Pilot Clinical Trial of the Safety and Efficacy of Telmisartan for the Mitigation of Pulmonary and Cardiac Complications in COVID-19 Patients

Phase 2

Terminated

Brief Summary: This study will enroll 40 symptomatic outpatients tested positive for Coronavirus 2019 (COVID-19). Patients to be randomized 1:1 to Telmisartan (40 mg) vs placebo to be administered orally once daily x 21 days. Daily, the study patients will be asked to keep a record of the severity of their fever, dyspnea and fatigue and take their blood pressure (BP) and temperature. Study visits to occur on day 1 (entry), day 4, day 10 and day 21. Oro-pharyngeal swabs, and approximately 25 cc of blood will be collected at each study visit for safety labs and for the evaluation of the renin-angiotensin system (RAS) system and for various blood biomarkers of inflammation, coagulation and fibrosis.

Recruitment & Eligibility

Inclusion Criteria

Able to provide written informed consent prior to initiation of any study procedures.
Understands and agrees to comply with planned study procedures including self testing of blood pressure daily
Male or non-pregnant female adult ≥18 years of age at time of enrolment.
Has laboratory-confirmed severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection as determined by FDA-approved commercial or public health assay in any specimen collected ideally < 72 hours prior to randomization. Exceptions to the <72 hr inclusion criteria may be made at the discretion of the investigator.
Positive for COVID-19 symptoms: fever defined as a temperature of >100.4 on study screening or self-report of daily fever at home OR shortness of breath of any degree OR fatigue causing greater than minimal interference with usual social & functional activities
Women of childbearing potential must agree to use at least one primary form of contraception for the duration of the study
Able to easily swallow pills

Exclusion Criteria

Immediate need for hospitalization on screening
Systolic blood pressure less than 100 mmHg
Self-reported presence of chronic kidney disease or requiring dialysis
Self-reported history of liver failure or untreated hepatitis B or C
Pregnancy or breast feeding
Allergy to the study medication
Current use of angiotensin receptor blocker (ARB) or angiotensin converting enzyme (ACE) Inhibitor medications. Other blood pressure medications will be permitted in the systolic BP is higher than 90 mmHg
Prior reaction or intolerance to ARB or ACE Inhibitor
Use of aliskiren in patients with diabetes
Current use of and on-going need for lithium, digoxin, potassium sparing diuretics such as spironolactone
Current use of and need for potassium supplements
Current or past participation in a research study within 12 weeks prior to the Screening Visit unless cleared by Study Team
Inability to drive safely for study visits
Subjects, who, in the opinion of the investigator, are unable to comply with the protocol evaluation, or for whom study participation may not be advisable

Arm && Interventions

Group	Intervention	Description
Placebo	Placebo	Placebo
Telmisartan	Telmisartan 40mg	Telmisartan 40 mg po daily x 21 days

Primary Outcome Measures

Name	Time	Method
Maximum Clinical Severity of Disease Since Entry	maximum clinical severity of disease post entry evaluated over the 21 day clinical study	We utilized the World Health Organization (WHO) COVID-19 7-point ordinal scale: 1 (not hospitalized, no limitations on activities), 2 (not hospitalized limitation on activities); 3 (hospitalized, not requiring oxygen); 4 (hospitalized and requiring oxygen); 5 (hospitalized, on non-invasive ventilation or high flow oxygen devices); 6 (hospitalized, on invasive mechanical ventilation or ECMO) and 7 (death). A symptom scale was devised to allow 'fine tuning' within the 2.0 WHO category of 'not hospitalized but limitation on activities' based on severity (no symptoms, mild, moderate, moderately severe and severe symptoms) of fever, breathing and fatigue severity scale (0 to 4 points for each factor allowing a max score of 12). A WHO scale within the '2' category was then 'fine tuned' as follows: 2.0 (\</=3 symptom points), 2.25 (4-6 symptom points), 2.5 (7-9 symptom points), and 2.75 (10-12 symptom points).

Secondary Outcome Measures

Name	Time	Method
Number of Adverse Events	Through study completion at day 21 of study	Number of adverse events grade 2 and above utilizing the Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events, Version 2.0, November 2014