Anti-Coronavirus Therapies to Prevent Progression of Coronavirus Disease 2019 (COVID-19) Trial

NCT ID: NCT04324463

Last Updated: 2024-01-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

6667 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-04-21

Study Completion Date

2022-12-30

Brief Summary

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ACT is a randomized clinical trial to assess therapies to reduce the clinical progression of COVID-19.

Detailed Description

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The ACT COVID-19 program consists of two parallel trials testing the effects of interventions in complementary populations in outpatients and inpatients.

In the outpatient study, symptomatic patients in the community who are COVID-19 positive and at high risk of disease progression: colchicine compared with control (anti-inflammatory); and ASA compared with control (anti-thrombotic); using a 2 x 2 factorial design. The primary outcome for colchicine vs. control is the composite of hospitalization or death. The primary outcome for ASA vs. control is the composite of hospitalization, death, or major thrombosis \[myocardial infarction(MI), stroke, acute limb ischemia(ALI), or pulmonary embolism (PE)\].

For inpatients, in symptomatic patients who are COVID-19 positive and who are hospitalized: colchicine is compared with control (anti-inflammatory), and the combination of ASA and rivaroxaban is compared with control (anti-thrombotic); using a 2 x 2 factorial design. The primary outcome for colchicine vs. control is the composite of high flow oxygen, mechanical ventilation, or death. The primary outcome for the combination of ASA and rivaroxaban vs. control is the composite of high flow oxygen, mechanical ventilation, death, or major thrombosis (MI, stroke, ALI, or PI).

\*The Inpatient study previously also included a comparison of Interferon-β with control in a 2x2x2 design. The Interferon-β arm was closed to recruitment in November 2020.

Conditions

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Coronavirus Severe Acute Respiratory Syndrome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Open-label, parallel group, factorial, randomized controlled trial
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Colchicine

Outpatients:

0.6 mg twice daily for 3 days, then 0.6 mg once daily for 25 days (total 28 days).

Inpatients:

1.2 mg followed by 0.6 mg 2 hours later, then 0.6 mg twice daily for 28 days.

(\*Depending on availability, 0.6 mg tablets can be substituted by 0.5 mg tablets for a regimen in outpatients of 0.5 mg twice daily for 3 days, then 0.5 mg once daily for 25 days \[total 28 days\]; and in inpatients of 1.0 mg followed by 0.5 mg 2 hours later, then 0.5 mg twice daily for 28 days).

Group Type EXPERIMENTAL

Colchicine

Intervention Type DRUG

oral medication

Interferon Beta [This arm is now closed to recruitment]

Inpatients Only:

0.25 mg by subcutaneous injection on days 1, 3, 5 \& 7

Group Type EXPERIMENTAL

Interferon-Beta

Intervention Type DRUG

subcutaneous injection

Aspirin (ASA)

Outpatients:

75 to 100 mg once daily for 28 days.

Inpatients:

75 to 100 mg once daily for 28 days

Group Type EXPERIMENTAL

Aspirin

Intervention Type DRUG

oral medication

Rivaroxaban

Inpatients Only:

2.5 mg twice daily for 28 days.

Group Type EXPERIMENTAL

Rivaroxaban

Intervention Type DRUG

oral medication

Usual Care (Control)

Outpatients and Inpatients: No constraints for treating physicians on the therapies within the standard of care arm. All key co-interventions will be documented.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Colchicine

oral medication

Intervention Type DRUG

Interferon-Beta

subcutaneous injection

Intervention Type DRUG

Aspirin

oral medication

Intervention Type DRUG

Rivaroxaban

oral medication

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. Symptomatic and laboratory-confirmed diagnosis of COVID-19.
2. Age ≥ 30 years.
3. High risk: either age ≥70 or one of the following: male; obesity (BMI ≥30); chronic cardiovascular, respiratory or renal disease; active cancer; diabetes.
4. Within 7 days (ideally 72 hours) of diagnosis, or worsening clinically.


1. Symptomatic and laboratory-confirmed diagnosis of COVID-19.
2. Age ≥18 years.
3. Within 72 hours (ideally 24 hours) of admission, or worsening clinically.

Exclusion Criteria

1. General: advanced kidney disease; advanced liver disease; pregnancy (known or potential) or lactation.
2. Colchicine: allergy or planned use; current or planned use of cyclosporine, verapamil, HIV protease inhibitor, azole antifungal, or macrolide antibiotic (except azithromycin).
3. ASA: allergy; high risk of bleeding, current or planned use of other anti-thrombotic drugs (e.g., P2Y12 inhibitors, direct oral anticoagulants, vitamin K antagonists, heparins)

Inpatient trial:


1. General: advanced kidney disease; advanced liver disease, pregnancy (known or potential) or lactation, already ventilated for \>72 hours.
2. Colchicine: allergy or planned use; current or planned use of cyclosporine, verapamil, HIV protease inhibitors, azole antifungals, or macrolide antibiotics (except azithromycin).
3. ASA and rivaroxaban: allergy; high risk of bleeding; estimated GFR \<15 ml/min; current or planned use of P2Y12 inhibitors or therapeutic doses of anticoagulants\* (e.g., direct oral anticoagulants, vitamin K antagonists, heparin, LMWH), current or planned use of strong inhibitors of both CYP 3A4 and P-gp (e.g., lopinavir/ritonavir, carbamazepine, ketoconazole). \*Note that prophylactic doses of anticoagulants can be used in patients who are randomized to control.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Bayer

INDUSTRY

Sponsor Role collaborator

Population Health Research Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Richard Whitlock, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Population Health Research Institute

Emilie Belley-Cote, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Population Health Research Institute

John Eikelboom, MBBS MSc

Role: PRINCIPAL_INVESTIGATOR

Population Health Research Institute

Locations

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Hospital Adventista de Manaus

Manaus, Amazonas, Brazil

Site Status

Hospital das Clinicas de Vitoria (Hospital Universitario Cassiano Antonio Moraes)

Vitória, Espírito Santo, Brazil

Site Status

Prodal Saude S/A

Salvador, Estado de Bahia, Brazil

Site Status

Ubermed Serviços em Saúde Eireli - Hospital São Domingos

Uberaba, Minas Gerais, Brazil

Site Status

Hospital de Clínicas da Universidade Federal de Uberlândia

Uberlândia, Minas Gerais, Brazil

Site Status

Hospital Universitario Julio Muller

Cuiabá, Mount, Brazil

Site Status

Instituto Tacchini de Pesquisa em Saude / Hospital Tacchini

Bento Gonçalves, Rio Grande do Sul, Brazil

Site Status

Hospital Universitario Prof. Dr. Horacio Carlos Panepucci da Universidade Federal de Sao Carlos (HU-UFSCar)

São Carlos, São Paulo, Brazil

Site Status

Hospital Alemão Oswaldo Cruz

São Paulo, São Paulo, Brazil

Site Status

Santa Casa de Votuporanga

Votuporanga, São Paulo, Brazil

Site Status

CardiAI Inc.

Calgary, Alberta, Canada

Site Status

Hamilton Health Sciences

Hamilton, Ontario, Canada

Site Status

London Health Sciences Centre

London, Ontario, Canada

Site Status

Southlake Regional Health Centre

Newmarket, Ontario, Canada

Site Status

Halton Healthcare/Oakville Trafalgar Memorial Hospital

Oakville, Ontario, Canada

Site Status

Niagara Health System-St. Catharine's

St. Catharines, Ontario, Canada

Site Status

Toronto Western Hospital Family Health Team

Toronto, Ontario, Canada

Site Status

Windsor Regional Hospital

Windsor, Ontario, Canada

Site Status

Woodstock Hospital

Woodstock, Ontario, Canada

Site Status

Centre Hospitalier de l'Université de Montréal (CHUM)

Montreal, Quebec, Canada

Site Status

CIUSSS de L'est-de-l'ile de Montreal, Hopital Maisonneuve-Rosemont

Montreal, Quebec, Canada

Site Status

Biomelab SAS

Barranquilla, Atlántico, Colombia

Site Status

Clinica de la Costa LTDA

Barranquilla, Atlántico, Colombia

Site Status

Instituto de Neumologico del Oriente

Bucaramanga, Santander Department, Colombia

Site Status

Unicormed

Guayaquil, Guayas, Ecuador

Site Status

Hospital de Especialidades Eugenio Espejo

Quito, Pichincha, Ecuador

Site Status

Hospital Enrique Garces

Quito, Pichincha, Ecuador

Site Status

Hospital General Pablo Arturo Suarez

Quito, Pichincha, Ecuador

Site Status

Oncoambato

Ambato, Tungurahua Province, Ecuador

Site Status

Giza Chest Hospital

Giza, Cairo Governorate, Egypt

Site Status

Fayoum University Hospital

Al Fayyum, , Egypt

Site Status

Abbasia Chest Hospital

Cairo, , Egypt

Site Status

Abbasia Fever Hospital

Cairo, , Egypt

Site Status

National Hepatology and Tropical Medicine Research Institute

Cairo, , Egypt

Site Status

St. John's Medical College and Hospital

Bangalore, Karnataka, India

Site Status

Bharathi Hospital and Research Center

Pune, Maharashtra, India

Site Status

Sanjeevan Hospital

Pune, Maharashtra, India

Site Status

Sidhu Hospital Pvt.Ltd

Dorāha, Punjab, India

Site Status

SRM Medical College Hospital & Research Center

Chengalpattu, Tamil Nadu, India

Site Status

AIG Hospital

Hyderabad, Telangana, India

Site Status

KIMS

Secunderabad, Telangana, India

Site Status

Chitwan Medical College

Bharatpur-10, Bagmati, Nepal

Site Status

Sahid Gangalal National Heart Center

Kathmandu, Bagmati, Nepal

Site Status

Province Hospital, Karnali Province

Surkhet, Karnali, Nepal

Site Status

Mechi Zonal Hospital

Bhadrapur, Province No. 1, Nepal

Site Status

Koshi Zonal Hospital

Biratnagar, Province No. 1, Nepal

Site Status

B.P. Koirala Institute of Health Sciences

Kathmandu, Province No.1, Nepal

Site Status

Aga Khan University Hospital

Karachi, Sindh, Pakistan

Site Status

Jinnah Postgraduate Medical Center

Karachi, Sindh, Pakistan

Site Status

Tabba Heart Institute

Karachi, Sindh, Pakistan

Site Status

Philippine General Hospital

Manila, National Capital Region, Philippines

Site Status

Central City Clinical Hospital No. 24

Yekaterinburg, Sverdlovsk Oblast, Russia

Site Status

State Budgetary Health Care Institution of Sverdlovsk region "Central city clinical hospital # 6 Ekaterinburg"

Yekaterinburg, Sverdlovsk Oblast, Russia

Site Status

Tver State Medical University

Tver', Tver Oblast, Russia

Site Status

Voronezh State Medical University named after N.N. Burdenko

Voronezh, Voronezh Oblast, Russia

Site Status

Altai Regional Center for Medical Prevention

Barnaul, , Russia

Site Status

City Clinical Hospital No. 15 named after O.M. Filatova

Moscow, , Russia

Site Status

National Medical Research Center for Therapy and Preventive Medicine

Moscow, , Russia

Site Status

City Clinical Hospital No. 3

Nizhny Novgorod, , Russia

Site Status

Rostov State Medical University

Rostov-on-Don, , Russia

Site Status

Tiervlei Trial Centre

Cape Town, Western Cape, South Africa

Site Status

University of Cape Town- Groote Schuur Hospital

Cape Town, Western Cape, South Africa

Site Status

TASK Eden

George, Western Cape, South Africa

Site Status

Hatta Hospital

Hatta, Dubai, United Arab Emirates

Site Status

Rashid Hospital, Dubai Health Authority

Dubai, , United Arab Emirates

Site Status

Thumbay Hospital Dubai

Dubai, , United Arab Emirates

Site Status

Countries

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Brazil Canada Colombia Ecuador Egypt India Nepal Pakistan Philippines Russia South Africa United Arab Emirates

References

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Fischer AL, Messer S, Riera R, Martimbianco ALC, Stegemann M, Estcourt LJ, Weibel S, Monsef I, Andreas M, Pacheco RL, Skoetz N. Antiplatelet agents for the treatment of adults with COVID-19. Cochrane Database Syst Rev. 2023 Jul 25;7(7):CD015078. doi: 10.1002/14651858.CD015078.

Reference Type DERIVED
PMID: 37489818 (View on PubMed)

Eikelboom JW, Jolly SS, Belley-Cote EP, Whitlock RP, Rangarajan S, Xu L, Heenan L, Bangdiwala SI, Luz Diaz M, Diaz R, Yusufali A, Kumar Sharma S, Tarhuni WM, Hassany M, Avezum A, Harper W, Wasserman S, Almas A, Drapkina O, Felix C, Lopes RD, Berwanger O, Lopez-Jaramillo P, Anand SS, Bosch J, Choudhri S, Farkouh ME, Loeb M, Yusuf S. Colchicine and the combination of rivaroxaban and aspirin in patients hospitalised with COVID-19 (ACT): an open-label, factorial, randomised, controlled trial. Lancet Respir Med. 2022 Dec;10(12):1169-1177. doi: 10.1016/S2213-2600(22)00298-3. Epub 2022 Oct 10.

Reference Type DERIVED
PMID: 36228641 (View on PubMed)

Eikelboom JW, Jolly SS, Belley-Cote EP, Whitlock RP, Rangarajan S, Xu L, Heenan L, Bangdiwala SI, Tarhuni WM, Hassany M, Kontsevaya A, Harper W, Sharma SK, Lopez-Jaramillo P, Dans AL, Palileo-Villanueva LM, Avezum A, Pais P, Xavier D, Felix C, Yusufali A, Lopes RD, Berwanger O, Ali Z, Wasserman S, Anand SS, Bosch J, Choudhri S, Farkouh ME, Loeb M, Yusuf S. Colchicine and aspirin in community patients with COVID-19 (ACT): an open-label, factorial, randomised, controlled trial. Lancet Respir Med. 2022 Dec;10(12):1160-1168. doi: 10.1016/S2213-2600(22)00299-5. Epub 2022 Oct 10.

Reference Type DERIVED
PMID: 36228639 (View on PubMed)

Mikolajewska A, Fischer AL, Piechotta V, Mueller A, Metzendorf MI, Becker M, Dorando E, Pacheco RL, Martimbianco ALC, Riera R, Skoetz N, Stegemann M. Colchicine for the treatment of COVID-19. Cochrane Database Syst Rev. 2021 Oct 18;10(10):CD015045. doi: 10.1002/14651858.CD015045.

Reference Type DERIVED
PMID: 34658014 (View on PubMed)

Other Identifiers

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PHRI.ACT.COVID19

Identifier Type: -

Identifier Source: org_study_id

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