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DSMB recommended study suspension slow accrual
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This Phase III trial four treatment strategies non-critically ill hospitalized participants (not requiring intensive care unit (ICU) admission and/or mechanical ventilation) with SARS CoV-2 infection, Participants will receive hydroxychloroquine or chloroquine with or without azithromycin.
This Phase III trial will utilize four treatment strategies in non-critically ill hospitalized participants (not requiring mechanical ventilation) with SARS CoV-2 infection, Participants will receive hydroxychloroquine or chloroquine with or without azithromycin. Investigators are primarily interested in the time to recovery. In addition to study medications there will be daily symptom surveys for 14 days, then weekly thereafter for 4 weeks resulting in a total duration of follow up of 42 days. During hospitalization, daily symptom surveys will be completed in conjunction with the study coordinators. On discharge participants will have the option to complete electronic symptom surveys or complete symptom surveys via telephone with study coordinator. In the event that the participant opts for electronic symptom surveys on discharge participants will in addition receive a follow up call from a study coordination every 7 days during the initial 14 day period. In addition, failure to submit a symptom survey will prompt a study follow up call. Data from standard of care SOC will be collected from medical records.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Hydroxychloroquine alone | Active Comparator | Arm 1: Hydroxychloroquine 400mg orally twice a day for one day, followed by 200mg twice a day for four consecutive days (Five days in total). The drug will be supplied in 200mg tablets. |
|
| Hydroxychloroquine plus azithromycin | Active Comparator | Arm 2: Hydroxychloroquine 400mg orally twice a day for one day, followed by 200mg twice a day for four consecutive days (Five days in total). The drug will be supplied in 200mg tablets. AND Azithromycin 500mg orally once, followed by 250mg daily for four consecutive days (five days total). The drug will be supplied in 250mg tablets. |
|
| Chloroquine alone | Active Comparator | Arm 3: Chloroquine phosphate 1000mg orally once, followed in 12 hours by 500mg, then 500mg orally twice daily for 4 days (Five days in total). The drug will be supplied in 500mg tablets. |
|
| Chloroquine plus azithromycin | Active Comparator | Arm 4: Chloroquine phosphate 1000mg orally once, followed in 12 hours by 500mg, then 500mg orally twice daily for 4 days (Five days in total). The drug will be supplied in 500mg tablets. AND Azithromycin 500mg orally once, followed by 250mg daily for 4 consecutive days (5 days total).The drug will be supplied in 250mg tablets. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Hydroxychloroquine Sulfate | Drug | anti-rheumatic drug (DMARD) |
|
| Measure | Description | Time Frame |
|---|---|---|
| Hours to Recovery | Time (hours) from randomization to recovery defined as 1) absence of fever, as defined as at least 48 hours since last temperature ≥ 38.0°C without the use of fever-reducing medications AND 2) absence of symptoms of greater than mild severity for 24 hours AND 3) not requiring supplemental oxygen beyond pre-COVID baseline AND 4) freedom from mechanical ventilation or death in each Arm/Group,respectively. | 42 days |
| Measure | Description | Time Frame |
|---|---|---|
| Time to Fever Resolution | Time to resolution of fever defined as at least 48 hours since last temperature ≥ 38.0°C without the use of fever-reducing medications in each Arm/Group,respectively. | 42 days |
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Inclusion Criteria:
Hospitalization for management of SARS CoV-2 infection
Positive SARS CoV-2 test
Age >=18 years
Provision of informed consent
Electrocardiogram (ECG) ≤48 hours prior to enrollment
Complete blood count, glucose-6 phosphate-dehydrogenase (G6PD), comprehensive metabolic panel and magnesium ≤48 hours prior to enrollment from standard of care.
If participating in sexual activity that could lead to pregnancy, individuals of reproductive potential who can become pregnant must agree to use contraception throughout the study. At least one of the following must be used throughout the study:
Exclusion Criteria:
Contraindication or allergy to chloroquine, hydroxychloroquine or azithromycin
Current use hydroxychloroquine, chloroquine or azithromycin
Concurrent use of another investigational agent
Invasive mechanical ventilation
Participants who have any severe and/or uncontrolled medical conditions such as:
Prior retinal eye disease
Concurrent malignancy requiring chemotherapy
Known Chronic Kidney disease, eGFR<10 or dialysis
G-6-PD deficiency, if unknown requires G6PD testing prior to enrollment
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| Name | Affiliation | Role |
|---|---|---|
| Jane O'Halloran, MD PhD | Washington University School of Medicine (ID-CRU) | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Washington University School of Medicine Infectious Disease Clinical Research Unit | St Louis | Missouri | 63110 | United States | ||
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| ID | Title | Description |
|---|---|---|
| FG000 | Hydroxychloroquine Alone | Arm 1: Hydroxychloroquine 400mg orally twice a day for one day, followed by 200mg twice a day for four consecutive days (Five days in total). The drug will be supplied in 200mg tablets. Hydroxychloroquine Sulfate: anti-rheumatic drug (DMARD) |
| FG001 | Hydroxychloroquine Plus Azithromycin | Arm 2: Hydroxychloroquine 400mg orally twice a day for one day, followed by 200mg twice a day for four consecutive days (Five days in total). The drug will be supplied in 200mg tablets. AND Azithromycin 500mg orally once, followed by 250mg daily for four consecutive days (five days total). The drug will be supplied in 250mg tablets. Hydroxychloroquine Sulfate: anti-rheumatic drug (DMARD) Azithromycin: Antibiotic |
| FG002 | Chloroquine Alone | Arm 3: Chloroquine phosphate 1000mg orally once, followed in 12 hours by 500mg, then 500mg orally twice daily for 4 days (Five days in total). The drug will be supplied in 500mg tablets. Chloroquine Sulfate: Antimalarial |
| FG003 | Chloroquine Plus Azithromycin | Arm 4: Chloroquine phosphate 1000mg orally once, followed in 12 hours by 500mg, then 500mg orally twice daily for 4 days (Five days in total). The drug will be supplied in 500mg tablets. AND Azithromycin 500mg orally once, followed by 250mg daily for 4 consecutive days (5 days total).The drug will be supplied in 250mg tablets. Azithromycin: Antibiotic Chloroquine Sulfate: Antimalarial |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Hydroxychloroquine Alone | Arm 1: Hydroxychloroquine 400mg orally twice a day for one day, followed by 200mg twice a day for four consecutive days (Five days in total). The drug will be supplied in 200mg tablets. Hydroxychloroquine Sulfate: anti-rheumatic drug (DMARD) |
| BG001 | Hydroxychloroquine Plus Azithromycin |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Median |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Hours to Recovery | Time (hours) from randomization to recovery defined as 1) absence of fever, as defined as at least 48 hours since last temperature ≥ 38.0°C without the use of fever-reducing medications AND 2) absence of symptoms of greater than mild severity for 24 hours AND 3) not requiring supplemental oxygen beyond pre-COVID baseline AND 4) freedom from mechanical ventilation or death in each Arm/Group,respectively. | The sample size of 30 was well below the threshold for analysis | Posted | Mean | Inter-Quartile Range | hours | 42 days |
|
6 weeks per participant
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Hydroxychloroquine Alone | Arm 1: Hydroxychloroquine 400mg orally twice a day for one day, followed by 200mg twice a day for four consecutive days (Five days in total). The drug will be supplied in 200mg tablets. Hydroxychloroquine Sulfate: anti-rheumatic drug (DMARD) |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Pneumonia due to COVID | Respiratory, thoracic and mediastinal disorders | DAIDS SAE criteria | Non-systematic Assessment | Subject was previously discharged from hospital on room air . Subject came back to emergency department 4 days later with increased shortness of breath, secondary to COVID and readmitted |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Diarrhea | Gastrointestinal disorders | DAIDS SAE criteria | Non-systematic Assessment |
Enrollment in the clinical trial did not reach the target number of subjects needed to achieve target power and was insufficient to produce statistically reliable results.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Jane O'Halloran | Washington University School of Medicine | 314 454 0058 | janeohalloran@wustl.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Mar 30, 2020 | Jan 27, 2023 | Prot_SAP_001.pdf |
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| ID | Term |
|---|---|
| D018352 | Coronavirus Infections |
| ID | Term |
|---|---|
| D003333 | Coronaviridae Infections |
| D030341 | Nidovirales Infections |
| D012327 | RNA Virus Infections |
| D014777 | Virus Diseases |
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| ID | Term |
|---|---|
| D006886 | Hydroxychloroquine |
| D017963 | Azithromycin |
| D002738 | Chloroquine |
| ID | Term |
|---|---|
| D000634 | Aminoquinolines |
| D011804 | Quinolines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
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| Azithromycin | Drug | Antibiotic |
|
|
| Chloroquine Sulfate | Drug | Antimalarial |
|
|
| Washington University School of Medicine |
| St Louis |
| Missouri |
| 63110 |
| United States |
| Lost to Follow-up |
|
Arm 2: Hydroxychloroquine 400mg orally twice a day for one day, followed by 200mg twice a day for four consecutive days (Five days in total). The drug will be supplied in 200mg tablets. AND Azithromycin 500mg orally once, followed by 250mg daily for four consecutive days (five days total). The drug will be supplied in 250mg tablets. Hydroxychloroquine Sulfate: anti-rheumatic drug (DMARD) Azithromycin: Antibiotic |
| BG002 | Chloroquine Alone | Arm 3: Chloroquine phosphate 1000mg orally once, followed in 12 hours by 500mg, then 500mg orally twice daily for 4 days (Five days in total). The drug will be supplied in 500mg tablets. Chloroquine Sulfate: Antimalarial |
| BG003 | Chloroquine Plus Azithromycin | Arm 4: Chloroquine phosphate 1000mg orally once, followed in 12 hours by 500mg, then 500mg orally twice daily for 4 days (Five days in total). The drug will be supplied in 500mg tablets. AND Azithromycin 500mg orally once, followed by 250mg daily for 4 consecutive days (5 days total).The drug will be supplied in 250mg tablets. Azithromycin: Antibiotic Chloroquine Sulfate: Antimalarial |
| BG004 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| OG001 |
| Hydroxychloroquine Plus Azithromycin |
Arm 2: Hydroxychloroquine 400mg orally twice a day for one day, followed by 200mg twice a day for four consecutive days (Five days in total). The drug will be supplied in 200mg tablets. AND Azithromycin 500mg orally once, followed by 250mg daily for four consecutive days (five days total). The drug will be supplied in 250mg tablets. Hydroxychloroquine Sulfate: anti-rheumatic drug (DMARD) Azithromycin: Antibiotic |
| OG002 | Chloroquine Alone | Arm 3: Chloroquine phosphate 1000mg orally once, followed in 12 hours by 500mg, then 500mg orally twice daily for 4 days (Five days in total). The drug will be supplied in 500mg tablets. Chloroquine Sulfate: Antimalarial |
| OG003 | Chloroquine Plus Azithromycin | Arm 4: Chloroquine phosphate 1000mg orally once, followed in 12 hours by 500mg, then 500mg orally twice daily for 4 days (Five days in total). The drug will be supplied in 500mg tablets. AND Azithromycin 500mg orally once, followed by 250mg daily for 4 consecutive days (5 days total).The drug will be supplied in 250mg tablets. Azithromycin: Antibiotic Chloroquine Sulfate: Antimalarial |
|
|
| Secondary | Time to Fever Resolution | Time to resolution of fever defined as at least 48 hours since last temperature ≥ 38.0°C without the use of fever-reducing medications in each Arm/Group,respectively. | The sample was well below the threshold for analysis | Posted | Mean | Inter-Quartile Range | hours | 42 days |
|
|
|
| 0 |
| 9 |
| 1 |
| 9 |
| 4 |
| 9 |
| EG001 | Hydroxychloroquine Plus Azithromycin | Arm 2: Hydroxychloroquine 400mg orally twice a day for one day, followed by 200mg twice a day for four consecutive days (Five days in total). The drug will be supplied in 200mg tablets. AND Azithromycin 500mg orally once, followed by 250mg daily for four consecutive days (five days total). The drug will be supplied in 250mg tablets. Hydroxychloroquine Sulfate: anti-rheumatic drug (DMARD) Azithromycin: Antibiotic | 0 | 7 | 2 | 7 | 2 | 7 |
| EG002 | Chloroquine Alone | Arm 3: Chloroquine phosphate 1000mg orally once, followed in 12 hours by 500mg, then 500mg orally twice daily for 4 days (Five days in total). The drug will be supplied in 500mg tablets. Chloroquine Sulfate: Antimalarial | 0 | 7 | 1 | 7 | 3 | 7 |
| EG003 | Chloroquine Plus Azithromycin | Arm 4: Chloroquine phosphate 1000mg orally once, followed in 12 hours by 500mg, then 500mg orally twice daily for 4 days (Five days in total). The drug will be supplied in 500mg tablets. AND Azithromycin 500mg orally once, followed by 250mg daily for 4 consecutive days (5 days total).The drug will be supplied in 250mg tablets. Azithromycin: Antibiotic Chloroquine Sulfate: Antimalarial | 0 | 7 | 1 | 7 | 3 | 7 |
|
| Urosepsis | Infections and infestations | DAIDS SAE criteria | Non-systematic Assessment | UTI the reason for the systemic shock |
|
| Respiratory Failure secondary to COVID | Respiratory, thoracic and mediastinal disorders | DAIDS SAE criteria | Non-systematic Assessment | Extended hospitalization due to worsening respiratory failure necessitating intubation and ECMO |
|
| Deep Vein Thrombosis- | Vascular disorders | DAIDS SAE criteria | Non-systematic Assessment | hospitalization |
|
| Respiratory Failure secondary to Covid | Respiratory, thoracic and mediastinal disorders | DAIDS SAE criteria | Non-systematic Assessment | requiring intubation |
|
| Bacterial Pneumonia | Infections and infestations | DAIDS SAE criteria | Non-systematic Assessment | Prolonged hospitalization |
|
| Anorexia | Gastrointestinal disorders | DAIDS SAE criteria | Non-systematic Assessment |
|
| Urinary Tract infection | Infections and infestations | DAIDS SAE criteria | Non-systematic Assessment |
|
| Diarrhea | Gastrointestinal disorders | DAIDS SAE criteria | Non-systematic Assessment |
|
| Pneumonia due to COVID | Respiratory, thoracic and mediastinal disorders | DAIDS SAE criteria | Non-systematic Assessment |
|
| Prolonged QtC | Cardiac disorders | DAIDS SAE criteria | Non-systematic Assessment |
|
| Blurred Vision | Nervous system disorders | DAIDS SAE criteria | Non-systematic Assessment |
|
| Respiratory Failure due to Covid | Respiratory, thoracic and mediastinal disorders | DAIDS SAE criteria | Non-systematic Assessment |
|
| Atrial Flutter | Cardiac disorders | DAIDS SAE criteria | Non-systematic Assessment |
|
| Catatonia | Psychiatric disorders | DAIDS SAE criteria | Non-systematic Assessment |
|
| Nausea | Gastrointestinal disorders | DAIDS SAE criteria | Non-systematic Assessment |
|
| Urinary Tract infection | Infections and infestations | DAIDS SAE criteria | Non-systematic Assessment |
|
| Acute kidney injury | Renal and urinary disorders | DAIDS SAE criteria | Non-systematic Assessment |
|
| Deep Vein Thrombosis | Vascular disorders | DAIDS SAE criteria | Non-systematic Assessment |
|
| Acute Kidney Injury | Renal and urinary disorders | DAIDS SAE criteria | Non-systematic Assessment |
|
| Hypernatremia | Endocrine disorders | DAIDS SAE criteria | Non-systematic Assessment |
|
| Coagulopathy | Blood and lymphatic system disorders | DAIDS SAE criteria | Non-systematic Assessment |
|
| Atrial fibrillation | Cardiac disorders | DAIDS SAE criteria | Non-systematic Assessment |
|
| Sepsis | Infections and infestations | DAIDS SAE criteria | Non-systematic Assessment |
|
| Rash | Skin and subcutaneous tissue disorders | DAIDS SAE criteria | Non-systematic Assessment |
|
| Prolonged QTc | Cardiac disorders | DAIDS SAE criteria | Non-systematic Assessment |
|
| Chest Pain | Cardiac disorders | DAIDS SAE criteria | Non-systematic Assessment |
|
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| D007239 |
| Infections |
| D006571 | Heterocyclic Compounds |
| D004917 | Erythromycin |
| D018942 | Macrolides |
| D061065 | Polyketides |
| D007783 | Lactones |
| D009930 | Organic Chemicals |