The severe acute respiratory syndrome coronavirus 2 (SARS-CoC-2), the virus responsible for coronavirus disease 2019 (COVID-19), is associated with a high incidence of acute respiratory distress syndrome (ARDS) and death. Aging, obesity, diabetes, hypertension and other risk factors associated with abnormal lipid and carbohydrate metabolism are risk factors for death in COVID-19. Recent studies suggest that COVID-19 progression is dependent on metabolic mechanisms. Moreover, gene expression analyses in cultured human bronchial cells infected with SARS-CoV-2 and lung tissue from patients with COVID-19, indicated a marked shift in cellular metabolism, with excessive intracellular lipid generation. In this cell culture system, fenofibrate (a widely available low-cost generic drug approved by the FDA and multiple other regulatory agencies around the world to treat dyslipemias) at concentrations that can be achieved clinically, markedly inhibited SARS-CoV-2 viral replication. Fenofibrate also has immunomodulatory effects that may be beneficial in the setting of COVID-19. The aim of this trial is to assess the clinical impact of fenofibrate (145 mg/d of Tricor or dose-equivalent preparations for 10 days, with dose adjustment in chronic kidney disease ([CKD]) to improve clinical outcomes in patients with COVID-19.
Other: Fenofibrate/fenofibric acid
The randomized intervention will be fenofibrate (Tricor) at a dose of 145 mg/d or dose-equivalent preparation of fenofibrate or fenofibric acid, for 10 days. In all cases, appropriate dose reductions will be implemented for patients with chronic kidney disease as per the approved preparation label. The intended duration of randomized treatment will be for 10 days.
Other: Placebo
The control intervention will be a placebo, for 10 days.
Other: Usual care
All participants will otherwise receive usual medical care
Inclusion Criteria:
- A diagnosis of COVID-19, based on: (a) A compatible clinical presentation with a
positive laboratory test for SARS-CoV-2, or (b) Considered by the primary team to be a
Person Under Investigation undergoing testing for COVID-19 with a high clinical
probability, in addition to compatible pulmonary infiltrates on chest x-ray
(bilateral, intersticial or ground glass opacities) or chest CT.
- Able to provide informed consent.
- Fewer than 14 days since symptom onset.
Exclusion Criteria:
- Known pregnancy or breastfeeding
- Estimated glomerular filtration rate (eGFR) <30 mL/min/1.73m2 or undergoing dialysis
(CKD stages 4-5).
- History of active liver disease, cholelithiasis, uncontrolled hypothyroidism, or
rhabdomyolysis (suspected or confirmed). Patients with a history of hypothyroidism
receiving a stable dose of thyroid replacement therapy for at least 6 weeks, with a
documented normal TSH (primary hypothyroidism) or free thyroxine (secondary or
tertiary hypothyroidism) level at least 6 weeks after the last dose change will be
considered eligible for enrollment.
- Known hypersensitivity to fenofibrate or fenofibric acid.
- Ongoing treatment with fenofibrate, clofibrate, warfarin and other coumarin
anticoagulants, glimepiride, cyclosporine, tacrolimus
- Use of statins other than simvastatin, pravastatin or atorvastatin ≤40 mg/d or
rosuvastatin ≤20 mg/d
- Prisoners/incarcerated individuals
- Inability to read, write or no access to a smart phone, computer or tablet device
- Intubated patients.
University of Pennsylvania Health System
Philadelphia, Pennsylvania, United States