COVID-19
Conditions
Brief summary
The goal of this clinical trial (phase 2/phase 3) is to evaluate the efficacy and safety of emetine administered orally for symptomatic Covid-19 patients in patients ages 30 years and above. Participants will be asked to: * Take Emetine 6mg orally for 10 consecutive days * Be monitored by healthcare staff or self-monitor for daily vital signs and symptoms * Undergo blood draws Researchers will compare the control group given placebo medicine to assess if emetine improved the symptoms of Covid-19.
Detailed description
More than 675 million cases of coronavirus disease-19 (COVID-19) have occurred in this ongoing pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). More than 6.8 million people have died so far, with case count and deaths cumulating every day. Despite the scale of the damage, there exists extremely limited antiviral treatment options for Covid-19. Emetine exhibits broad spectrum antiviral activity including inhibition of SARS-CoV-2 by inhibiting viral replication and protein biosynthesis. It has been have recently shown that by lowering the standard amoebicidal dose by a factor of 10, emetine can inhibit viral replication while avoiding cardiovascular toxicity. Therefore, the investigators plan to evaluate emetine's efficacy and safety for treatment of symptomatic Covid-19 in a randomized, clinical trial. Emetine, an alkaloid extracted from ipecacuanha roots, was widely used for the treatment of amoebic dysentery. Because of cardiotoxicity (cardiac dysrhythmias), emetine was replaced by metronidazole. The toxicity was unequivocally associated with high-dose emetine (60 mg/day for 10 days to achieve a minimum inhibitory concentration (MIC) of 25 µM against Entamoeba hystolytica); however, the cardiovascular side-effects were minimal or none when emetine was used for various indications in low dose (\<20 mg/day). In a screening of 3000 potential compounds against SARS-CoV-2, emetine was found to have the lowest half maximal inhibitory concentration (IC50) of 4.0e-4 µM and a half maximum cytotoxicity concentration (CC50) \>10 µM in Vero E6 cells providing it a high therapeutic index. Likewise, several in-vitro studies have demonstrated very low IC50 (\ 0.05µM) against SARS-CoV-2 for emetine. Based on this, a lower dose of emetine (6 mg/day for 10 days) has been calculated for the treatment of SARS-CoV-2. The investigators hypothesize that low dose emetine will be effective and safe in the treatment of Covid-19. Extensive use of the drug in the past has documented that low dose usage avoids the cardiovascular side-effects there were present at higher doses (\>20 mg per day); however, the safety has not been systematically documented in a clinical trial, a key objective of this study. The primary objective of the trial would be to evaluate the safety and efficacy of oral formulation of emetine for patients diagnosed with Covid-19 in a phase 2 study to be followed up by a multicenter phase 3 study based on the preliminary results. Proven beneficial, this study has the potential to save millions of lives by providing a viable, convenient option for treatment of Covid-19. Preliminary results can provide the basis for additional research to evaluate added benefit to patients by combining emetine with other drugs. Emetine has also been shown in-vitro to have activity against Middle East Respiratory Syndrome (MERS), Zika, Cytomegalovirus and Ebola virus infections-this highlights a broader application for emetine beyond coronavirus infections.
Interventions
DRUGEmetine Hydrochloride
To administer Emetine Hydrochloride 6mg orally for 10 consecutive days to evaluate the efficacy and safety of emetine for symptomatic Covid-19 patients.
DRUGPlacebo
Participant takes a placebo for 10 consecutive days.
Sponsors
Johns Hopkins University
Nepal Health Research Council
Bharatpur Hospital Chitwan
Stony Brook University
Rutgers University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Masking description
Double-blinded trial
Intervention model description
Double-blinded randomized controlled clinical trial (RCT) with placebo and intervention group
Eligibility
Sex/Gender
ALL
Age
30 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 30 years of age or older at time of randomization * RT-PCR positive for SARS-CoV-2 infection within ≤ 10 days of the screening visit. * In addition to confirmed RT-PCR, symptomatic Covid-19 patients with at least two or more symptoms within 7 days of the screening visit: Cough, shortness of breath, fever/chills, sore throat, nausea, vomiting, diarrhea, fatigue, body aches, headache * Ability to give informed consent (administered in local language)
Exclusion criteria
* Asymptomatic Covid-19 patients * Pregnant or breastfeeding woman * Current or recent use of the study drug * Known allergy to study drug * Current or planned participation in another interventional trial in next 10 days. * Critical Covid-19 patients (ARDS) at the time of screening. * Patients needing intubation, mechanical ventilation, or ICU care at screening * Patients with prior cardiac disease including cardiac dysrhythmias, heart failure, ischemic heart disease or cardiomyopathies.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Evaluate effectiveness of emetine in symptomatic Covid-19 patients | After medication administration up to 30 days | Effectiveness of emetine will be assessed by a 1) composite outcome of Hospitalization, ICU admission, mechanical ventilation, death |
| Evaluate safety of emetine in symptomatic Covid-19 patients | Duration of the intervention and for up to 30 days post intervention | All serious adverse events (SAEs), adverse events (AEs) will be documented and described using descriptive statistics. Adverse events will be per the Medical Dictionary for Regulatory Activities (MedDRA) and categorized by system organ class, accompanied by duration (in days), and start and stop dates. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Virologic conversion as assessed by SARS-CoV-2 real time polymerase chain reaction (RT-PCR) | Day 0 and then at days 3, 5 and 10 | We will measure the time to virologic conversion as a single outcome. Qualitative SARS-CoV-2 RT-PCR result from nasopharyngeal swabs with cycle threshold (ct) value. |
| Anti-inflammatory effect of emetine | Days 0 (baseline), 3 and 7 for up to 10 days after intervention | Measure interleukin-6 (IL-6) in picograms per milliliter (pg/ml) for in-patients. |
Countries
Nepal, United States
Contacts
PRINCIPAL_INVESTIGATORKunchok Dorjee, MBBS, PhD, MPH
Johns Hopkins School of Medicine
Outcome results
None listed