An Outpatient Clinical Trial Using Ivermectin and Doxycycline in COVID-19 Positive Patients at High Risk to Prevent COVID-19 Related Hospitalization

Purpose of the study:

The purpose of this Clinical trial is to explore the therapeutic benefits of Ivermectin and
Doxycycline in different combinations. The investigators are studying known medications at
already FDA approved dosages for therapeutic benefit. The investigators are not seeking new
indications for these medications.

Null Hypothesis:

The investigators hypothesize that treating high-risk populations positive for COVID-19
illness with Ivermectin, Doxycycline, or Ivermectin only in the outpatient setting will
decrease hospitalizations related to COVID-19 illness in comparison with Placebo.

Sample Size: Minimum of 50 high risk COVID 19 positive patients who volunteer and provide
consent to participate in this study to be placed in three different groups (A,B,C). Subjects
are to be randomized 1:1:1 and enrolled in sequential order to Group A, then B, then C as
they enroll. This distribution pattern will be followed for the entirety of the study.

Group A: Ivermectin plus Doxycycline Group B: Ivermectin plus Placebo Group C: Placebo plus
Placebo

Drug Dosing schedule:

Group A: Ivermectin 200 mcg/kg on day 1 and day 2-plus doxycycline 100 mg tablets twice a day
for seven days

Group B: Ivermectin 200 mcg/kg on day 1 and day 2-plus placebo tablet twice a day for seven
days

Group C: Placebo (number of tablets according to weight) plus placebo twice a day for seven
days

Body Weight (kg) Table for tablets of Ivermectin

15-24 kg 1 tablet 25-35 kg 2 tablets 36-50 kg 3 tablets 51-65 kg 4 tablets 66-79 kg 5 tablets
80-109 kg 6 tablets >110 kg 7 tablets

The designated pharmacy will provide pre-packed treatment to patients based on the order of
enrollment to the clinical trial.

Methods:

(A) Upon diagnosis of COVID-19 with NAAT-PCR or Rapid Antigen Test for SARS-COV 2, patients
will be evaluated by their primary care physician who will consider the health risk of
patients and provide all alternatives. Primary care physicians will recommend these patients
to a treatment hotline number. Patients can also self refer to the treatment hot line.
Patients will call this provided hotline number, and if they wish to be a part of the above
said clinical trial, it will connect them to the Principal Investigator's (Dr Werther
Marciales) Team. Based on inclusion and exclusion criteria, patients will be assigned to one
of three different study groups outlined above. Each participant in all randomized groups
will receive treatment as specified above as soon as the patient signs consent and agrees to
participate in said clinical trial. Patient's subjective data including but not limited to
age, gender, height, weight, detailed medical history, or any objective data will be
collected and kept confidential.

(B) Patients will undergo blood work (CBC, CMP, Ferritin, D-dimer, CRP, CK, PT/INR, PTT and
Fibrinogen, Interleukin 6 level,TNF alpha level, IL6 receptor level and TNF alpha receptor
level) at baseline. Blood work will be repeated on days 7 and 14. These medications used in
the clinical study will have a good safety profile, which has been tested over a period of
time. All patients enrolled in the trial will be thoroughly evaluated prior to detailed
history, especially regarding home medications, and severe co-morbid conditions as listed in
the exclusion criteria.

(C) During the clinical trial, the study doctor, or the subject's primary care provider will
be involved in treatment of subjects if and when there are any adverse reactions or if
subjects need additional care. If a patient's COVD-19 relayed symptoms worsen then, he/she
would be admitted to the hospital for further care, including mechanical ventilation if
required. These patients clinical data will be followed for the remainder of he
hospitalization. A patient admitted to the hospital for COVID-19 related illness will be
considered to reach outcome.

Criteria for admission of confirmed COVID-19:

A patient must have COVID-19 illness and at least one of the following two conditions:

1. At least 2 of the CURB-65 criteria

2. SpO2 <93% on room air or a 4% decrease from baseline

CURB 65 criteria

1. Confusion of new onset

2. Blood Urea Nitrogen greater then 7 mmol/L (19 mg/dl)

3. Respiratory rate of 30 breaths per minute or greater

4. Blood Pressure less then 90 mm Hg systolic or 60 mm Hg diastolic

5. Age 65 or older

(D) Patients will be advised to quarantine themselves and record their temperature twice
daily and maintain a home log. Patients will obtain a pulse oximeter to monitor their oxygen
levels at least twice a day. Patients will also be submitted to symptoms questionnaire or
ARDS questionnaire either in person or over telephone or through televist twice a week for
total of five weeks.

(E) All treatment groups will also be monitored for any adverse events related to medication
therapy during treatment and for 4 weeks thereafter on a twice a week basis using ADR
Monitoring form. All moderate and severe adverse drug reactions will be notified to the
principal investigator for immediate actions, which might include discontinuation of therapy
after establishing a causal relationship. All adverse drug reactions will be recorded and
reported to the FDA using Form 3500, which will be faxed to 1 800 FDA 0178. Due to the severe
nature of transmissibility of COVID-19 and the importance of minimizing human interaction and
preservation of Personal Protective Equipment, patients will be followed either in person,
telephonically or via Televisit. Exclusion Criteria will mitigate the risk of involving
patients susceptible to side effects of study treatment medications.

Data Analysis:

The total sample size is estimated at 150 participants (Minimum 50 patients in each group).
The one-way analysis of variance (ANOVA) will compare group differences at baseline,
midpoint, and endpoint. Data analysis will be carried out using statistical package for the
social sciences software (SPSS). Interim data analysis will be performed at three different
levels of the number of participants starting at sample size 20, 30 and 50. If no significant
findings are obtained from the data at N=50, then it will add more participants to the study
to achieve statistical significance. Sponsor and Principal Investigator will defer data
analysis to a statistician. A Data Monitoring Committee (DMC) is going to be established in
order to review accumulating trial data by treatment group in order to monitor patient safety
and efficacy, ensure validity and integrity of the trial and make benefit-risk assessment.
This is going to be conducted by a third party external DMC.

Ethical Considerations:

Informed consent will be obtained via phone, telecommunications, or in person and a copy of
the consent will be sent to the subjects via postal mail, email or both. All information will
be kept confidential. For research records, name, social security number, address, or phone
number will not identify patients. In the event of any publication or presentation resulting
from the research, no personally identifiable information will be shared. The investigators
will keep the patients participation in the research study confidential to the extent
permitted by law. Patient identifiers might be removed from data and, after such removal, the
data could be used for future research or distributed to another investigator for future
studies without additional informed consent from the subject.

Resources:

There is no funding available at this time, and the study will be self sponsored by MAX
HEALTH.

Compensation:

There is no compensation offered as part of participation in this study.

Cost:

Patients will be charged for any services that are performed as part of their clinical care.
Patients will not be compensated for travel or time. Patients are required to get their
medication (s) used in the clinical trial from a dedicated pharmacy. Study drugs will be
provided to the patients at no cost to the patient.

Removal from this study:

The patient may elect to withdraw from the study at any point. During the clinical trial, if
a patients COVID-19 related symptoms worsen, then they would admitted to the hospital for
further care, including mechanical ventilation if required, and the clinical data from this
subset of patients will not be used for statistical consideration of this study. Still, these
patients clinical data will be followed for the remainder of the hospitalization.