The COVID-19 pandemic has been characterized by high morbidity and mortality, especially in certain subgroups of patients. To date, no treatment has been shown to be effective in controlling this disease in hospitalized patients with moderate and / or severe cases of this disease. Hydroxychloroquine and lopinavir / ritonavir have been shown to inhibit SARS-CoV viral replication in experimental severe acute respiratory symptoms models and have similar activity against SARS-CoV2. Although widely used in studies of critically ill patients, to date, no study has demonstrated its role on the treatment of high-risk, newly diagnosed patients with COVID-19 and mild symptoms.
In December 2019 a series of viral pneumonia cases were reported in the city of Wuhan, China.
A new subtype of coronavirus has been identified as the causative agent of this condition. On
February 11, 43,103 cases had already been described and on this day the World Health
Organization (WHO) named this disease as COVID-19. With. The disease had spread out to
several countries on different continents and on March 11, WHO declared a state of worldwide
pandemic. Today (April 25, 2020) there are 2,719,897 cases and 187,705 deaths documented,
with a global case-fatality ratio of 6.9%.
To date, no treatment has been identified as effective in combating this disease which has
been identified as with high mortality, therefore there are no specific therapeutic options.
So far, efforts have been focused on the treatment of patients hospitalized with dyspnea and,
although several promising drugs are being evaluated, none has demonstrated effectiveness in
reducing morbidity and mortality at this stage of the disease, suggesting that perhaps the
best time to use medications either before the onset of severe symptoms of respiratory
distress.
Thus, we propose the use of two drugs which experimentally have shown activity against
SARS-CoV2 and being used in severely ill patients with COVID-19. Our hypothesis is that
perhaps using such drugs before onset of complications will allow better outcomes on this
patient population.
Drug: Hydroxychloroquine Sulfate Tablets
Tablets of 400 mg: Loading dose of 02 tablets followed by one tablet of 400 mg orally on the following 09 days
Drug: Lopinavir/ Ritonavir Oral Tablet
tablets of 200/ 50 mg; Loading dose of 04 tablets twice a day on day 1 followed by two tablets twice a day on the following 09 days
Drug: Hydroxychloroquine Sulfate Tablets plus Lopinavir/ Ritonavir Oral Tablets
Hydroxychloroquine Oral Tablet 400 mg: Loading dose of 02 tablets followed by one tablet of 400 mg orally on the following 09 days
plus
Lopinavir/ Ritonavir Oral Tablet of 200/ 50 mg: Loading dose of 04 tablets twice a day on day 1 followed by two tablets twice a day on the following 09 days
Drug: Placebo
Placebo tablets - 01 tablet twice daily from day 01 through day 10.
Inclusion Criteria:
Patients with RT-PCR diagnosis of COVID-19 or a clinical condition compatible with COVID-19
and respiratory symptoms, presenting:
A. Persistent dry cough associated with axillary temperature > 37.7 Celsius;
OR
B. Recent onset of Flu-like Respiratory Symptoms associated with dry cough
OR
C. Tomographic image compatible with COVID 19 infection;
2. Men and women aged > 50 years OR: Patients over 18 years of age with at least one of the
following criteria
- Diabetes requiring oral medication or insulin.
- Arterial hypertension requiring at least 01 oral medication for treatment
- Known cardiovascular diseases (CHF of any etiology, documented Coronary Artery
Disease, Clinically overt heart disease)
- Symptomatic chronic lung disease and/ or medically controlled
- Patients with a history of transplantation
- Patient with stage IV chronic kidney disease or on dialysis.
- Patients on current Immunosuppression and/or using corticosteroid therapy (equivalent
to at least 10 mg of oral prednisone per day)
- Willingness to comply with study related procedures
3. Ability to provide informed consent before any protocol-related procedures.
Exclusion Criteria:
1. RT-PCR exam for COVID-19 negative during the screening visit.
2. Patients with an acute respiratory condition compatible with COVID-19 being
hospitalized;
3. Patients with an acute respiratory condition and with moderate to high probability of
not being a COVID infection 19;
4. Dyspnea secondary to other acute and chronic respiratory causes or infections (eg,
decompensated Chronic Obstructive Pulmonary Disease, acute bronchitis, pneumonia,
primary pulmonary arterial hypertension);
5. Severe respiratory clinical condition, presenting at least ONE of the criteria below:
1. Respiratory Rate> 28 / min;
2. Arterial Oxygen Saturation < 92% with nasal oxygen therapy at 10 l/ min;
3. PaO2 / FIO2 <300 mmHg
4. History of Cardiac Arrhythmia or Long QT Syndrome; 5. Use of Medications that are known
to prolong QTc: Citalopram, Venlafaxine, Bupropion and with no possibility of suspension
during the period of investigational medical product administration. 6. Inability to take
oral medications; 7. Patients on continuous use of Amiodarone and / or PGE5 Inhibitors (Ex
.: Sildenafil and similar). 8. Use of Digoxin, Cyclosporine, Cimetidine, Tamoxifen. 9. Use
of anticonvulsants, antifungals, immunosuppressants other than corticotherapy. 10. Use of
Hydroxychloroquine for other indications 11. Use of chemoprophylaxis for malaria. 12.
Psoriasis in a form other than cutaneous 13. Porphyria 14. Use of protease inhibitors,
ritonavir or Cobicistat 15. Clinical history of Liver Cirrhosis or Child-Pugh C
classification; 16. Patients with a history of degenerative retinal diseases (patients with
retinal diseases due to diabetes and hypertension can participate in the research); 17.
Patient with a clinically relevant history of hearing loss; 18. Patients with known severe
degenerative neurological diseases and / or severe mental illness; 19. Inability of the
patient or representative to give consent or adhere to the procedures proposed in the
protocol; 20. Known hypersensitivity and / or intolerance to Hydroxychloroquine. 21.
Hypersensitivity and / or intolerance Lopinavir / Ritonavir
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CARDRESEARCH - Cardiologia Assistencial e de Pesquisa
Belo Horizonte, Minas Gerais, Brazil
Pontificia Universidade Catolica de Minas Gerais
Belo Horizonte, Minas Gerais, Brazil
Fundo Municipal de Saúde de Betim
Betim, Minas Gerais, Brazil
Universidade Federal de Ouro Preto
Ouro Preto, Minas Gerais, Brazil
Gilmar Reis, MD, PhD
+5531332416574
greisbh@uol.com.br
Rosemary Oliveira, SC
+5531992636703
roliveira@cardresearch.org
Gilmar Reis, MD, PhD, Principal Investigator
Cardresearch - Cardiologia Assistencial e de Pesquisa LTDA