Ivermectin Treatment Efficacy in Covid-19 High Risk Patients

NCT ID: NCT04920942

Last Updated: 2023-06-01

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE3
• Total Enrollment: 500 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-05-31
• Study Completion Date: 2021-10-31

Brief Summary

This is a multicenter study, which is aimed to investigate the efficacy of the Ivermectin drug in high risk COVID-19 patients. This study will compare Ivermectin treatment efficacy with standard of care alone. Target cohort is mild to moderate symptomatic Covid-19 (Stage 2-3), high risk patients aged 50 years and above with comorbidity, who presented to hospitals within first 7 days of illness.

Detailed Description

Objectives

Primary Objective:

To assess the effectiveness of Ivermectin in preventing progression of Covid-19 to severe disease (clinical stage 4 or 5), which is defined as severe pneumonia requiring oxygen supplement or critically ill requiring intensive care.

Secondary Objectives:

1. To assess the efficacy of Ivermectin in reducing mortality rate among high risk COVID-19 patients.

2. To compare difference in resolution of symptoms, chest radiograph, laboratory investigations, ICU admission, mechanical ventilation and length of hospital stay.

Methodology Study Type and Design This is a multicenter, open-label, randomized controlled clinical trial involving COVID-19 designated hospitals in Malaysia. Patients are randomized at ratio of 1:1 to groups receiving ivermectin for 5 days plus standard-of-care versus standard-of-care only. Patients will be assigned to stratified randomized treatments based on a central, computer-generated randomization scheme coordinated by an independent third party. Based on national guidelines, all high risk COVID-19 patients will be admitted to hospitals, and allow discharge once criteria are met.

Rationale of ivermectin dose and duration in this study:

The dose regimens used in various randomized control trials with positive results range from 0.2mg/kg single dose to 0.6mg/kg/day for 5 days 10-15. PK/PD studies have shown that the antiviral effect of Ivermectin is dose dependent 9,15. As SARS-CoV-2 viral load peaks during the first week of illness and may prolong in severe disease 18, we believe a high dose of ivermectin 0.4mg/kg/day for 5 days would be reasonable and safe to achieve our study objectives.

Standard of care:

Based on the current Malaysian guidelines, standard of care for mild to moderate Covid-19 patients includes isolation, infection control, close monitoring (clinical findings, laboratory tests, chest imaging) and symptomatic treatment.

Study Population The population for this clinical trial will be comprised of adults with a polymerase chain reaction (PCR) confirmed diagnosis of COVID-19 admitted to any of the participating hospitals. Participants who

1. Treatment group: Ivermectin 0.4mg/kg/day for 5 days + standard-of-care

2. Control group: Standard-of-care only

Patients who fulfil the inclusion criteria and do not meet the exclusion criteria will be enrolled. Identification of eligible participants will be done prospectively at each study site.

Sample Size Sample size calculation was performed using ScalexProp Version 1.0.2 (Naing, 2016). The calculation is based on superiority trial design and the primary outcome measure of the need to have supplemental oxygen therapy during the hospital admission. We regard a 9% difference between intervention arm and control arm as a clinically important outcome. Based on local data, 17.5% of COVID-19 aged 50 years and above, with stage 2 and 3 disease and comorbidity, progressed to severe disease 3. The need of supplemental oxygen therapy is expected to be about 8.8% in intervention arm and 17.5% in control arm. With a margin of superiority set to be 1%, the study requires 231 patients for each arm or in total 462 patients. Considering potential dropouts during the trial, we would require up to 500 patients or 250 patients each arm. The sample size provides a level of significance at 5% with 80% power (2-sided test).

Conditions

COVID-19

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Treatment group

Ivermectin 0.4mg/kg/day for 5 days + standard-of-care

Group Type: EXPERIMENTAL

Ivermectin 0.4mg/kg/day for 5 days

Intervention Type: DRUG

Ivermectin 0.4mg/kg/day for 5 days with standard-of-care

Control group

Standard-of-care only

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Ivermectin 0.4mg/kg/day for 5 days

Ivermectin 0.4mg/kg/day for 5 days with standard-of-care

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

1. RT-PCR or antigen test confirmed COVID-19 cases

2. Aged 50 years and above,with at least one co-morbidities*

3. Within the first 7 days of illness (from symptom onset)

4. Mild to moderate clinical severity

Exclusion Criteria

1. Asymptomatic stage 1 patients

2. Patients with SpO2 less than 95% at rest. (unless it is an expected baseline SpO2 due to preexisting disease, eg. COAD or pulmonary fibrosis)

3. Patients who need oxygen supplements

4. Patients with concomitant bacterial, fungal, parasitic or other viral infections prior to enrollment.

5. Patients with severe hepatic impairment (>Grade 3: ALT >10 times of upper normal limit)

6. Malabsorptionsyndromeorotherclinicallysignificantgastrointestinaldisease that may affect absorption of the study drug (non-correctable vomiting, diarrhea, ulcerative colitis, and others).

7. Pregnant or nursing women.

8. Female patients of reproductive age who cannot consent to contraceptive use of oral contraceptives, mechanical contraceptives such as intrauterine devices or barrier devices (pessaries, condoms), or a combination of these devices from the start of ivermectin administration to 7 days after the end of ivermectin administration.

9. Male patient who has female partner of reproductive age and he cannot agree to use contraception from the start of ivermectin treatment till 7 days after treatment.

10. Patients receiving chemotherapy

11. Patients who received interferon or drugs with reported antiviral activity against COVID-19 (favipiravir, hydroxychloroquine sulfate, chloroquine phosphate, lopinavir-ritonavir combination, remdesivir) in the past 7 days before enrollment.

12. Patients in whom this episode of infection is a recurrence or reinfection of COVID- 19.

13. Patients who have previously received ivermectin.

14. Patient receiving warfarin or any medications known to interact with ivermectin.

15. Acute medical or surgical emergency (eg. DKA/MI/stroke).

16. Other patients judged ineligible by the principal investigator or sub-investigator.

• Minimum Eligible Age: 50 Years
• Maximum Eligible Age: 100 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Clinical Research Centre, Malaysia

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

CHEE L LIM, MRCP

Role: PRINCIPAL_INVESTIGATOR

Ministry of Health, Malaysia

Locations

Sultanah Aminah Hospital

Johor Bahru, Johor, Malaysia

Sultanah Bahiyah Hospital

Alor Star, Kadah, Malaysia

Sultan Abdul Halim Hospital

Sungai Petani, Kedah, Malaysia

Hospital Raja Permaisuri Bainun, Ipoh

Ipoh, Perak, Malaysia

Taiping Hospital

Taiping, Perak, Malaysia

Tuanku Fauziah Hospital

Kangar, Perlis, Malaysia

Pulau Pinang Hospital

George Town, Pulau Pinang, Malaysia

Lahad Datu Hospital

Tawau, Sabah, Malaysia

Sarawak General Hospital

Kuching, Sarawak, Malaysia

Sungai Buloh Hospital

Shah Alam, Selangor, Malaysia

Permai Hospital

Kempas, , Malaysia

Kepala Batas Hospital

Kepala Batas, , Malaysia

Kuala Kangsar Hospital

Kuala Kangsar, , Malaysia

Kuala Lumpur Hospital

Kuala Lumpur, , Malaysia

Sultanah Nur Zahirah

Kuala Terengganu, , Malaysia

Melaka Hospital

Malacca, , Malaysia

Putrajaya Hospital

Putrajaya, , Malaysia

Duchess of Kent Hospital

Sandakan, , Malaysia

Low Risk COVID-19 Quarantine & Treatment Centre - Malaysia Agro Exposition Park Serdang (MAEPS)

Serdang, , Malaysia

Sg Siput Hospital

Sungai Siput, , Malaysia

Tumpat Hospital

Tumpat, , Malaysia

Countries

Malaysia

References

Lim SCL, Hor CP, Tay KH, Mat Jelani A, Tan WH, Ker HB, Chow TS, Zaid M, Cheah WK, Lim HH, Khalid KE, Cheng JT, Mohd Unit H, An N, Nasruddin AB, Low LL, Khoo SWR, Loh JH, Zaidan NZ, Ab Wahab S, Song LH, Koh HM, King TL, Lai NM, Chidambaram SK, Peariasamy KM; I-TECH Study Group. Efficacy of Ivermectin Treatment on Disease Progression Among Adults With Mild to Moderate COVID-19 and Comorbidities: The I-TECH Randomized Clinical Trial. JAMA Intern Med. 2022 Apr 1;182(4):426-435. doi: 10.1001/jamainternmed.2022.0189.

Reference Type: DERIVED

PMID: 35179551 (View on PubMed)

Other Identifiers

I-TECH21

Identifier Type: -

Identifier Source: org_study_id