Efficacy and Safety of Ivermectin and Doxycycline in Combination or IVE Alone in Patients With COVID-19 Infection.
Condition: COVID-19 Patients
MeSH terms: COVID-19
Study type: Interventional
Phase: Phase 2

Summary: 
      Burden:

      Initial outbreak of corona virus disease 2019 (COVID-19) was reported from Wuhan, China in
      early December 2019.Presently known to be caused by a novel beta-corona virus, named as
      Severe acute respiratory syndrome corona virus 2 ( SARS-CoV-2).

      World Health Organization (WHO) declared a pandemic on March.

      The clinical characteristics of COVID-19 include respiratory symptoms, fever, cough, dyspnoea
      and pneumonia

      Infected individuals exhibit:

        1. Mostly mild illness (80% +) recover without any treatment (~80%)

        2. Moderate illness that needs hospitalization and recovers after standard

        3. supportive treatment (~14%)

        4. Critical illness (~5%) needs ICU support

        5. Death (1-2% )

      COVID-19 has now spread >210 countries and territories globally. SARS-CoV-2 is a respiratory
      virus which spreads primarily through droplets generalized when an infected person coughs or
      sneezes or through droplets of saliva or discharge from the nose.

      Symptomatic management remains the mainstay of treatment strategy. Mortality appears to be
      more common in older individuals and those with co-morbidities, such as chronic lung disease,
      cardiovascular disease and diabetes. Young people with no comorbidities also appear to be at
      risk for critical illness including multi-organ failure and death. Seen more in Bangladesh
      between 21-40 yrs of age.

      Knowledge Gap:

      There is no specific treatment against this new virus that WHO has officially declared until
      now.There are many pharmacologic therapies that are being used or considered for treatment of
      COVID-19. National Guidelines on Clinical Management of Corona virus Disease 2019 (Covid-19):
      V 5.0 date 9th April 2020) CDC, DGHS, GoB

      Thus an RCT is urgently needed in Bangladesh: Based on recent literatures on Rx studies in
      COVID-19 patients from other countries as well as its availability & affordability of those
      repurposed medicines
    

Detailed description: 
      Objectives:

      General Objective:

      The aim of the study is to evaluate efficacy and safety of ivermectin in combination with
      doxycycline or ivermectin alone for the treatment of hospitalized SARS-CoV-2 infected adult
      Bangladeshi COVID-19 +ve patients and to compare with placebo; where all three arms will
      receive the standard care of treatment of COVID-19 infected patients in the hospital. By
      successful demonstration of the safety and efficacy of these repurposed medicines, it may
      have the potential to play an important role in the treatment of COVID-19+ve patients.

      Specific Objective:

        1. Duration of the virological clearance rate

        2. Days required for remission of fever and cough

      Secondary Objective:

        -  Patients requiring oxygen

        -  Patients failing to maintain SpO2 >88 despite oxygenation

        -  Number of days on oxygen support

        -  Chest X-ray improvement

        -  Duration of hospitalization

        -  All cause mortality
    

Intervention name(s): Ivermectin + Doxycycline + Placebo; Ivermectin + Placebo; Placebo
Intervention type(s): Drug; Drug; Drug
Intervention description(s): Arm I: 200 mcg/kg (12 mg tablet) ivermectin (IVERA) single dose and 200 mg stat doxycycline day-1 followed by 100mg doxycycline 12hrly for 4 day (i.e. day2-day5)
Placebo one tablet D2-5; Arm II: Ivermectin - 200 mcg/kg (12 mg tablet) once per day D1-D5 + Placebo two tablets D1 followed by Placebo one tablet D2-5; Arm III: 3 Placebo tablets D1 followed by 2 tablets D2-5
Other intervention name(s): Tab IVERA +Cap Doxycycline; Tab IVERA; Tab Placebo
Intervention MeSH terms: Doxycycline; Ivermectin
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized, Double-Blind, Placebo-Controlled Trial
Masking: Double (Participant, Investigator)
Primary purpose: Treatment