No optimal antiviral intervention has been yet validated to treat COVID-19 disease. Comorbidities, such as older age, obesity, diabetes, history of cardiovascular diseases are associated with poor prognosis. This study aims to evaluate the efficacy of two experimental antiviral treatments, compared to standard of care (SOC), to prevent clinical worsening, hospitalization or death at day 14 in adults with documented SARS-CoV-2 infection, asymptomatic or with symptoms lasting less than 8 days, and associated comorbidities without any severity criteria of the disease at inclusion. Participants will be randomized to receive SOC alone or SOC + hydroxychloroquine 200 mg three times a day during 10 days or SOC + association of niclosamide 2 g at J1 then 500 mg two times a day with diltiazem 60 mg three times a day during 10 days. Efficacy and tolerance of each treatments will be compared across the three treatment groups during the 28 days of follow-up.
Other: Standard of care (SOC)
SOC procedures including self-monitoring and medical follow-up of clinical signs and if necessary any other symptomatic treatment (paracetamol, antibiotics, steroids, oxygen…) during the whole study duration
Drug: Hydroxychloroquine
200 mg x 3 per day during 10 days in addition to SOC
Drug: Association of diltiazem and niclosamide
niclosamide 500 mg x 4 at J1 then 500 mg x 2 per day + diltiazem 60 mg x 3 per day during 10 days in addition to SOC
Inclusion Criteria:
- Positive SARS-CoV-2 test on nasopharyngeal swab
- Onset of symptoms <8 days prior to randomization
- NEWS score<4 AND no item ≥2
- At least one comorbidity among: age ≥ 70 years old, history of cardiac disease,
diabetes, obesity, chronic kidney disease, chronic respiratory failure,
immunosuppression, neoplasia, liver failure (stage ≥ Child-Pugh B)
- Fully able to understand the challenges of the trial
- Signed informed consent
- Covered by Health Insurance
Exclusion Criteria:
For all patients:
- Inability to decide to participate
- Pregnancy or breath feeding
- Hypersensitivity to any of the test drugs
- stage 4 or 5 chronic kidney disease (DFG <30 mL/min/1.73 m²)
For hydroxychloroquine arm:
- Long QT syndrome or QTc space >500 ms
- Treatment with piperazine, halofantrine, dasatinib, nilotinib, citalopram,
escitalopram, hydroxyzine, domperidone
- Hepatic porphyria, retinopathy, known glucose-6-phosphate dehydrogenase deficiency,
- Heart rate <50/min
- hypokaliemia < 3.5 mmol/L
For diltiazem arm:
- Heart rate<40/min
- Sinus bradycardia, second- or third-degree atrioventricular block
- Left heart insufficiency with pulmonary stasis
- Treatment with dantrolene, pimozide, dihydroergotamine, ergotamine, nifedipine,
ivabradine, esmolol, bêta-blockers (bisoprolol, carvedilol, metoprolol, nebivolol),
fingolimod
Karine Faure, MD,PhD, Principal Investigator
University Hospital, Lille