prophylaxis for patients at risk of covid-19 infection

Conditions: COVID-19

Summary: the protect open-label randomised basket trial will assess the effectiveness of hydroxychloroquine (hcq) as chemoprophylaxis against covid-19 in multiple vulnerable populations in the united kingdom.

covid-19 (novel coronavirus-induced disease) was declared a global pandemic by the who on 11th march 2020. currently there are no drugs proven to treat or delay progression of covid-19 and no vaccine is yet available. efforts are underway to repurpose established drugs with well understood drug interactions and safety profiles. vulnerable populations such as those receiving in-centre dialysis are largely excluded from ongoing trials. the protect basket clinical trial aims to enrol patients at particularly high risk of covid-19 and its complications, seeking to test treatments that either might prevent the disease from occurring or may reduce the number of cases where the disease becomes serious or life-threatening. the protect trial will use innovative design and analysis methodologies to allow the simultaneous assessment of one or more treatments in multiple populations. patients will be eligible for recruitment to the trial if they fall within one of the following vulnerable populations: a) patients receiving in-centre haemodialysis, b) transplant patients, c) vasculitis, or d) other disease groups that may be added during the course of this trial. protect will use an innovate basket design to carry out a series of individually powered prospective, randomised comparisons in distinct vulnerable patient groups in the uk while applying bayesian approaches to conduct pooled assessment of efficacy. once consented, eligible participants will be randomised to active treatment or control, stratified by protect subpopulation (disease specific). enrolment to the trial will be via an online platform and following informed consent subsequent assessments will be done via email or telephone thus reducing the burden to participants as well as reducing their exposure to covid-19. the master protect protocol describes core components that are shared between disease specific appendices to the core protocol.

Eligibility criteria:
inclusion criteria: * have no previous confirmed covid-19 diagnosis * fall into one of the high risk population groups exclusion criteria: * inability to provide informed consent * symptomatic for possible covid-19 at baseline or symptoms highly suggestive of covid-19 experienced since 1st march 2020 * hypersensitivity reaction to hydroxychloroquine, chloroquine or 4-aminoquinolines or any formulation excipients * contraindication to taking hydroxychloroquine as prophylaxis e.g known epilepsy * already taking chloroquine, hydroxychloroquine or 4-aminoquinolines * history of any retinopathy including diabetic retinopathy requiring laser therapy * taking medications which are contra-indicated alongside hcq - digoxin, halofantrine, amiodarone, moxifloxacin, cyclosporin, mefloquine, praziquantel, tamoxifen * known history of prolonged qtc * type i diabetes or insulin-dependent type ii diabetes

Keywords: haemodialysis transplant immunosuppression vasculitis hydroxychloroquine chemoprophylaxis covid-19