<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT04400019</url>
  </required_header>
  <id_info>
    <org_study_id>COV20/00565</org_study_id>
    <nct_id>NCT04400019</nct_id>
  </id_info>
  <brief_title>Prevention of COVID19 Infection in Nursing Homes by Chemoprophylaxis With Hydroxychloroquine (PREVICHARM)</brief_title>
  <acronym>PREVICHARM</acronym>
  <official_title>Prevention of COVID19 Infection by the Administration of Hydroxychloroquine to Institutionalized Older People and Nursing Home Staff. Controlled Clinical Trial, Randomized Triple Blind by Clusters (PREVICHARM Study)</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>University of Malaga</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>Instituto de Investigacion Biomedica de Malaga</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Carlos III Health Institute</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>University of Malaga</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
    <is_us_export>No</is_us_export>
  </oversight_info>
  <brief_summary>
    <textblock>
      Professionals and residents of nursing homes are one of the most vulnerable groups in this&#xD;
      public health crisis of COVID-19, since they have the highest rate of positives for COVID-19,&#xD;
      despite the restriction measures carried out, such as prohibition of family visits to these&#xD;
      centers, the infection occurs by cross transmission with the care staff of the centers, or&#xD;
      with other residents.&#xD;
&#xD;
      At the moment, there are no clinical trials to test the hypothesis that hydroxychloroquine is&#xD;
      effective in coronavirus treatment. Although what has been observed is a better prognosis in&#xD;
      infected patients, since this drug inhibits the replication of the virus and its expansion to&#xD;
      other tissues.&#xD;
&#xD;
      This study is a clinical trial to test the effectiveness of hydroxychloroquine as a&#xD;
      preventive drug for SARS-CoV-2 infection. This drug will be applied to 1050 people residing&#xD;
      in nursing home care and 880 professionals who work in close contact with these people and&#xD;
      who have not yet contracted the infection.&#xD;
&#xD;
      This project will be carried out in the territories of Madrid, Navarra, Aragon and Andalusia&#xD;
      (Spain).&#xD;
&#xD;
      Hydroxychloroquine is a widely known drug that is used in two scenarios, against autoimmune&#xD;
      diseases, such as lupus or rheumatoid arthritis, and as an antimalarial drug.&#xD;
&#xD;
      It is also intended to demonstrate that the presumed reduction in viral load that would be&#xD;
      obtained with hydroxychloroquine prophylaxis, would have no effect in development of immunity&#xD;
      against the virus. This fact can create a new paradigm for the de-escalation of the&#xD;
      confinement to which the population has been subjected to stop the virus spread, allowing the&#xD;
      development of general immunity in controlled populations until reaching total immunity.&#xD;
&#xD;
      In addition to testing the effect of this drug, a non-pharmacological intervention based on a&#xD;
      safety record will be tested in the management of infection on nursing home, to assess its&#xD;
      effectiveness in detecting risk areas or bad practices carried out in this vulnerable&#xD;
      environment.&#xD;
&#xD;
      The study is led by researchers of the Institute of Biomedicine of Malaga (Spain), and has&#xD;
      obtained a financing of 1,024,199 euros from Carlos III Health Institute (Spain).&#xD;
&#xD;
      The period of execution of the clinical trial is one year, and with this intervention, the&#xD;
      intention is to reduce cross-infection in residents by a minimum threshold of 15%, as well as&#xD;
      to decrease infection in the professionals.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      The objective of this study is to evaluate the effectiveness of hydroxychloroquine&#xD;
      chemoprophylaxis in healthcare personnel and residents:&#xD;
&#xD;
        1. the incidence of secondary cases of SARS-CoV-2 infection in residents&#xD;
&#xD;
        2. the incidence of SARS-CoV-2 infection in the staff. To assess the effect of measures to&#xD;
           promote infection control. Design: Controlled, randomized, triple-blind cluster&#xD;
           multicentre trial. Subjects: Institutionalized older people and nursing homes staff in&#xD;
           four Autonomous Communities.&#xD;
&#xD;
      Sample: 880 professionals, 1050 residents in 84 residences. They will be given 800mg of&#xD;
      hydorxychloroquine the first day and 400mg in the subsequent four days. Nasopharyngeal&#xD;
      exudate will be taken for baseline RT-PCR, and at six and 14 days after the adminsitration of&#xD;
      hydroxychloroquine.&#xD;
&#xD;
      Mortality, compliance, safety, symptoms, and hospital admission will be evaluated&#xD;
      secondarily.&#xD;
&#xD;
      The highest risk group for SARS-CoV-2 infection is that of people over 60 years of age, with&#xD;
      cardiovascular disease, diabetes, COPD and immunosuppression, reaching up to 32% of those&#xD;
      infected. But, in addition, the impact is especially insidious among institutionalized older&#xD;
      people. The Spanish MInistry of Health has developed some regulations with measures to curb&#xD;
      the impact in this context. WHO places institutionalized people as a very vulnerable group&#xD;
      due to their permanent close contact with other people in the residence, the abundance of&#xD;
      group activities, the presence of people with cognitive impairment and the need for help for&#xD;
      their activities of daily living, which involves close physical contact with healthcare&#xD;
      personnel. Even the interventions for preventing and controlling the infection could&#xD;
      seriously affect the mental health and well-being of this vulnerable people, even if they do&#xD;
      not contract the infection. In the province of Malaga (Spain), a checklist has been developed&#xD;
      consisting of 13 items related to knowledge and compliance with the rules of prevention,&#xD;
      self-protection, isolation and circuits, carried out by case management nurses. This&#xD;
      instrument contains many of the WHO recommendations and may be an element that could make a&#xD;
      difference in this context.&#xD;
&#xD;
      A significant proportion of those infected are known to have had close contact with probable&#xD;
      or confirmed SARS-CoV-2 cases. In institutionalized people, the main source of contact (once&#xD;
      family visits have been eliminated) is caused by cross-contamination with the care staff who&#xD;
      provide direct care or other infected residents. In nursing homes, staff ratios are much more&#xD;
      limited than in acute care hospitals (aggravated by the demand for professionals due to the&#xD;
      epidemic). Furthermore, the possibility of isolation of infected patients is very limited: On&#xD;
      average, residences only have 15% of their rooms prepared for isolation.&#xD;
&#xD;
      Among the various therapeutic strategies being tested, the use of hydroxychloroquine (HCQ)&#xD;
      emerges as a viable option, albeit with limitations in the studies. This use has already been&#xD;
      proposed for a long time due to its potential antiviral action, since it alkalinizes the&#xD;
      cellular pH necessary for binding of the virus to the host cell and interferes with&#xD;
      glycosylation of ECA2 receptors and blocks endosomatic transport of the virus. HCQ&#xD;
      administered in a safe dose range is distributed throughout the body, including the lung&#xD;
      parenchyma after oral administration, with few adverse effects. Compared to the antivirals&#xD;
      under study for SARS-CoV-2 infection, it is much more feasible in real clinical practice&#xD;
      conditions to access HCQ, a drug on which, in addition, there is enormous experience, its&#xD;
      safety is well known, It is funded by the National Health System (NHS), it is cheap and&#xD;
      accessible on the NHS. There are currently several clinical trials underway and a consensus&#xD;
      has been developed that recommends their use in patients with SARS-CoV-2 pneumonia. Regarding&#xD;
      the prophylactic use of HCQ, another trial in Spain has just started to use it in a &quot;test and&#xD;
      treat&quot; strategy in patients among the general population, but it does not directly affect the&#xD;
      institutionalized population. Our study aims to explore whether the administration of&#xD;
      chemoprophylaxis in nursing homes is a protective strategy for both institutionalized people&#xD;
      and the professionals themselves.&#xD;
&#xD;
      This is an controlled, randomized, triple-blind cluster study.The primary target population&#xD;
      of the study consists of professionals who provide direct care in nursing homes (nursing&#xD;
      assistants and nurses) and institutionalized older people.&#xD;
&#xD;
      The sampling frame will be integrated by the Communities of Andalusia, Madrid, Aragon and the&#xD;
      Autonomous Community of Navarra. A conservative sample calculation has been designed, due to&#xD;
      the current uncertainty regarding incidence. The incidence of Andalusia has been taken as the&#xD;
      lower limit and the incidence provided in the study by Kimball et al. as an upper limit, and&#xD;
      bearing in mind that many nursing homes are taking measures to isolate and relocate&#xD;
      residents. To decrease the minimum infection rate in residents from 25% to 10% (delta =&#xD;
      -0.15), with an alpha of 0.05, a power of 80%, assuming a minimum of 13 residents per cluster&#xD;
      with a CCI of 0.1, with a replacement rate of losses of 25%, a total of 1050 residents would&#xD;
      be necessary, with 7 clusters in each step, distributed in a total of 84 nursing homes.&#xD;
      Regarding workers, taking the references from Andalusia and the study by McMichael et al. to&#xD;
      decrease the minimum infection rate in professionals from 18% to 5% (delta = -0.13), with the&#xD;
      same power parameters, assuming a minimum of 10 professionals per cluster with a CCI 0.1, and&#xD;
      a replacement rate of 5% 880 professionals with the same number of clusters and nursing homes&#xD;
      are required.&#xD;
&#xD;
      The PREVICHARM study was originally conceived at the end of March 2020 as a randomized&#xD;
      clinical trial by stepped wedge clusters, since it was a methodological path that at that&#xD;
      time allowed all participating subjects to receive the drug as chemoprophylaxis, in a&#xD;
      staggered manner, without losing the comparison with a control group. After the evolution of&#xD;
      the pandemic and the research around HCQ, the research team has considered the need to&#xD;
      introduce some modifications in the design, to eliminate the staggering in the trial&#xD;
      sequence, maintaining the design controlled and randomized by clusters, but, introducing an&#xD;
      assignment of two parallel arms by triple blind to, on the one hand, have a totally blinded&#xD;
      design that improves the robustness of the conclusions and, on the other, simplify the&#xD;
      operationalization of the trial and thus further strengthen its feasibility. A criterion on&#xD;
      the period of time necessary for inclusion has also been updated, reducing it to 8 days, in&#xD;
      light of current knowledge on the predictive value of PCR in the course of infection in&#xD;
      exposed patients.&#xD;
&#xD;
      The modifications do not affect the objectives, or hypotheses, or the outcomes, or the&#xD;
      evaluation procedures thereof, or the follow-ups or the evaluation of the safety of the&#xD;
      trial.&#xD;
&#xD;
      Variables: Sociodemographic, adjustment and control of confounders (Cluster, follow-up time,&#xD;
      hours worked by each professional during the study, gradient of application of&#xD;
      non-pharmacological measures); Primary endpoints: Number of secondary cases of SARS-CoV2&#xD;
      infection among residents, and SARS-CoV-2 infection in caregivers who provide direct care;&#xD;
      Secondary endpoints: mortality, compliance with treatment, symptoms of SARS-CoV-2 infection,&#xD;
      hospital admission of personnel and adverse events.&#xD;
&#xD;
      All the nursing homes in the province will be invited to participate and after randomization,&#xD;
      the phased inclusion of residences will begin, requesting the consent of professionals to be&#xD;
      included and proceeding to collect basal exudate and study variables. In the randomized&#xD;
      nursing homes in each step as an intervention, the HCQ regimen will be provided and the&#xD;
      nasopharyngeal exudate follow-up will be performed for RT-PCR at 6 and 14 days. In those in&#xD;
      the control group step, an exudate will be collected on the same days than intervention&#xD;
      group. Once enrolled, subjects will receive a double naso-oro-pharyngeal swab and will be&#xD;
      provided blinded medication (HCQ or placebo, as appropriate) for the entire chemoprophylaxis&#xD;
      cycle. Subsequently, smears will be taken again at 6 and 14 days. The sample collection&#xD;
      procedure will be standardized through the protocol developed by the Ministry of Health and&#xD;
      technicians will be trained in advance in its performance.&#xD;
&#xD;
      The technicians will go to each residence according to a cadence pre-established by the&#xD;
      research team.&#xD;
&#xD;
      Adverse events will be monitored at each weekly visit using a standardized procedure&#xD;
      (gastrointestinal disorders, appetite disturbances, hypoglycemia, weight loss, decreased&#xD;
      visual acuity, photophobia, impaired visual accommodation with symptoms of blurred vision,&#xD;
      deafness, tinnitus, and vertigo, muscle weakness, symptoms of liver and kidney disorders,&#xD;
      neurological disorders). Serious and non-serious adverse events will be distinguished and&#xD;
      will be notified by means of a standard procedure to the Research Ethics Committee, and to&#xD;
      the Spanish Agency for Medicines and Health Products. An insurance policy has been contracted&#xD;
      for risk coverage.&#xD;
&#xD;
      The study will comply with all the precepts of the Declaration of Helsinki and its subsequent&#xD;
      revisions, as well as the Standards of Good Practice. Participants will be informed of the&#xD;
      characteristics and purpose of the study and will be asked for informed consent in accordance&#xD;
      with the regulations in force in Spain using the form and the corresponding information&#xD;
      sheet. The study has been approved by the Malaga Provincial Research Ethics Committee and the&#xD;
      Spanish Agency for Medicines and Health Products, as well as the participating institutions.&#xD;
&#xD;
      All the trial monitoring process and pharmacovigilance will be carried out by the Clinical&#xD;
      Trial Units of the Spanish Clinical Research Network of the participating Centers.&#xD;
&#xD;
      Exploratory data analysis, bivariate analysis (chi square, Student t, ANOVA or their&#xD;
      non-parametric equivalents in case of non-normality) will be performed and the main&#xD;
      hypothesis will be tested using generalized linear binomial and Poisson models, also taking&#xD;
      the cluster, as random effects factor, and time as a fixed factor. Intrasubject analyzes will&#xD;
      be carried out using mixed generalized linear models. All the analyses will be performed by&#xD;
      intention to treat, using multiple imputation models.&#xD;
&#xD;
      The total estimated duration is a maximum of 12 months.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Unknown status</overall_status>
  <last_known_status>Not yet recruiting</last_known_status>
  <start_date type="Anticipated">September 2020</start_date>
  <completion_date type="Anticipated">April 1, 2021</completion_date>
  <primary_completion_date type="Anticipated">December 15, 2020</primary_completion_date>
  <phase>Phase 2/Phase 3</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <intervention_model_description>Controlled, randomized, triple-blind cluster study.</intervention_model_description>
    <primary_purpose>Prevention</primary_purpose>
    <masking>Double (Participant, Outcomes Assessor)</masking>
    <masking_description>The HCQ and the placebo will be manufactured by Laboratorios Rubio, blinded in similar containers for HCQ and placebo and will be stored in the pharmacy of the participating reference hospitals and will be distributed to the participating residences by the research technicians hired for the project.&#xD;
A record of doses delivered and monitoring of doses consumed will be carried out. The containers must be wrapped in a disposable protective cover, which can be removed before entering the residences, in order to minimize the accidental transmission of the virus through this route.</masking_description>
  </study_design_info>
  <primary_outcome>
    <measure>Number of secondary cases of SARS-CoV2 infection among residents at six days</measure>
    <time_frame>This outcome will be evaluated at six days from the administration of chemoprophylaxis with hydroxychloroquine</time_frame>
    <description>Discrete quantitative variable. Residents with active viral load (diagnosed by polymerase chain reaction test) will be considered infected.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Number of secondary cases of SARS-CoV2 infection among residents at 14 days</measure>
    <time_frame>This outcome will be evaluated at 14 days from the administration of chemoprophylaxis with hydroxychloroquine</time_frame>
    <description>Discrete quantitative variable. Residents with active viral load (diagnosed by polymerase chain reaction test) will be considered infected.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Number of secondary cases of SARS-CoV2 infection among residents at 28 days</measure>
    <time_frame>This outcome will be evaluated at 28 days from the administration of chemoprophylaxis with hydroxychloroquine</time_frame>
    <description>Discrete quantitative variable. Residents with active viral load (diagnosed by polymerase chain reaction test) will be considered infected.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>SARS-CoV-2 infection in nursing home staff who provide direct care at six days</measure>
    <time_frame>This outcome will be evaluated at six days from the administration of chemoprophylaxis with hydroxychloroquine</time_frame>
    <description>Dichotomous categorical variable</description>
  </primary_outcome>
  <primary_outcome>
    <measure>SARS-CoV-2 infection in nursing home staff who provide direct care at 14 days</measure>
    <time_frame>This outcome will be evaluated at 14 days from the administration of chemoprophylaxis with hydroxychloroquine</time_frame>
    <description>Dichotomous categorical variable</description>
  </primary_outcome>
  <primary_outcome>
    <measure>SARS-CoV-2 infection in nursing home staff who provide direct care at 28 days</measure>
    <time_frame>This outcome will be evaluated at 28 days from the administration of chemoprophylaxis with hydroxychloroquine</time_frame>
    <description>Dichotomous categorical variable</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Mortality</measure>
    <time_frame>This outcome will be evaluated at 28 days from the administration of chemoprophylaxis with hydroxychloroquine</time_frame>
    <description>Dichotomous qualitative variable (1: Death 0: Survival)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Compliance with treatment</measure>
    <time_frame>It will be evaluated during the five days that the chemoprophylaxis with hydorxychloroquine is administered</time_frame>
    <description>Continous variable. It will be evaluated with the AIDS Clinical Trials Group method: investigation of medications not taken in a period of 4 days prior to the interview)% adherence = (total prescribed galenic units for that period-total units not taken) / total prescribed galenic units for that period</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Symptoms of SARS-CoV-2 infection at six days</measure>
    <time_frame>This outcome will be evaluated at 6 days from the administration of chemoprophylaxis with hydroxychloroquine</time_frame>
    <description>Dichotomous categorical variable. The participant presents symptoms compatible with SARS-CoV-2 infection. High temperature, cephalea, dyspnea,diarrhea, vomiting, arthro-myalgia, pharynx pain, abdominal pain, anosmia, cough.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Symptoms of SARS-CoV-2 infection at 14 days</measure>
    <time_frame>This outcome will be evaluated at 14 days from the administration of chemoprophylaxis with hydroxychloroquine</time_frame>
    <description>Dichotomous categorical variable. The participant presents symptoms compatible with SARS-CoV-2 infection. High temperature, cephalea, dyspnea,diarrhea, vomiting, arthro-myalgia, pharynx pain, abdominal pain, anosmia, cough.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Symptoms of SARS-CoV-2 infection at 28 days</measure>
    <time_frame>This outcome will be evaluated at 28 days from the administration of chemoprophylaxis with hydroxychloroquine</time_frame>
    <description>Dichotomous categorical variable. The participant presents symptoms compatible with SARS-CoV-2 infection. High temperature, cephalea, dyspnea,diarrhea, vomiting, arthro-myalgia, pharynx pain, abdominal pain, anosmia, cough.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Hospitalization</measure>
    <time_frame>This outcome will be evaluated at 28 days from the administration of chemoprophylaxis with hydroxychloroquine</time_frame>
    <description>Dichotomous categorical variable. Participant requires hospital admission attributable to SARS-CoV-2 infection</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Adverse events at six days</measure>
    <time_frame>This outcome will be evaluated at six days from the administration of chemoprophylaxis with hydroxychloroquine</time_frame>
    <description>Polycotomic categorical variable. Collected by clinical interview and also monitored simultaneously by external trial monitors</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Adverse events at 14 days</measure>
    <time_frame>This outcome will be evaluated at 14 days from the administration of chemoprophylaxis with hydroxychloroquine</time_frame>
    <description>Polycotomic categorical variable. Collected by clinical interview and also monitored simultaneously by external trial monitors</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Adverse events at 28 days</measure>
    <time_frame>This outcome will be evaluated at 28 days from the administration of chemoprophylaxis with hydroxychloroquine</time_frame>
    <description>Polycotomic categorical variable. Collected by clinical interview and also monitored simultaneously by external trial monitors</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Anticipated">1930</enrollment>
  <condition>Sars-CoV2</condition>
  <condition>Coronavirus Infection</condition>
  <condition>Prevention &amp; Control</condition>
  <condition>Nursing Home</condition>
  <condition>Hydroxychloroquine</condition>
  <arm_group>
    <arm_group_label>Tracking control</arm_group_label>
    <arm_group_type>No Intervention</arm_group_type>
    <description>According to the randomization process described, those nursing homes assigned to the control arm of the trial will receive the same treatment as those assigned to the intervention group, except for the medication, which will be a masked placebo.&#xD;
The study is triple blind, so neither the professionals who carry out the follow-up, nor the patients, nor the person in charge of analyzing the data, know to which group each nursing home belongs.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Intervention</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>The dose to be used as chemoprophylaxis will be 800mg of Hydroxychloroquine (HCQ) on the first day and 400mg during the subsequent four days. Participating subjects will be followed up at 6, 14 and 28 days.</description>
  </arm_group>
  <intervention>
    <intervention_type>Drug</intervention_type>
    <intervention_name>Hydroxychloroquine Only Product in Oral Dose Form</intervention_name>
    <description>The dose to be used as chemoprophylaxis will be 800mg of HCQ on the first day and 400mg for the following four days.</description>
    <arm_group_label>Intervention</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Institutionalized people in nurswing homes since the beginning of the COVID19 epidemic&#xD;
             who do not have the infection present at the time of entering into the study.&#xD;
&#xD;
          -  Healthcare professionals who provide direct care (nursing assistants and registered&#xD;
             nurses) to institutionalized older people in nursing homes with confirmed cases of&#xD;
             COVID19 during the past 8 days.&#xD;
&#xD;
          -  Subjects that give their consent to participate in the study or that it be obtained&#xD;
             from their representative / legal guardian.&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Staff members who do not provide direct care to residents.&#xD;
&#xD;
          -  Residents with active SARS-CoV-2 infection present, or with symptoms compatible with&#xD;
             COVID19 confirmed by PCR test.&#xD;
&#xD;
          -  Staff members with present or past SARS-CoV-2 infection, or with PCR-confirmed&#xD;
             symptoms consistent with COVID19.&#xD;
&#xD;
          -  History of QT interval prolongation or arrhythmias of any etiology.&#xD;
&#xD;
          -  Presence of retinopathy of any etiology, changes in acuity or visual field.&#xD;
&#xD;
          -  Severe hearing loss (requires the use of hearing aids).&#xD;
&#xD;
          -  Structural heart disease.&#xD;
&#xD;
          -  History of non-structural heart failure, ischemic heart disease, SCASEST, or SCACEST&#xD;
&#xD;
          -  Chronic liver disease.&#xD;
&#xD;
          -  Alcoholism.&#xD;
&#xD;
          -  Epilepsy.&#xD;
&#xD;
          -  For the participating professionals, pregnancy or suspected pregnancy (if they are&#xD;
             planning pregnancy, or in fertilizer treatment, they must abandon the study).&#xD;
&#xD;
          -  Subjects with known HDQ hypersensitivity.&#xD;
&#xD;
          -  Subjects diagnosed with G6PDH deficiency.&#xD;
&#xD;
          -  Taking other medicines that prolong QT: domperidone, ondansetron, cilostazol,&#xD;
             antiarrhythmics (procainamide, amiodarone, flecainide, sotalol), macrolides&#xD;
             (azithromycin, clarithromycin, erythromycin), quinolones (ciprofloxacin,),&#xD;
             moxofloxacin,) neuroleptics (haloperidol, chlorpromazine, pimozide), antidepressants&#xD;
             (citalopram, escitalopram), sulpiride, anticholinesterase drugs (donepezil)&#xD;
&#xD;
          -  Denial to participate in the study&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>José M Morales-Asencio, PhD</last_name>
    <role>Principal Investigator</role>
    <affiliation>University of Malaga; Malaga, Spain.</affiliation>
  </overall_official>
  <overall_official>
    <last_name>Ricardo Gómez-Huelgas, PhD</last_name>
    <role>Principal Investigator</role>
    <affiliation>Hospital Regional de Malaga</affiliation>
  </overall_official>
  <overall_official>
    <last_name>Juan C Morilla-Herrera, PhD</last_name>
    <role>Principal Investigator</role>
    <affiliation>Distrito de Atención Primaria Málaga-Valle del Guadalhorce</affiliation>
  </overall_official>
  <overall_contact>
    <last_name>José M Morales-Asencio, Professor</last_name>
    <phone>+34 629 77 68 95</phone>
    <email>jmmasen@uma.es</email>
  </overall_contact>
  <link>
    <url>https://www.segg.es/media/descargas/pautas-SEGG-covid-19.pdf</url>
    <description>Sociedad Española de Geriatría y Gerontología. Colaboración servicios de geriatría hospitalarios - hospitales de media estancia - residencias de mayores y centros sociosanitarios. 2020</description>
  </link>
  <link>
    <url>https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-000890-25/FR</url>
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  <verification_date>September 2020</verification_date>
  <study_first_submitted>May 20, 2020</study_first_submitted>
  <study_first_submitted_qc>May 20, 2020</study_first_submitted_qc>
  <study_first_posted type="Actual">May 22, 2020</study_first_posted>
  <last_update_submitted>September 26, 2020</last_update_submitted>
  <last_update_submitted_qc>September 26, 2020</last_update_submitted_qc>
  <last_update_posted type="Actual">September 29, 2020</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>University of Malaga</investigator_affiliation>
    <investigator_full_name>JOSE MIGUEL MORALES ASENCIO</investigator_full_name>
    <investigator_title>Professor of Research Methods and Evidence Based Health Care at University of Málaga (Spain)</investigator_title>
  </responsible_party>
  <keyword>clinical trial</keyword>
  <keyword>Hydroxychloroquine</keyword>
  <keyword>chemoprophylaxis</keyword>
  <keyword>Sars-CoV2</keyword>
  <keyword>COVID-19</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Infections</mesh_term>
    <mesh_term>Communicable Diseases</mesh_term>
    <mesh_term>COVID-19</mesh_term>
    <mesh_term>Coronavirus Infections</mesh_term>
  </condition_browse>
  <intervention_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Hydroxychloroquine</mesh_term>
  </intervention_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT04400019
org study id: COV20/00565
nct id: NCT04400019
lead sponsor: 
collaborator: 
collaborator: 
has dmc: Yes
is fda regulated drug: No
is fda regulated device: No
is us export: No
Professionals and residents of nursing homes are one of the most vulnerable groups in this
      public health crisis of COVID-19, since they have the highest rate of positives for COVID-19,
      despite the restriction measures carried out, such as prohibition of family visits to these
      centers, the infection occurs by cross transmission with the care staff of the centers, or
      with other residents.

      At the moment, there are no clinical trials to test the hypothesis that hydroxychloroquine is
      effective in coronavirus treatment. Although what has been observed is a better prognosis in
      infected patients, since this drug inhibits the replication of the virus and its expansion to
      other tissues.

      This study is a clinical trial to test the effectiveness of hydroxychloroquine as a
      preventive drug for SARS-CoV-2 infection. This drug will be applied to 1050 people residing
      in nursing home care and 880 professionals who work in close contact with these people and
      who have not yet contracted the infection.

      This project will be carried out in the territories of Madrid, Navarra, Aragon and Andalusia
      (Spain).

      Hydroxychloroquine is a widely known drug that is used in two scenarios, against autoimmune
      diseases, such as lupus or rheumatoid arthritis, and as an antimalarial drug.

      It is also intended to demonstrate that the presumed reduction in viral load that would be
      obtained with hydroxychloroquine prophylaxis, would have no effect in development of immunity
      against the virus. This fact can create a new paradigm for the de-escalation of the
      confinement to which the population has been subjected to stop the virus spread, allowing the
      development of general immunity in controlled populations until reaching total immunity.

      In addition to testing the effect of this drug, a non-pharmacological intervention based on a
      safety record will be tested in the management of infection on nursing home, to assess its
      effectiveness in detecting risk areas or bad practices carried out in this vulnerable
      environment.

      The study is led by researchers of the Institute of Biomedicine of Malaga (Spain), and has
      obtained a financing of 1,024,199 euros from Carlos III Health Institute (Spain).

      The period of execution of the clinical trial is one year, and with this intervention, the
      intention is to reduce cross-infection in residents by a minimum threshold of 15%, as well as
      to decrease infection in the professionals.
The objective of this study is to evaluate the effectiveness of hydroxychloroquine
      chemoprophylaxis in healthcare personnel and residents:

        1. the incidence of secondary cases of SARS-CoV-2 infection in residents

        2. the incidence of SARS-CoV-2 infection in the staff. To assess the effect of measures to
           promote infection control. Design: Controlled, randomized, triple-blind cluster
           multicentre trial. Subjects: Institutionalized older people and nursing homes staff in
           four Autonomous Communities.

      Sample: 880 professionals, 1050 residents in 84 residences. They will be given 800mg of
      hydorxychloroquine the first day and 400mg in the subsequent four days. Nasopharyngeal
      exudate will be taken for baseline RT-PCR, and at six and 14 days after the adminsitration of
      hydroxychloroquine.

      Mortality, compliance, safety, symptoms, and hospital admission will be evaluated
      secondarily.

      The highest risk group for SARS-CoV-2 infection is that of people over 60 years of age, with
      cardiovascular disease, diabetes, COPD and immunosuppression, reaching up to 32% of those
      infected. But, in addition, the impact is especially insidious among institutionalized older
      people. The Spanish MInistry of Health has developed some regulations with measures to curb
      the impact in this context. WHO places institutionalized people as a very vulnerable group
      due to their permanent close contact with other people in the residence, the abundance of
      group activities, the presence of people with cognitive impairment and the need for help for
      their activities of daily living, which involves close physical contact with healthcare
      personnel. Even the interventions for preventing and controlling the infection could
      seriously affect the mental health and well-being of this vulnerable people, even if they do
      not contract the infection. In the province of Malaga (Spain), a checklist has been developed
      consisting of 13 items related to knowledge and compliance with the rules of prevention,
      self-protection, isolation and circuits, carried out by case management nurses. This
      instrument contains many of the WHO recommendations and may be an element that could make a
      difference in this context.

      A significant proportion of those infected are known to have had close contact with probable
      or confirmed SARS-CoV-2 cases. In institutionalized people, the main source of contact (once
      family visits have been eliminated) is caused by cross-contamination with the care staff who
      provide direct care or other infected residents. In nursing homes, staff ratios are much more
      limited than in acute care hospitals (aggravated by the demand for professionals due to the
      epidemic). Furthermore, the possibility of isolation of infected patients is very limited: On
      average, residences only have 15% of their rooms prepared for isolation.

      Among the various therapeutic strategies being tested, the use of hydroxychloroquine (HCQ)
      emerges as a viable option, albeit with limitations in the studies. This use has already been
      proposed for a long time due to its potential antiviral action, since it alkalinizes the
      cellular pH necessary for binding of the virus to the host cell and interferes with
      glycosylation of ECA2 receptors and blocks endosomatic transport of the virus. HCQ
      administered in a safe dose range is distributed throughout the body, including the lung
      parenchyma after oral administration, with few adverse effects. Compared to the antivirals
      under study for SARS-CoV-2 infection, it is much more feasible in real clinical practice
      conditions to access HCQ, a drug on which, in addition, there is enormous experience, its
      safety is well known, It is funded by the National Health System (NHS), it is cheap and
      accessible on the NHS. There are currently several clinical trials underway and a consensus
      has been developed that recommends their use in patients with SARS-CoV-2 pneumonia. Regarding
      the prophylactic use of HCQ, another trial in Spain has just started to use it in a "test and
      treat" strategy in patients among the general population, but it does not directly affect the
      institutionalized population. Our study aims to explore whether the administration of
      chemoprophylaxis in nursing homes is a protective strategy for both institutionalized people
      and the professionals themselves.

      This is an controlled, randomized, triple-blind cluster study.The primary target population
      of the study consists of professionals who provide direct care in nursing homes (nursing
      assistants and nurses) and institutionalized older people.

      The sampling frame will be integrated by the Communities of Andalusia, Madrid, Aragon and the
      Autonomous Community of Navarra. A conservative sample calculation has been designed, due to
      the current uncertainty regarding incidence. The incidence of Andalusia has been taken as the
      lower limit and the incidence provided in the study by Kimball et al. as an upper limit, and
      bearing in mind that many nursing homes are taking measures to isolate and relocate
      residents. To decrease the minimum infection rate in residents from 25% to 10% (delta =
      -0.15), with an alpha of 0.05, a power of 80%, assuming a minimum of 13 residents per cluster
      with a CCI of 0.1, with a replacement rate of losses of 25%, a total of 1050 residents would
      be necessary, with 7 clusters in each step, distributed in a total of 84 nursing homes.
      Regarding workers, taking the references from Andalusia and the study by McMichael et al. to
      decrease the minimum infection rate in professionals from 18% to 5% (delta = -0.13), with the
      same power parameters, assuming a minimum of 10 professionals per cluster with a CCI 0.1, and
      a replacement rate of 5% 880 professionals with the same number of clusters and nursing homes
      are required.

      The PREVICHARM study was originally conceived at the end of March 2020 as a randomized
      clinical trial by stepped wedge clusters, since it was a methodological path that at that
      time allowed all participating subjects to receive the drug as chemoprophylaxis, in a
      staggered manner, without losing the comparison with a control group. After the evolution of
      the pandemic and the research around HCQ, the research team has considered the need to
      introduce some modifications in the design, to eliminate the staggering in the trial
      sequence, maintaining the design controlled and randomized by clusters, but, introducing an
      assignment of two parallel arms by triple blind to, on the one hand, have a totally blinded
      design that improves the robustness of the conclusions and, on the other, simplify the
      operationalization of the trial and thus further strengthen its feasibility. A criterion on
      the period of time necessary for inclusion has also been updated, reducing it to 8 days, in
      light of current knowledge on the predictive value of PCR in the course of infection in
      exposed patients.

      The modifications do not affect the objectives, or hypotheses, or the outcomes, or the
      evaluation procedures thereof, or the follow-ups or the evaluation of the safety of the
      trial.

      Variables: Sociodemographic, adjustment and control of confounders (Cluster, follow-up time,
      hours worked by each professional during the study, gradient of application of
      non-pharmacological measures); Primary endpoints: Number of secondary cases of SARS-CoV2
      infection among residents, and SARS-CoV-2 infection in caregivers who provide direct care;
      Secondary endpoints: mortality, compliance with treatment, symptoms of SARS-CoV-2 infection,
      hospital admission of personnel and adverse events.

      All the nursing homes in the province will be invited to participate and after randomization,
      the phased inclusion of residences will begin, requesting the consent of professionals to be
      included and proceeding to collect basal exudate and study variables. In the randomized
      nursing homes in each step as an intervention, the HCQ regimen will be provided and the
      nasopharyngeal exudate follow-up will be performed for RT-PCR at 6 and 14 days. In those in
      the control group step, an exudate will be collected on the same days than intervention
      group. Once enrolled, subjects will receive a double naso-oro-pharyngeal swab and will be
      provided blinded medication (HCQ or placebo, as appropriate) for the entire chemoprophylaxis
      cycle. Subsequently, smears will be taken again at 6 and 14 days. The sample collection
      procedure will be standardized through the protocol developed by the Ministry of Health and
      technicians will be trained in advance in its performance.

      The technicians will go to each residence according to a cadence pre-established by the
      research team.

      Adverse events will be monitored at each weekly visit using a standardized procedure
      (gastrointestinal disorders, appetite disturbances, hypoglycemia, weight loss, decreased
      visual acuity, photophobia, impaired visual accommodation with symptoms of blurred vision,
      deafness, tinnitus, and vertigo, muscle weakness, symptoms of liver and kidney disorders,
      neurological disorders). Serious and non-serious adverse events will be distinguished and
      will be notified by means of a standard procedure to the Research Ethics Committee, and to
      the Spanish Agency for Medicines and Health Products. An insurance policy has been contracted
      for risk coverage.

      The study will comply with all the precepts of the Declaration of Helsinki and its subsequent
      revisions, as well as the Standards of Good Practice. Participants will be informed of the
      characteristics and purpose of the study and will be asked for informed consent in accordance
      with the regulations in force in Spain using the form and the corresponding information
      sheet. The study has been approved by the Malaga Provincial Research Ethics Committee and the
      Spanish Agency for Medicines and Health Products, as well as the participating institutions.

      All the trial monitoring process and pharmacovigilance will be carried out by the Clinical
      Trial Units of the Spanish Clinical Research Network of the participating Centers.

      Exploratory data analysis, bivariate analysis (chi square, Student t, ANOVA or their
      non-parametric equivalents in case of non-normality) will be performed and the main
      hypothesis will be tested using generalized linear binomial and Poisson models, also taking
      the cluster, as random effects factor, and time as a fixed factor. Intrasubject analyzes will
      be carried out using mixed generalized linear models. All the analyses will be performed by
      intention to treat, using multiple imputation models.

      The total estimated duration is a maximum of 12 months.
allocation: Randomized
intervention model: Parallel Assignment
intervention model description: Controlled, randomized, triple-blind cluster study.
primary purpose: Prevention
masking: Double (Participant, Outcomes Assessor)
masking description: The HCQ and the placebo will be manufactured by Laboratorios Rubio, blinded in similar containers for HCQ and placebo and will be stored in the pharmacy of the participating reference hospitals and will be distributed to the participating residences by the research technicians hired for the project.
A record of doses delivered and monitoring of doses consumed will be carried out. The containers must be wrapped in a disposable protective cover, which can be removed before entering the residences, in order to minimize the accidental transmission of the virus through this route.
measure: Number of secondary cases of SARS-CoV2 infection among residents at six days
time frame: This outcome will be evaluated at six days from the administration of chemoprophylaxis with hydroxychloroquine
description: Discrete quantitative variable. Residents with active viral load (diagnosed by polymerase chain reaction test) will be considered infected.
measure: Number of secondary cases of SARS-CoV2 infection among residents at 14 days
time frame: This outcome will be evaluated at 14 days from the administration of chemoprophylaxis with hydroxychloroquine
description: Discrete quantitative variable. Residents with active viral load (diagnosed by polymerase chain reaction test) will be considered infected.
measure: Number of secondary cases of SARS-CoV2 infection among residents at 28 days
time frame: This outcome will be evaluated at 28 days from the administration of chemoprophylaxis with hydroxychloroquine
description: Discrete quantitative variable. Residents with active viral load (diagnosed by polymerase chain reaction test) will be considered infected.
measure: SARS-CoV-2 infection in nursing home staff who provide direct care at six days
time frame: This outcome will be evaluated at six days from the administration of chemoprophylaxis with hydroxychloroquine
description: Dichotomous categorical variable
measure: SARS-CoV-2 infection in nursing home staff who provide direct care at 14 days
time frame: This outcome will be evaluated at 14 days from the administration of chemoprophylaxis with hydroxychloroquine
description: Dichotomous categorical variable
measure: SARS-CoV-2 infection in nursing home staff who provide direct care at 28 days
time frame: This outcome will be evaluated at 28 days from the administration of chemoprophylaxis with hydroxychloroquine
description: Dichotomous categorical variable
measure: Mortality
time frame: This outcome will be evaluated at 28 days from the administration of chemoprophylaxis with hydroxychloroquine
description: Dichotomous qualitative variable (1: Death 0: Survival)
measure: Compliance with treatment
time frame: It will be evaluated during the five days that the chemoprophylaxis with hydorxychloroquine is administered
description: Continous variable. It will be evaluated with the AIDS Clinical Trials Group method: investigation of medications not taken in a period of 4 days prior to the interview)% adherence = (total prescribed galenic units for that period-total units not taken) / total prescribed galenic units for that period
measure: Symptoms of SARS-CoV-2 infection at six days
time frame: This outcome will be evaluated at 6 days from the administration of chemoprophylaxis with hydroxychloroquine
description: Dichotomous categorical variable. The participant presents symptoms compatible with SARS-CoV-2 infection. High temperature, cephalea, dyspnea,diarrhea, vomiting, arthro-myalgia, pharynx pain, abdominal pain, anosmia, cough.
measure: Symptoms of SARS-CoV-2 infection at 14 days
time frame: This outcome will be evaluated at 14 days from the administration of chemoprophylaxis with hydroxychloroquine
description: Dichotomous categorical variable. The participant presents symptoms compatible with SARS-CoV-2 infection. High temperature, cephalea, dyspnea,diarrhea, vomiting, arthro-myalgia, pharynx pain, abdominal pain, anosmia, cough.
measure: Symptoms of SARS-CoV-2 infection at 28 days
time frame: This outcome will be evaluated at 28 days from the administration of chemoprophylaxis with hydroxychloroquine
description: Dichotomous categorical variable. The participant presents symptoms compatible with SARS-CoV-2 infection. High temperature, cephalea, dyspnea,diarrhea, vomiting, arthro-myalgia, pharynx pain, abdominal pain, anosmia, cough.
measure: Hospitalization
time frame: This outcome will be evaluated at 28 days from the administration of chemoprophylaxis with hydroxychloroquine
description: Dichotomous categorical variable. Participant requires hospital admission attributable to SARS-CoV-2 infection
measure: Adverse events at six days
time frame: This outcome will be evaluated at six days from the administration of chemoprophylaxis with hydroxychloroquine
description: Polycotomic categorical variable. Collected by clinical interview and also monitored simultaneously by external trial monitors
measure: Adverse events at 14 days
time frame: This outcome will be evaluated at 14 days from the administration of chemoprophylaxis with hydroxychloroquine
description: Polycotomic categorical variable. Collected by clinical interview and also monitored simultaneously by external trial monitors
measure: Adverse events at 28 days
time frame: This outcome will be evaluated at 28 days from the administration of chemoprophylaxis with hydroxychloroquine
description: Polycotomic categorical variable. Collected by clinical interview and also monitored simultaneously by external trial monitors
arm group label: Tracking control
arm group type: No Intervention
description: According to the randomization process described, those nursing homes assigned to the control arm of the trial will receive the same treatment as those assigned to the intervention group, except for the medication, which will be a masked placebo.
The study is triple blind, so neither the professionals who carry out the follow-up, nor the patients, nor the person in charge of analyzing the data, know to which group each nursing home belongs.
arm group label: Intervention
arm group type: Experimental
description: The dose to be used as chemoprophylaxis will be 800mg of Hydroxychloroquine (HCQ) on the first day and 400mg during the subsequent four days. Participating subjects will be followed up at 6, 14 and 28 days.
intervention type: Drug
intervention name: Hydroxychloroquine Only Product in Oral Dose Form
description: The dose to be used as chemoprophylaxis will be 800mg of HCQ on the first day and 400mg for the following four days.
arm group label: Intervention
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
healthy volunteers: Accepts Healthy Volunteers
last name: José M Morales-Asencio, PhD
role: Principal Investigator
affiliation: University of Malaga; Malaga, Spain.
last name: Ricardo Gómez-Huelgas, PhD
role: Principal Investigator
affiliation: Hospital Regional de Malaga
last name: Juan C Morilla-Herrera, PhD
role: Principal Investigator
affiliation: Distrito de Atención Primaria Málaga-Valle del Guadalhorce
last name: José M Morales-Asencio, Professor
phone: +34 629 77 68 95
email: jmmasen@uma.es
url: https://www.segg.es/media/descargas/pautas-SEGG-covid-19.pdf
description: Sociedad Española de Geriatría y Gerontología. Colaboración servicios de geriatría hospitalarios - hospitales de media estancia - residencias de mayores y centros sociosanitarios. 2020
url: https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-000890-25/FR
description: Mitja O. Antiviral Treatment of COVID-19 Confirmed Cases and Ring Chloroquine Chemoprevention in Close Contacts: a Cluster Randomized Clinical Trial. 2020 [cited 2020 Mar 22]. (Clinical Trials.gov). Report No.: NCT04304053.
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PMID: 32020029
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PMID: 32205204
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PMID: 23208422
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PMID: 32194981
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PMID: 32208486
responsible party type: Principal Investigator
investigator affiliation: University of Malaga
investigator full name: JOSE MIGUEL MORALES ASENCIO
investigator title: Professor of Research Methods and Evidence Based Health Care at University of Málaga (Spain)
mesh term: Infections
mesh term: Communicable Diseases
mesh term: COVID-19
mesh term: Coronavirus Infections
mesh term: Hydroxychloroquine
sharing ipd: No