PATCH 2&3:Prevention & Treatment of COVID-19 (Severe Acute Respiratory Syndrome Coronavirus 2) With Hydroxychloroquine

Phase 2

Terminated

Conditions: Coronavirus
Corona Virus Infection

Interventions: Drug: Group 1 HCQ
Drug: Group 2 Placebo

Registration Number: NCT04353037

Lead Sponsor: UnitedHealth Group

Brief Summary: The proposed hypothesis is that high doses of hydroxychloroquine (HCQ) for at least 2 weeks can be effective antiviral medication both as a treatment in ambulatory patients and prophylaxis/treatment in health care workers because it impairs lysosomal function and reorganizes lipid raft (cholesterol and sphingolipid rich microdomains in the plasma membrane) content in cells, which are both critical determinants of Emerging Viral Disease (EVD) infection. This hypothesis is based on a growing literature linking chloroquine to antiviral activity. It is estimated that enough information exists to launch a clinical trial of hydroxychloroquine for COVID-19.

Detailed Description: Sub-Study 1: COVID-19 patients in self-quarantine. Group 1: Hydroxychloroquine 400 mg bid (two 200 mg tablets taken twice a day; totaling 800 mg per day) for two weeks; Group 2: Placebo 2 pills twice a day for two weeks

Sub-Study 2: Asymptomatic health care worker prophylaxis. Group 1: Hydroxychloroquine 600 mg once a day (three 200 mg tablets taken once a day) for up to 2 months; Group 2: Placebo 3 pills once a day for up to 2 months; cross-over from placebo to HCQ 600 mg once a day is allowed upon confirmatory diagnosis for COVID-19.

PRIMARY OBJECTIVES:

Sub-Study 1 (Patients tested for COVID-19 who meet symptomology and age requirements for eligibility): Rate of hospitalization

Sub-Study 2 (Health Care Workers): Rate of COVID-19 infection (confirmed by accepted testing methods) at 2 months

SECONDARY OBJECTIVES Sub-Study 1: Rate of secondary infection of co-inhabitants, adverse events, and negative for COVID-19 (confirmed by accepted testing methods) at 14 days

Sub-Study 2: Number of shifts missed; rate of adverse events, and hospitalization at 2 months

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 39

Inclusion Criteria

Able to give informed consent
Subjects meeting the following criteria by Sub-Study:

Sub-Study 1: 50-75 years of age; self-reporting as having a fever within four days prior to time of enrollment; and not requiring hospitalization. Enrolled individuals will undergo testing for COVID-19 and sent home for self-quarantine.Participant must be willing and able to provide informed consent, agree to testing for COVID-19 at time of enrollment to confirm diagnosis and two weeks at the end of treatment.

Sub-Study 2: Currently employed as a health care worker. Health care workers are defined as :

Medical Doctor (MD)
Doctor of Osteopathic Medicine (DO)
Nurse Practitioner (NP)
Physician's Assistant (PA)
Registered Nurse (RN)
other members of the medical care team with significant COVID-19 exposure;

Health care workers meeting the following criteria:

asymptomatic and presumed negative for COVID-19 (no confirmatory testing conducted);
scheduled for an average of >20 hours per week of clinical care over the next 2 months.

Participant must agree to standard clinical guidelines and undergo COVID-19 testing upon the presentation of symptoms indicative of an influenza like illness; if a confirmatory COVID-19 diagnosis is given, participant will be offered to cross-over to HCQ 600 mg qd.

Willing to report compliance with HCQ in the form of a diary and participate in other forms of self-reporting (e.g., symptom tracker and experience log).
Subjects are willing and able to go to designated areas for testing of COVID-19/SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2).
Participants must be able to swallow and retain oral medication and must not have any clinically significant gastrointestinal abnormalities that may alter absorption such as malabsorption syndrome or major resection of the stomach or bowels.
Participants must have adequate baseline organ function

Exclusion Criteria

Inclusion Criteria
- Able to give informed consent
- Subjects meeting the following criteria by Sub-Study:

Sub-Study 1: 50-75 years of age; self-reporting as having a fever within four days prior to time of enrollment; and not requiring hospitalization. Enrolled individuals will undergo testing for COVID-19 and sent home for self-quarantine. Participant must be willing and able to provide informed consent, agree to testing for COVID-19 at time of enrollment to confirm diagnosis and two weeks at the end of treatment.

Sub-Study 2: Currently employed as a health care worker (Medical Doctor, MD; Doctor of Osteopathic Medicine, DO; Nurse Practitioner, NP; Physician's Assistant, PA; and Registered Nurse, RN or other members of the medical care team with significant COVID-19 exposure); asymptomatic and presumed negative for COVID-19 (no confirmatory testing conducted); scheduled for an average of >20 hours per week of clinical care over the next 2 months. Participant must agree to standard clinical guidelines and undergo COVID-19 testing upon the presentation of symptoms indicative of an influenza like illness; if a confirmatory COVID-19 diagnosis is given, participant will be offered to cross-over to HCQ 600 mg qd.

Willing to report compliance with HCQ in the form of a diary and participate in other forms of self-reporting (e.g., symptom tracker and experience log).
Subjects are willing and able to go to designated areas for testing of COVID-19/SARS-CoV-2.
Participant must be able to swallow and retain oral medication and must not have any clinically significant gastrointestinal abnormalities that may alter absorption such as malabsorption syndrome or major resection of the stomach or bowels.
Participant must have adequate baseline organ function

Exclusion Criteria

Allergy to hydroxychloroquine
Pregnant or lactating or positive pregnancy test during pre-medication examination
Receiving any trial treatment drug for 2019-ncov within 14 days prior to screening evaluation (off label, compassionate use or trial related).
Known retinal disease including but not limited to macular degeneration, retinal vein occlusion, visual field defect, diabetic retinopathy
History of interstitial lung disease or chronic pneumonitis unrelated COVID-19.
Due to risk of disease exacerbation, participants with porphyria or psoriasis are ineligible unless the disease is well-controlled, and they are under the care of a specialist for the disorder who agrees to monitor the Participant for exacerbations.
Participants with serious intercurrent illness that requires active intravenous therapy, intense monitoring, or frequent dose adjustments for medication including but not limited to infectious disease, cancer, autoimmune disease, cardiovascular disease.
Participants who have undergone major abdominal, thoracic, spine or central nervous system (CNS) surgery in the last 2 months, or plan to undergo surgery during study participation.
Participants receiving cytochrome P450 enzyme-inducing anticonvulsant drugs (i.e. phenytoin, carbamazepine, Phenobarbital, primidone or oxcarbazepine) within 4 weeks of the start of the study treatment
Participants currently taking digoxin
History or evidence of increased cardiovascular risk including any of the following:
Left ventricular ejection fraction (LVEF) < institutional lower limit of normal. Baseline echocardiogram is not required.
Current clinically significant uncontrolled arrhythmias. Exception: Subjects with controlled atrial fibrillation
History of acute coronary syndromes (including myocardial infarction and unstable angina), coronary angioplasty, or stenting within 6 months prior to enrollment
Current ≥ Class II congestive heart failure as defined by New York Heart Association.
Deemed unable to participate for medical reasons identified by Co-PI and study staff.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Sub Study 1 Patients	Group 1 HCQ	Patients tested for COVID-19 who meet symptomology and age requirements for eligibility
Sub Study 1 Patients	Group 2 Placebo	Patients tested for COVID-19 who meet symptomology and age requirements for eligibility
Sub Study 2 Health Care Workers	Group 1 HCQ	Rate of COVID-19 infection (confirmed by accepted testing methods) at 2 months
Sub Study 2 Health Care Workers	Group 2 Placebo	Rate of COVID-19 infection (confirmed by accepted testing methods) at 2 months

Primary Outcome Measures

Name	Time	Method
Substudy 1 - Number of COVID-19+ PCR Patients in Self-quarantine Who Are Hospitalized	Until completion of study, 29 to 31 days after beginning treatment.	Number of COVID-19+ PCR patients in self-quarantine who are hospitalized up to 31 days after beginning HCQ or Placebo
Sub Study 2:Number of Health Care Workers Testing Positive at 2 Months	Until completion of study, 2 months after start of treatment.	Rate of COVID-19 infection (confirmed by accepted testing methods) at 2 months

Secondary Outcome Measures

Name	Time	Method
Sub Study 1 - Secondary Infection of Co-inhabitants of COVID-19 Positive PCR Patients in Self-quarantine	Until completion of study, 29 to 31 days after beginning treatment.	Co-inhabitants of COVID-19 positive PCR patients in self-quarantine that test positive up to 31 days after patient begins treatment with HCQ or Placebo
Sub Study 1 - Rate of Negative Tests at End of Treatment for COVID-19 Positive PCR Patients in Self-quarantine	1-3 days after completion of 14 day treatment	Rate of negative tests at end of treatment for COVID-19 positive PCR patients in self-quarantine
Sub Study 2:Health Care Workers:Number of Shifts Missed	up to ~60 days after enrollment	Any work time missed because the participant experienced COVID-like symptoms during their active 2 month period
Sub Study 2:Health Care Workers: Assessment of Any Medical Events That Occur During the ~60 Day Active Period	Until completion of study, 2 months (~60 days) after start of treatment.	Assessment of any medical events that occur during the \~60 day active period that is felt to be related to receipt of HCQ
Sub Study 2:Health Care Workers:Rate of Hospitalization	Until completion of study, 2 months after start of treatment.	if the participant gets COVID and has severe symptoms and hospitalized, end point reached if before the end of the 2 month period