended dose is 800 mg (four 200 mg capsules) taken orally 12-hourly for five days, and should be administered as soon as possible after diagnosis of COVID-19 has been made and within five days of symptom onset.
Primary Outcome Measure Information:
Title
To evaluate the effectiveness of molnupiravir compared to placebo in preventing severe disease progression in adults with mild COVID-19
Description
Combination of incidence of COVID-19-related hospitalisation (24 hours of care in a hospital or similar acute care facility) and COVID-19-related mortality to Day 29
Time Frame
29 Days
Title
To evaluate the safety of molnupiravir in adults with mild COVID-19
Description
Adverse events (including serious adverse events and adverse drug reactions)
Time Frame
29 Days
Title
To evaluate the safety of molnupiravir in adults with mild COVID-19
Description
Self-assessed vital signs to Day 10
Time Frame
29 Days
Secondary Outcome Measure Information:
Title
To facilitate same-day COVID-19 diagnosis and treatment initiation in adults with mild COVID-19 and comorbid conditions
Description
Proportion of enrolled patients for whom diagnosis and same day treatment initiation was facilitated through use of a LumiraDx™ rapid antigen test
Time Frame
29 Days
Title
To assess the tolerability of molnupiravir in adults with mild COVID-19
Description
Severity of adverse events
Time Frame
29 Days
Title
To assess the tolerability of molnupiravir in adults with mild COVID-19
Description
Adverse event-related study drug discontinuations
Time Frame
29 Days
Title
To describe time to symptom resolution in adults with mild COVID-19 treated with molnupiravir compared to placebo
Description
Time to sustained resolution of symptoms as reported in the Flu-PRO© Plus
Time Frame
29 Days
Title
To evaluate maximum COVID-19 disease severity in adults treated with molnupiravir compared to placebo
Description
Maximum score on the WHO Clinical Progression Scale from Day 1 to Day 29
Time Frame
29 Days
Title
To evaluate the relationship between effectiveness of molnupiravir and time between onset of symptoms and initiation of treatment
Description
Number of days from symptom onset to initiation of treatment
Time Frame
29 Days
Title
To evaluate the relationship between effectiveness of molnupiravir and time between onset of symptoms and initiation of treatment
Description
Incidence of hospitalisation (24 hours of care in a hospital or similar acute care facility) and/or death to Day 29 in patients with co-morbid conditions
Time Frame
29 Days
Title
To evaluate the relationship between effectiveness of molnupiravir and time between onset of symptoms and initiation of treatment
Description
Time to sustained resolution of symptoms as reported in the Flu-PRO Plus
Time Frame
Day 1 to Day 10 and Day 29
Title
To evaluate the relationship between effectiveness of molnupiravir and time between onset of symptoms and initiation of treatment
Description
Maximum score on the WHO Clinical Progression Scale from Day 1 to Day 29. On a scale of 0 to 10 (0 being uninfected and 10 being worse/death)
Time Frame
Day 0, 3, 6, 10, 29
Title
To describe adherence to a 5-day course of molnupiravir in adults with mild COVID-19
Description
Proportion of patients completing the course of molnupiravir as prescribed
Time Frame
29 Days
Title
To describe the utilisation of health care services by adults with mild COVID-19 treated with molnupiravir compared to placebo
Description
Rate of hospital, emergency facility, clinic, health care practitioner or home visits to Day 29
Time Frame
29 Days
Title
To report the incidence and outcome of pregnancies in female participants who received molnupiravir
Description
Incidence of pregnancy in female participants to Day 29
Time Frame
29 Days
Title
To report the incidence and outcome of pregnancies in female participants who received molnupiravir
Description
20-week gestational age ultrasound findings
Time Frame
Once
Title
To report the incidence and outcome of pregnancies in female participants who received molnupiravir
Description
Pregnancy complications
Time Frame
Throughout the pregnancy
Title
To report the incidence and outcome of pregnancies in female participants who received molnupiravir
Description
Pregnancy outcome
Time Frame
Once
Title
To report the incidence and outcome of pregnancies in female participants who received molnupiravir
Description
Infant wellbeing to three months of age
Time Frame
Once

10. Eligibility

Sex
All
Minimum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Able and willing to provide written or electronic informed consent prior to any study-specific procedure. Age ≥50 at the time of signing the informed consent form. Women of reproductive potential must have a negative pregnancy test at screening and be using a highly effective method of contraception. Highly effective methods of contraception A male participant must wear a condom when engaging in any activity that allows for passage of ejaculate to another while taking the investigational product. Male participants should also be advised of the benefit for a female partner to use a highly effective method of contraception as condom may break or leak. Self-reported symptoms of COVID-19 with onset no more than five days prior to screening informed consent including at least one of, fever or chills, cough, sore throat, rhinorrhoea or rhinitis or sinusitis, shortness of breath, headache, myalgia, new onset anosmia or ageusia, nausea, diarrhoea, or extreme fatigue, or other symptoms recognized in local and international guidelines as typical of mild COVID-19. SARS-CoV-2 infection confirmed through a positive LumiraDx rapid antigen test on the day of screening or a positive RT-PCR within two days prior to screening. Participant is at high risk for progression to severe COVID-19, this defined as either: Age ≥50 with at least one of the following background or medical conditions: diabetes mellitus, obesity (BMI 30 kg/m2), hypertension, HIV, active or previous TB. Age ≥65 Participant agrees to comply with study procedures, including the completion of a daily diary for 10 days from the time of enrolment, and to be available for study contacts and visits. - Exclusion Criteria: Pregnant or breastfeeding women, or women planning/desiring to become pregnant during the 28 days following enrolment into the study. Duration of self-reported symptoms of COVID-19 for more than five days prior to screening. Signs of respiratory distress or severe disease prior to enrolment, including: Inability/unlikely to be in the study area for the duration of the 28-day follow-up period. Inability to tolerate oral medications. 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 patient or the objectives of the study. The Investigator should make this determination in consideration of the volunteer's medical history. The volunteer is assessed to be clinically unstable in the Investigator's opinion. Participation in another investigational study involving an investigational product within 30 days, or 5 half-lives, whichever is longer, prior to screening. 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. Any physical, mental, or social condition, drug/alcohol use, history of illness or laboratory abnormality that, in the Investigator's judgment, might jeopardise the safety of the patient in the context of this study, or might interfere with study procedures or the ability of the subject to adhere to and complete the study. The Investigator should make this determination in consideration of the volunteer's medical history.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Bukani X Dyariwe
Phone
0110844961
Email
bdyariwe@ezintsha.org
First Name & Middle Initial & Last Name or Official Title & Degree
Simiso M Sokhela
Phone
0110844933
Email
ssokhela@ezintsha.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Francois WD Venter
Organizational Affiliation
Ezintsha, Faculty of Health Sciences University of the Witwatersrand
Official's Role
Study Director
Facility Information:
Facility Name
Nelson Mandela Academic Clinical Research Unit (NeMACRU)
City
Umtata
State/Province
Eastern Cape
ZIP/Postal Code
5099
Country
South Africa
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Pamela Mda, M.Med
Phone
0471500012
Email
pmda@witshealth.co.za
First Name & Middle Initial & Last Name & Degree
Bomikazi Tutshana
Phone
0471500012
Email
btutshana@witshealth.co.za
First Name & Middle Initial & Last Name & Degree
Thozama Dubula, M.Med
First Name & Middle Initial & Last Name & Degree
Sinalo Toni, MBCHB
First Name & Middle Initial & Last Name & Degree
Bulelwa Mabindla, MBCHB
Facility Name
Sunnyside Office Park
City
Johannesburg
State/Province
Gauteng
ZIP/Postal Code
2193
Country
South Africa
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Nonkululeko Mashabane, BPharm
Phone
0110844953
Email
nmashabane@ezintsha.org
First Name & Middle Initial & Last Name & Degree
Godspower Akpomiemie, MPH
Phone
0110844984
Email
gakpomiemie@ezintsha.org
First Name & Middle Initial & Last Name & Degree
Simiso M Sokhela, MBBCh
First Name & Middle Initial & Last Name & Degree
Nomathemba Chandiwana, MBBCh
First Name & Middle Initial & Last Name & Degree
Joana Woods, MBBCh
First Name & Middle Initial & Last Name & Degree
Esther S Bhasker, MBBCh
First Name & Middle Initial & Last Name & Degree
Ncomeka Manentsa, MBBCh
First Name & Middle Initial & Last Name & Degree
Bronwyn Bosch, MBBCh
First Name & Middle Initial & Last Name & Degree
Karlien Moller, MBBCh
First Name & Middle Initial & Last Name & Degree
Francois WD Venter, MBBCh
Facility Name
Nelson R. Mandela School of Medicine 3rd Floor, K-RITH Tower Building
City
Durban
State/Province
Kwa-Zulu Natal
ZIP/Postal Code
3935
Country
South Africa
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Limakatso Lebina, MD
Phone
0312604112
Email
limakatso.lebina@ahri.org
First Name & Middle Initial & Last Name & Degree
Willem Hanekom, MD
Phone
0312604112
Email
willem.hanekom@ahri.org
First Name & Middle Initial & Last Name & Degree
Mark Siedner, MD
First Name & Middle Initial & Last Name & Degree
Ngundu Behuhuma, MD
First Name & Middle Initial & Last Name & Degree
Ngcebo Mhlongo, MD
Facility Name
The Aurum Institute: Gavin J Churchyard Legacy Centre Klerksdorp Clinical Research Centre
City
Klerksdorp
State/Province
North West
ZIP/Postal Code
2571
Country
South Africa
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Tania Adonis, BPsych
Email
tadonis@auruminstitute.org
First Name & Middle Initial & Last Name & Degree
Olebogeng Jonkane, BA
Email
ojokane@auruminstitute.org
First Name & Middle Initial & Last Name & Degree
Oteng Letlape, MBBCH
First Name & Middle Initial & Last Name & Degree
James C Innes, MBChB
First Name & Middle Initial & Last Name & Degree
Raesibe AP Selepe, MBChB
First Name & Middle Initial & Last Name & Degree
Mgcini Moyo, MBChB
First Name & Middle Initial & Last Name & Degree
Tanya Nielson, MSc

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
The data that will be shared is all of the individual participant data collected during the trial, after deidentification.
IPD Sharing Time Frame
Immediately following publication
IPD Sharing Access Criteria
Anyone who wishes to access the data

Learn more about this trial

A Randomised, Multi-centre, Double-blind, Phase 3 Study to Observe the Effectiveness, Safety and Tolerability of Molnupiravir Compared to Placebo Administered Orally to High-risk Adult Outpatients With Mild COVID-19 Receiving Local Standard of Care in South Africa

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