This is a clinical trial to evaluate the efficacy of LAM-002A compared to placebo treatment in adults with a confirmed SARS-CoV-2 infection who are receiving standards supportive care in an outpatient setting.

This is a Phase II randomized, double-blind, placebo-controlled, clinical study to evaluate the efficacy of LAM-002A compared to placebo treatment in adults with a confirmed SARS-CoV-2 infection who are receiving standard supportive care in an outpatient setting.

Study eligibility will be assessed during screening. All study participants must sign a written informed consent and satisfy the inclusion and exclusion criteria for the study. Confirmation of SARS-CoV-2 infection, medical history, and current medication will be assessed for each consenting participant at screening.

Study participants will be randomized in a 1:1 ratio, to receive study therapy (either LAM-002A, 125 mg [5 capsules/dose]) PO BID or placebo [5 capsules/dose] PO BID) for 10 days. Participants who experience an adverse event (AE) considered to be related to study therapy may have a decrease in study dose of LAM-002A to 100 mg [4 capsules/dose]) PO BID or placebo [4 capsules/dose] PO BID). After the start of treatment on Day 1, participants will be followed at Days 4,6,8,11,22, and 28. Days 6,8, and 22 will be phone visits. Participants can withdraw from the study therapy or study participation at any time.

The study will incorporate an interim safety analysis after the first 30 participants (15 on LAM-002A and 15 on placebo) have completed treatment and have been followed up for 11 days post-first dose. Recruitment and randomization will continue while this analysis is conducted. Recommendations from an independent Data Safety Monitoring Board (DSMB) will be used for decisions of early termination or study design adaptations.

Non-parametric and parametric statistical analysis will be conducted, as appropriate. For the comparison of the LAM-002A active arm and the control arm for the primary endpoint and secondary endpoints of drug effect, appropriate methods will be employed. Baseline subject characteristics, study therapy administration/compliance, safety, supportive care administration, and pharmacokinetics will be analyzed descriptively.

Inclusion Criteria:

1. Written documentation of SARS-CoV-2 infection confirmed by a validated test.
2. Presence of greater than or equal to ≥1 of the following COVID-19-related symptoms indicating mild disease: fever (temperature ≥100.4), anosmia (loss of taste or smell), cough, sore throat, gastrointestinal complaints (e.g. nausea, vomiting, or diarrhea), chills, congestion, or runny nose, headaches, muscle or body aches, fatigue, or asymptomatic patients who have tested positive for COVID-19 via a validated test within the past 4 days.
3. If symptomatic, symptom onset less than or equal to ≤ 8 days.
4. For female participants of childbearing potential, a negative urine (or serum) pregnancy test.
5. For female participants of childbearing potential, willingness to use a protocol-recommended method of contraception from the start of the screening period until greater than or equal to ≥30 days after the final dose of study therapy. Note: A female subject is considered to be of childbearing potential unless she has had a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy; has medically documented ovarian failure (with serum estradiol and follicle-stimulating hormone [FSH] levels within the institutional laboratory postmenopausal range and a negative serum or urine beta human chorionic gonadotropin [βHCG]); or is menopausal (age ≥50 years with amenorrhea for ≥6 months).
6. For male participants who can father a child and are having intercourse with females of childbearing potential who are not using adequate contraception, willingness to use a protocol-recommended method of contraception from the start of study therapy until ≥30 days after the final dose of study therapy and to refrain from sperm donation from the start of study therapy until ≥90 days after administration of the final dose of study therapy. Note: A male subject is considered able to father a child unless he has had a bilateral vasectomy with documented aspermia or a bilateral orchiectomy.
7. Willingness and ability of the participant to ingest study drug capsules.
8. Willingness of the participant to comply with scheduled visits, drug administration plan, protocol-specified laboratory tests, study procedures, and study restrictions.
9. Evidence of a personally signed informed consent indicating that the participant is aware of the nature of the disease and has been informed of the procedures to be followed, the experimental nature of the therapy, alternatives, potential risks and discomforts, potential benefits, and other pertinent aspects of study participation.

Exclusion Criteria:

1. Respiratory rate greater than or equal to ≥20 breaths per minute.

2. Oxygen saturation by pulse oximetry less than or equal to ≤93 percent % on room air or requirement for supplemental oxygen to maintain oxygen saturation greater than >93 percent %.

3. Total NEWS score greater than or equal to ≥6 or presence of a score of 3 on any of the individual NEWS parameters.

4. Radiographic evidence of pulmonary infiltrates (clinical X-ray within 2 days of referral)

5. Hepatic profile showing any of the following:

   • Serum alanine aminotransferase (ALT) greater than >5 × upper limit of normal (ULN) (CTCAE Grade greater than or equal to ≥3).
   • Serum aspartate aminotransferase (AST) greater than >5 × ULN (CTCAE Grade greater than or equal to ≥3).
   • Serum bilirubin greater than >1.5 × ULN (CTCAE Grade greater than or equal to ≥2).

6. Renal profile showing an estimated creatinine clearance (eClCR) less than <30 mL/minute (with eClCR to be calculated by the method at the laboratory performing the serum creatinine test).

7. Presence of a cancer with disease manifestations or therapy that could adversely affect subject safety or longevity, create the potential for drug-drug interactions, or compromise the interpretation of study results.

8. Significant cardiovascular disease (e.g. myocardial infarction, arterial thromboembolism, cerebrovascular thromboembolism) within 1 month prior to start of study therapy; unstable angina; symptomatic peripheral vascular disease; CTCAE Grade greater than or equal to ≥2 congestive heart failure; or uncontrolled CTCAE Grade greater than or equal to ≥3 hypertension (diastolic blood pressure greater than or equal to ≥100 mmHg or systolic blood pressure greater than or equal to ≥160 mmHg) despite antihypertensive therapy.

9. Significant screening ECG abnormalities, including atrial fibrillation/flutter, 2nd degree atrioventricular (AV) block type II, 3rd-degree AV block, Grade greater than or equal to ≥2 bradycardia, or corrected QT (QTc by Fridericia [QTcF]) greater than >480 msec (Grade greater than >1).

10. Gastrointestinal disease (e.g. gastric or intestinal bypass surgery, pancreatic enzyme insufficiency, malabsorption syndrome, symptomatic inflammatory bowel disease, chronic diarrheal illness, bowel obstruction) that might interfere with drug absorption or with interpretation of gastrointestinal AEs.

11. Pregnancy or breastfeeding.

12. Prior solid organ transplantation.

13. Use within 5 days prior to randomization of an approved or investigational therapy intended to treat COVID-19 (e.g. remdesivir, , anti-interleukin [IL]-6 antibodies, therapeutic anti-SARS CoV-2 antibodies or post-convalescent plasma, anti- SARS CoV-2 vaccine, Bruton tyrosine kinase [BTK] inhibitor), use within 3 months of chloroquine or hydroxychloroquine. Note: participants are not precluded from undergoing evaluations involving observation, noninvasive diagnostic procedures or sampling, or questionnaires as follow-up to a prior study or as components of a concurrent noninterventional study.

14. Use within 5 days prior to randomization of a strong inhibitor or inducer of cytochrome P450 (CYP) 3A4 or expected requirement for chronic use of a strong inhibitor or inducer of CYP3A4 during study therapy.

15. Use within 5 days prior to randomization of drug that is a moderate-to-strong substrate of CYP2C9 (including warfarin, tolbutamide, phenytoin, glimepiride) or expected requirement for chronic use of such drugs during study therapy.

16. Use within 5 days prior to randomization of a drug known to prolong the QT interval

17. Ongoing immunosuppressive therapy including systemic or enteric corticosteroids. (Note: At study entry, participants may be using intraarticular, inhaled, or topical corticosteroids. During study therapy, participants may use systemic, enteric, intraarticular, inhaled, or topical corticosteroids as required for intercurrent conditions.)

18. Any illness, medical condition, organ system dysfunction, or social situation, including mental illness or substance abuse, deemed by the investigator to be likely to interfere with a participant's ability to provide informed consent, adversely affect the participant's ability to cooperate and participate in the study, or compromise the interpretation of study results.

The intention-to-treat (ITT) population included all participants randomized according to their initial randomized assignment regardless of the treatment actually received.

Adverse events were collected from the first administration of study drug through Day 28 or when any ongoing drug-related adverse events (AEs) and/or serious adverse events (SAEs) resolved or became stable, up to 30 days.

Adverse Events were analyzed for all participants who received at least 1 dose of study treatment. In the Placebo group, 1 subject did not initiate treatment.

The study was potentially limited in its ability to discern a benefit of LAM-002A on viral and clinical endpoints due to the number of participants enrolled, the low baseline viral loads, and the short (4-day) duration of viral load evaluation.

Double-blinded