treatments are no longer proposed to this type of patients

To date no treatment has proven its effectiveness in the caring of patients infected with type 2 Coronavirus. The Centre Hospitalier Princesse Grace (CHPG) has decided to only propose randomized double-blind placebo-controlled clinical trials to patients at the early and symptomatic stages of the disease. Data from the literature show in vitro results on the potential clinical benefit of some treatments such as chloroquine or hydroxychloroquine (HXCQ). Observational data suggest a potential benefit of this treatment alone or in combination with azithromycin (HXCQ + AZ). These data were advertised or led to a request from ambulatory medicine and patients to have access to these treatments despite their poor level of evidence. This leads to a decrease in the number of patients recruitable for clinical trials because they refuse the concept of control arms or they wish active treatment (CQ, HXCQ or HXCQ + AZ) from the start.

In this context, we propose to conduct in parallel with randomized trials, a so-called "patient preference" protocol which, after patients information, gives them the choice, either to participate in the trial or to choose between treatment with HXCQ, treatment with HXCQ + AZ or standard of care without medication. The patients follow-up and the main endpoint will be the same under the patient preference protocol as for the randomized trial.

The advantage of this approach is to offer a common follow-up to all patients, to take into account patients who refuse to participate in the clinical trial, to obtain external validity data, to reduce selection bias and to increase the heterogeneity of patients exposed to treatment options.

The expected objective is to see if the patient preference protocol leads to observe the same effects as in the randomized trial.

Conduct of the research

• Pre-selection / Recruitment It is proposed to participate in the study to patients who cannot or do not wish to participate in a randomized therapeutic trial.

• Inclusion procedure During the inclusion visit, if the patient meets the study selection criteria, the investigator delivers oral and written information and responds to any patient questions.

• Follow-up of people suitable for research

  1. Inclusion visit The treatment chosen by the patient is administered. Socio-demographic, history, clinical and biological data are collected.
  2. Visit on day 3 ± 1 Hydroxychloroquinemia is dosed.
  3. Visit on day 5 ± 1 A nasopharyngeal swab sample is collected during the routine visit. This sampling is only performed for patients for whom the diagnosis of COVID-19 has been made by RT-PCR.
  4. Visit on day 10 ± 1 A nasopharyngeal swab sample is collected during the routine visit. This sampling is only performed for patients for whom the diagnosis of COVID-19 has been made by RT-PCR. Hydroxychloroquinemia is dosed.
  5. Visit on day 14 A visit or a telephone call is made to gather the occurrence of clinical events of interest on day 14. The treatments received during the last 14 days are collected.
  6. Visit on day 28 A visit or a telephone call is made to gather the occurrence of clinical events of interest on day 28.

The treatments received during the last 14 days are collected.

Inclusion Criteria:

• Adult patients (18+)
• Infection with COVID-19 diagnosed by positive RT-PCR SARS-CoV-2 or, if not performed, by thorax CT-scan suggesting viral pneumonia of peripheral predominance in a clinically significant context.
• Diagnosed within the previous 48 hours.
• Having at least one of the following two risk factors for complications:
• age ≥75 years old
• Peripheral oxygen saturation (SpO2) ≤ 94% while breathing ambient air, or a partial oxygen pressure (PaO2) to fraction of inspired oxygen (FiO2) ratio ≤ 300 mmHg.
• Patients affiliated with or benefitting from a social security scheme
• Written and signed consent of the patient or a relative or, if not possible, emergency inclusion procedure
• Electrocardiogram showing absence of QT prolongation greater than 440 ms in men and 460 ms in women.
• Patient that can't or don't want to participate to a randomized clinical trial

Exclusion Criteria:

• Age below 18-year of age
• Negative RT-PCR SARS-CoV-2
• Peripheral capillary oxygen saturation less than or equal to 94% (SpO2≤94%) despite oxygen therapy greater than or equal to 3 L/min (≥ 3 L/min)
• Organ failure requiring admission to a resuscitation or high dependency unit
• Comorbidity that is life-threatening in the short-term (life expectancy <3 months)
• Any reason that makes follow-up at day 28 impossible
• Current treatment with hydroxychloroquine or hydroxychloroquine plus azithromycin
• Absolute contraindication to treatment with hydroxychloroquine (known hypersensitivity, concomitant treatment with risk of torsades de pointe) or azithromycin (known hypersensitivity to azithromycin, erythromycin, other macrolide, ketolide, in association with rye ergot alkaloids, cisapride, colchicine or severe hepatic failure)
• glucose-6-phosphate dehydrogenase (G6PD) known deficit
• Porphyria
• Hypokaliemia < 3.5 mmol/L
• Electrocardiogram showing corrected QT prolongation greater than 440 ms in men and 460 ms in women
• Child C liver cirrhosis
• Chronic kidney failure with estimated glomerular filtration rate (GFR) ≤ 30 ml/min
• Pregnant, lactating or parturient women
• Patient included in a randomized clinical trial

Adult patients with COVID-19 infection diagnosed by positive RT-PCR SARS-CoV-2 or, if not performed, by thorax CT-scan suggesting viral pneumonia of peripheral predominance in a clinically significant context that can't or don't want to participate to a randomized clinical trial