COVID-19
Conditions
Brief summary
The ECLA PHRI COLCOVID Trial is a simple, pragmatic randomized open controlled trial to test the effects of colchicine on moderate/high-risk hospitalized COVID-19 patients with the aim of reducing mortality and/or new requirement for mechanical ventilation.
Detailed description
Various anti-viral treatments are being tested in clinical trials worldwide. The World Health Organization (WHO) launched a simple,pragmatic worldwide open-label trial to test Remdesivir, Lopinavir/Ritonavir, Interferon and Hydroxychloroquine or Chloroquine.The most important complication of COVID-19 severe cases is respiratory failure from severe acute respiratory syndrome (SARS), the leading cause of mortality. Accumulating evidence suggests that patients with severe COVID-19 might have a cytokine storm syndrome, a hyperinflammatory syndrome characterized by a fulminant and fatal hypercytokinemia and multiorgan failure. The proposed pathophysiological mechanism of cytokine storm and inflammatory cascade activation is based on evidence collected primarily during the SARS-CoV and MERS-CoV epidemics (with a significant increase in IL1B, IL6, IL12, IFNγ, IP10, TNFα, IL15, and IL17 among others). The data collected during the pandemic with COVID-19 also shows a significant increase in inflammatory cytokines (GCSF, IP10, MCP1, MIP1A, and TNFα, among others) in sicker patients admitted to intensive care. In the absence of effective treatments for the management of patients with COVID-19 and respiratory failure, the immunomodulatory and anti-inflammatory effect of colchicine on cytokines involved in the hyper-inflammatory state is postulated. Several lines of research worldwide are testing powerful anti-inflammatory drugs for the pandemic, with different options including steroids, cytokine blockers, and other potent anti-inflammatory agents. Steroids are partially contraindicated in viral infections. Colchicine is a powerful anti-inflammatory drug approved for the treatment or prevention of gout and Familial Mediterranean Fever at doses ranging between 0.3 mg and 2.4 mg/day. Its mechanism of action is through the inhibition of tubulin polymerization, as well as through potential effects on cellular adhesion molecules and inflammatory chemokines. It might also have direct anti-inflammatory effects by inhibiting key inflammatory signalling networks known as inflammasome and pro-inflammatory cytokines. Additionally, evidence suggests that colchicine exerts a direct anti-inflammatory effect by inhibiting the synthesis of tumor necrosis factor alpha and IL-6, monocyte migration, and the secretion of matrix metalloproteinase-9. Through the disruption of the cytoskeleton, colchicine is believed to suppress secretion of cytokines and chemokines as well as in vitro platelet aggregation. All these are potentially beneficial effects that might diminish or ameliorate the COVID-19 inflammatory storm associated with severe forms of the disease. Importantly, in one contemporary trial low-dose colchicine administered to patients who survived from acute coronary syndrome shows a statistically significantly reduction of cardiovascular complications. We have therefore designed in a simple, pragmatic randomized controlled trial to test the effects of colchicine on severe hospitalized COVID-19 cases with the aim of reducing mortality. Sample size calculation: A minimum sample size of 1200 patients will provide 80% power to detect a relative risk reduction of approximately 30% in the treated group if the assumed composite rate (new requirement of intubation and / or death) in the control group is about 24%. The ECLA PHRI COLCOVID Trial allows randomization to another trial, specifically patients included in the trial might be (or not) randomized to an antithrombotic strategy.
Interventions
DRUGColchicine
The colchicine dosage schedule will vary according to the following scenarios: 1. In patients not receiving Lopinavir/Ritonavir * Loading dose of 1.5 mg followed by 0.5 mg after two hours (day 1) * The next day 0.5 mg bid for 14 days or until discharge. 2. In patients receiving Lopinavir/Ritonavir * Loading dose of 0.5 mg (day 1) * After 72 hours from the loading dose, 0.5 mg every 72 hours for 14 days or until discharge. 3. Patients under treatment with Colchicine that are starting with Lopinavir/Ritonavir * Dose of 0.5 mg 72 hours after starting Lopinavir/Ritonavir. * Continue with 0.5 mg every 72 hours for 14 days or until discharge. Only the oral route will be used except in the case of patients associated with mechanical ventilation or with contraindications to the oral route, in whom it will be administered by nasogastric tube.
Local standard of care for COVID-19 SARS moderate /high-risk patients
Sponsors
Population Health Research Institute
Estudios Clínicos Latino América
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Simple pragmatic randomized open controlled trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
(case definition) * Consented adults (age ≥18 years) and * COVID-19 suspicious and * Admitted to hospital or already in hospital and * COVID-19 suggestive symptoms (fever or febrile equivalent, loss of smell and taste, fatigue, etc.) that may be present or absent at randomization time and * SARS (severe acute respiratory syndrome) * shortness of breath (dyspnea) or * image of typical or atypical pneumonia or * oxygen desaturation (SpO2 ≤ 93)
Exclusion criteria
* Clear indication or contraindication for the use of colchicine * Pregnant or breastfeeding female. * Chronic renal disease with creatinine clearance \<15 ml/min/m2 * Negative PCR test for SARS-COV2
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Composite outcome: New requirement for mechanical ventilation or death | 28 days post randomization | Number of participants who require new intubation for mechanical ventilation or die |
| Mortality | 28 days post randomization | Number of participants who die |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mortality due to respiratory failure | 28 days post randomization | Number of participants who die from respiratory failure |
| Mortality due to non-respiratory failure | 28 days post randomization | Number of participants who die from non-respiratory failure |
| In hospital - Composite outcome | During hospitalization or until death, whichever comes first, assessed up to 28 days | Number of participants who require intubation for mechanical ventilation or die |
| In hospital - Mortality | During hospitalization or until death, whichever comes first, assessed up to 28 days | Number of participants who die |
| New requirement for mechanical ventilation or death from respiratory failure | 28 days post randomization | Number of participants who require new intubation for mechanical ventilation or die from respiratory failure |
| Mortality evaluated in Non-intubated population | 28 days post randomization | Number of participants who were not intubated at randomization and die |
| Mean WHO descriptive score of COVID-19 during hospitalization | During hospitalization or until death, whichever comes first, assessed up to 28 days | Mean WHO descriptive score of COVID-19 in the active treatment group compared to the placebo group |
| Highest WHO descriptive score of COVID-19 during hospitalization | During hospitalization or until death, whichever comes first, assessed up to 28 days | Mean highest WHO descriptive score of COVID-19 in the active treatment group compared to the placebo group |
| Composite outcome (New requirement for mechanical ventilation or death) evaluated in Non-intubated population | 28 days post randomization | Number of participants who were not intubated at randomization and require new intubation for mechanical ventilation or die |
| New requirement for mechanical ventilation or death from non-respiratory failure | 28 days post randomization | Number of participants who require new intubation for mechanical ventilation or die from non-respiratory failure |
Countries
Argentina
Outcome results
None listed