COVID-19
Conditions
Keywords
SARS-CoV-2, Coronavirus, COVID-19, chemoprophylaxis, Hydroxychloroquine
Brief summary
The number of confirmed cases of COVID-19 infectious disease arising from the SARS-CoV-2 coronavirus is rising substantially and rapidly, with the potential to overwhelm the ability of the entire National Health Service (NHS) to cope with the increased demand. The availability of personal protective equipment is limited and reports of high risk procedures such as aerosol generating procedures (e.g. intubation for the sickest patients) is a source of great concern for infection transmission. Frontline NHS staff with direct patient contact have the highest likelihood of exposure to SARS-CoV-2 and development of COVID-19 disease. Efforts to protect these workers from development of COVID-19, using drugs to prevent the disease, require urgent evaluation.
Detailed description
The number of confirmed cases of COVID-19 infectious disease arising from the SARS-CoV-2 coronavirus is rising substantially and rapidly, with the potential to overwhelm the ability of the entire National Health Service (NHS) to cope with the increased demand. The availability of personal protective equipment is limited and reports of high risk procedures such as aerosol generating procedures (e.g. intubation for the sickest patients) is a source of great concern for infection transmission. Frontline NHS staff with direct patient contact have the highest likelihood of exposure to SARS-CoV-2 and development of COVID-19 disease. Efforts to protect these workers from development of COVID-19, using drugs to prevent the disease, require urgent evaluation. This trial will be a double-blind, randomized, placebo-controlled trial in a cohort of frontline healthcare workers, who will potentially be exposed to SARS-CoV-2. Eligible participants will be frontline NHS workers aged 18 to 70 years who work in a healthcare setting with direct patient care. Participants will be randomised to one of 3 arms and receive either: (1) Hydroxychloroquine Daily (loading phase: 800mg for first 2 days; maintenance phase: 1 x 200mg tablet every day) + weekly placebo; (2) Hydroxychloroquine weekly (loading phase: 800mg for first 2 days; maintenance phase: 2 x 200mg tablets every 7th day/weekly) + daily placebo, or (3) placebo (daily and weekly). Participants will be reviewed at an interim visit 6 weeks after baseline and again and the end of the study treatment in 90 days (approximately 3 months) after randomization. Participants will also complete brief questions about their health weekly while on treatment (remotely, via app/web/phone-based interface).
Interventions
Active HCQ: Days 1-2: Loading phase - 400mg (2 x 200mg capsules) taken TWICE A DAY for 2 days Days 3 onwards: Maintenance Phase - 200mg (1 x 200mg capsule) taken ONCE A DAY, every day for 90 days (\ 3 months), Matched Placebo HCQ: Days 3 onwards: Maintenance Phase - 2 capsules taken ONCE A WEEK on the same day each week (every 7th day) for 90 days (\ 3 months)
Active HCQ: Days 1-2: Loading Phase - 400mg (2 x 200mg capsules) taken TWICE A DAY for 2 days Days 3 onwards: Maintenance Phase - 400mg (2 x 200mg capsules) taken ONCE A WEEK on the same day each week (every 7th day) for 90 days (\ 3 months) Matched Placebo HCQ: Days 3 onwards: Maintenance Phase - 1 capsule taken ONCE A DAY for 90 days (\ 3 months)
OTHERMatched Placebo Hydroxychloroquine
Matched placebo HCQ - daily dosing: Days 1-2: Loading Phase - 2 capsules taken TWICE A DAY for 2 days Days 3 onwards: Maintenance Phase - 1 capsule taken ONCE A DAY for 90 days (\ 3 months) Matched placebo HCQ - weekly dosing Days 3 onwards: Maintenance Phase - 2 capsules taken ONCE A WEEK on the same day each week (every 7th day) for 90 days (\ 3 months)
Sponsors
Cambridge University Hospitals NHS Foundation Trust
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Masking description
Double-blind
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
Yes
Inclusion criteria
To be included in the trial the participant MUST: 1. Have given written informed consent to participate 2. Be aged 18 years to 70 years 3. Not previously have been diagnosed with COVID-19 4. Work in a high-risk secondary or tertiary healthcare setting (hospitals accepting COVID-19 patients) with direct patient-facing care
Exclusion criteria
The presence of any of the following will mean participants are ineligible: 1. Known COVID-19 positive test at baseline (if available) 2. Symptomatic for possible COVID-19 at baseline 3. Known hypersensitivity reaction to HCQ, chloroquine or 4-aminoquinolines 4. Known retinal disease 5. Known porphyria 6. Known chronic kidney disease (CKD; eGFR\<30ml/min) 7. Known epilepsy 8. Known heart failure or conduction problems 9. Known significant liver disease (Gilbert's syndrome is permitted) 10. Known glucose-6-phosphate dehydrogenase (G6PD) deficiency 11. Currently taking any of the following contraindicated medications: 1. Digoxin 2. Chloroquine 3. Halofantrine 4. Amiodarone 5. Moxifloxacin 6. Cyclosporin 7. Mefloquine 8. Praziquantel 9. Ciprofloxacin 10. Clarithromycin 11. Prochlorperazine 12. Fluconazole 12. Currently taking hydroxychloroquine or having a clinical indication for taking hydroxychloroquine 13. Currently breastfeeding 14. Unable to be followed-up during the trial 15. Current or future involvement in the active treatment phase of other interventional research studies (excluding observational/non-interventional studies) before study follow-up visit 16. Not able to use or have access to a modern phone device/web-based technology 17. Any other clinical reason which may preclude entry in the opinion of the investigator
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to positive COVID-19 disease | Assessed up to 90 days | Time taken for incidence of COVID-19 disease between Hydroxychloroquine and placebo arms |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of COVID-19 test positive cases | Assessed up to 90 days | Number of COVID-19 symptoms based on clinical guidelines and test positive infections per study arm |
| Number of COVID-19 serological test positive cases | Assessed up to 90 days | Number of test positive COVID-19 serological test positive cases per study arm |
| Severity of COVID-19 disease between each arm | Assessed up to 90 days | Severity based on hospitalisation |
| Number of common COVID-19 complications between each arm | Assessed up to 90 days | Number of common COVID-19 complications between arms |
Countries
United Kingdom
Contacts
Primary ContactElla James, PhD
Backup ContactHeike Templin
Outcome results
None listed