This is a phase II randomised, multicentre, prospective, open label clinical trial. The trial aims to recruit patients who test positive for COVID-19 who have mild symptoms and therefore can treat their symptoms in the community. Patients who test positive for COVID-19 at hospital may also be able to participate.
Coronavirus-induced disease 2019 (COVID-19) caused by SARS-CoV-2 infection is a highly contagious disease with a high and unpredictable morbidity and mortality, for which there is currently no specific treatment. Progression from a mild fatigue, fever and cough, to severe respiratory failure requiring mechanical ventilation may occur 1 to 2 weeks into the disease. This provides a window of opportunity in which patients in the early phase of the disease could be treated with a disease-modifying agent, to halt disease progression, prevent hospital admissions with respiratory failure and prevent death. Camostat is a serine protease inhibitor in clinical use in Japan since 1985 to treat patients with chronic pancreatitis (inflammation of the pancreas) and has an acceptable safety profile. Camostat has been shown to inhibit SARS-CoV-2 entry into epithelial cells in vitro. A trial of this repurposed drug for treatment of COVID-19 in humans is urgently required to assess its impact on disease progression to respiratory failure and whether it can reduce mortality. This trial will recruit up to 100 patients. Patients will be randomised into a treatment arm (camostat tablets) or control arm (best supportive care). Community patients will be called daily at home for 14 days by the clinical trial team to collect symptoms and record the general well-being of the patient. For those patients recruited from hospital, visits will continue in hospital, where feasible, until discharge when home visits will be able to continue. The primary aim of this trial is to further assess the safety and toxicity profile of camostat to support integration into a Phase III trial. Secondary aims are to determine if camostat can reduce the clinical progression of COVID-19 and therefore the need for hospital admission and supplemental oxygen as well as include collection of patient reported health status, severity of symptoms and biological markers of the virus and confirm PK profile for the active metabolite of camostat. As the understanding of COVID-19 develops and improves, the inclusion criteria may be adapted to support the trial outcomes. Patients will be recruited through various settings which may include primary care 'COVID-19 hub' clinics, COVID-19 community-based testing centres, identification through other hospital departments, NHS digital, Test and Trace (or equivalent) or other clinical environments.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
34
Patient to receive treatment with camostat tablets, 200mg four times daily (qds) for 14 days.
Chawton Park Surgery
Alton, United Kingdom
The Royal Infirmary of Edinburgh
Edinburgh, United Kingdom
Church Avenue Medical Group
Harrogate, United Kingdom
John Radcliffe Hospital
Oxford, United Kingdom
Number of Camostat Related AEs and SAEs.
Number of AEs and SAEs assessed as related to camostat by the Investigator.
Time frame: Days 1 - 28
Number of AEs by Severity Grade
Number of AEs by Severity Grade (mild, moderate, severe)
Time frame: Days 1 - 28
PK Parameter Maximum Concentration (Cmax) of 4-(4-Guanidinobenzoyloxy)Phenylacetic Acid (GBPA).
Maximum concentration (Cmax) of GBPA as assessed by population estimates from population PK analysis.
Time frame: Days 7 and 14
PK Parameter Time to Maximum Concentration (Tmax) of GBPA
Time to maximum concentration (Tmax) of GBPA, as assessed by population estimates from population PK analysis.
Time frame: Days 7 and 14
PK Parameter Area Under the Curve (AUC) of GBPA
Area under the curve (AUC) of GBPA, as assessed by population estimates from population PK analysis.
Time frame: Days 7 and 14
PK Parameter to Confirm Half-life (T1/2) of GBPA
Half-life (T1/2) of GBPA as assessed by population estimates from population PK analysis
Time frame: Days 1 - 28
Number of Community Patients Admitted to Hospital Due to COVID-19
Number of patients who were recruited in community healthcare settings who were subsequently admitted to hospital due to COVID-19.
Time frame: Days 1 - 28
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Preston Lantern Centre
Preston, United Kingdom
Clarence Medical Centre
Rhyl, United Kingdom
Trafalgar Medical Practice
Southsea, United Kingdom
Velindre Hospital
Wales, United Kingdom
Eynsham Medical Centre
Witney, United Kingdom
Number of Oxygen Free Days
Number of days from Day 1 that each patient did not supplementary oxygen (median and range).
Time frame: Days 1 - 28
Number of Ventilator - Free Days
Number of days from Day 1 that each patient did not require ventilation (median and range).
Time frame: Days 1 - 28
Time to Worst Point on the Scale or Deterioration of Two Points or More (From Randomisation) on 9 Point Category Ordinal Scale Ranging From '0 - Uninfected, no Clinical or Virological Evidence of Infection' to '8 - Death'
Median time and range to worst point on the scale or deterioration of two points or more (from randomisation) on 9 point category ordinal scale. The scale was described in the protocol as follows: '0 - Uninfected, no clinical or virological evidence of infection, 1 - Ambulatory, no limitation of activities, 2 - Ambulatory, limitation of activities, 3 - Hospitalised - mild disease, no oxygen therapy, 4 - Hospitalised - mild disease, oxygen by mask or nasal prongs, 5 - Hospitalised - severe disease, non-invasive, ventilation or high-flow oxygen, 6 - Hospitalised - severe disease, intubation and mechanical ventilation, 7 - Hospitalised - severe disease, ventilation and additional organ support - vasopressors, renal replacement therapy (RRT), extracorporeal membrane oxygenation (ECMO), 8 - Death'
Time frame: Days 1 - 28