Trial of Open Label Dipyridamole- In Hospitalized Patients With COVID-19

A Randomized, Open-label Study of the Vascular and Microbiologic Efficacy of Dipyridamole Plus Standard Care vs. Standard Care in Hospitalized COVID19 Patients

Brief Summary:

The goal here is to evaluate dipyridamole in treating respiratory tract infection and circulatory dysfunction due to SARS-CoV-2 coronavirus in hospitalized CVID-19 patients.

Infection with SARS-CoV-2 causes human COVID-19 (HCoV-19). The infection is associated with a deleterious inflammatory response and a prothrombotic state in addition to tissue damage from direct viral entry and proliferation. Dipyridamole has anti-platelet and anti-inflammatory effects. The drug was recently demonstrated to have anti-SARS-Cov-2 effect primarily in vitro. The concentration causing anti-viral effect in vitro is within that in the blood of humans taking this drug. As an oral tablet, it has the advantage of easy administration.

Anti thrombotic, anti viral and anti inflammatory actions of this drug may be efficacious and safe in hospitalized subjects

The original protocol stipulated an enrollment of 100 patients, randomized in a 1 to 1 distribution of treatment versus control [placebo] group. However, the study was terminated because of insufficient enrollment due to the dramatic reduction in the number of hospitalized COVID patients.

A total of 41 patients were randomized prior to study termination. Detailed reports and overall results were reviewed for all patients.

Adverse event occurrences were similar in groups. Given the severity of COVID, these numbers were not unexpected.

The DSMC concluded that all the AEs seen in study subjects are either unrelated or probably unrelated to the TOLD study intervention.

The DSMC reviewed the primary outcome results. No statistically significant change in either the platelet count or the D-dimer results.

Inclusion Criteria:

1. Adults ≥18 years of age.

2. COVID-19 positive by PCR and hospitalized for respiratory infection with a range of respiratory severity as follows.

   Moderate ● Diagnosed with SARS-CoV-2 infection by standard RT-PCR assay or equivalent testing

   ● Symptoms of moderate illness with COVID-19, which could include:

   o Fever, cough, sore throat, malaise, headache, muscle pain, gastrointestinal symptoms; shortness of breath with exertion

   • Clinical signs suggestive of moderate illness with COVID-19, such as:

     o RR ≥ 20, HR ≥ 90, SaO2 ≥93% on room air or requires ≤2L oxygen by nasal cannula (NC) in order maintain SaO2 ≥93%, fever >38.3 Celsius

   • No clinical signs indicative of Severe or Critical Illness Severity

   Severe

   • Diagnosed with SARS-CoV-2 infection by standard RT-PCR assay or equivalent testing

   • Symptoms suggestive of severe systemic illness with COVID-19, which could include:

     o any symptom of Moderate Illness; shortness of breath at rest or respiratory distress

   • Clinical signs indicative of severe systemic illness with COVID-19, such as

     o RR ≥ 30, HR ≥ 125, requires > 2L oxygen by NC in order maintain SaO2 ≥93%, PaO2/FiO2 <300

   • No criteria for Critical Severity

   Critical ● Diagnosed with SARS-CoV-2 infection by standard RT-PCR assay or equivalent testing

   • Evidence of critical illness, defined by at least 1 of the following:

     • Respiratory failure defined based on resource utilization requiring at least 1 of the following:

       ◙, Oxygen delivered by high-flow nasal cannula (heated, humidified, oxygen delivered via reinforced nasal cannula at flow rates >20L/min with fraction of delivered oxygen ≥0.5), noninvasive positive pressure ventilation, ECMO, or clinical diagnosis of respiratory failure (i.e., clinical need for one of the preceding therapies, but preceding therapies not able to be administered in setting of resource limitation)

     • Shock (defined by SBP < 90 mm Hg, or Diastolic BP < 60 mm Hg or requiring vasopressors)

     • Multiple organ dysfunction/failure

3. Able to give written informed consent in English to participate in the study by patient.

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Exclusion Criteria:

• Exclusion Criteria:

  1. Inability to swallow or ingest oral medication in either tablet form or in suspension form.

  2. Patient is known to be pregnant

  3. Patients with a history of allergy or hypersensitivity to dipyridamole

  4. Patient is unable to consent -intubated, on mechanical ventilation

  5. Bleeding disorders (e.g. thrombocytopenia with platelet counts < 50,000)

  6. Existing severe medical illnesses unrelated to Covid-19 infection such as end stage heart, kidney, liver disorders;

     or hepatic insufficiency defined as liver enzymes ≥5 times upper limit normal if baseline is normal or 5 times baseline if baseline is abnormal.

     Metastatic cancer as well as those with severe coronary artery disease, unstable angina, STEMI, NSTEMI, hypotension (systolic blood pressure <90mmHg), myocarditis, bradycardia with resting heart rate less than 60 bpm, atrioventricular block without pacemaker.

     Those with myasthenia gravis and those treated with cholinesterase inhibitors

  7. Patient is enrolled in a clinical trial for another investigational drug designed to test for efficacy for SARS-CoV-2