Dose-Ranging Study to Assess the Safety and Efficacy of Melatonin in Outpatients Infected With COVID-19

A pilot placebo-controlled randomized double-blind trial of Melatonin in outpatients with COVID-19 infection to evaluate Safety, Efficacy and Dose-ranging.

Studies have shown in the blood of patients with COVID-19 there was a marked increase in the cytokines and chemokines interleukin 1β (IL-1β), interferon-γ (IFN-γ), interferon-inducible protein 10 (IP-10), monocyte chemoattractant protein 1 (MCP-1) and interleukin-4 (IL-4). Consequently, treatments that reduce cytokine/chemokine production that result in a less severe course of disease could be potentially beneficial. Melatonin, a pineal hormone, has been shown to have anti-inflammation, anti-oxidation and immune enhancing features. In multiple animal models of lung injury, Melatonin supplementation has been shown to decrease the number of inflammatory cells, reduce the levels of the cytokines IL-4, IL-5, IL-13 and TNF-a and reduce nitric oxide and hydroxyl radical concentrations. We propose a dose ranging pilot study to assess the safety and efficacy of melatonin in reducing hospitalization in COVID-19 patients with mild-moderate disease. A total of 50 participants will be randomized to the intervention arm (melatonin: 3 mg, or 30 mg three times a day for 14 days) or control arm (placebo) in a 2:2:1 fashion using a permuted block randomization scheme. Analyses will be performed with a focus on estimation of specific clinically important parameters, including safety and preliminary evidence of activity, for planning of a subsequent definitive comparative trial designed to fully assess efficacy.

Eligibility Criteria:
Inclusion Criteria:

1. Male or non-pregnant female adult ≥18 years of age at time of enrollment.
2. Women of childbearing potential must agree to use at least one primary form of contraception for the duration of the study.
3. Positive testing for COVID-19 infection by standard RT-PCR assay or equivalent test.
4. Meets criteria for mild or moderate COVID-19 disease
5. Subject provides written informed consent prior to initiation of any study procedures.
6. Understands and agrees to comply with planned study procedures.
7. Agrees to the collection and storage of saliva samples per protocol.
8. Subject can provide an emergency contact who the study team can contact in case the subject is not reachable on any of the study visits.

Exclusion Criteria:

1. Severe (eGFR\<30 ml/min) and moderate (eGFR 30-60 ml/min) chronic kidney disease or requiring dialysis
2. Severe hepatic insufficiency defined as one or more of the following: Cirrhosis diagnosis, Serum ALT \> 3x ULN or Alkaline phosphatase \>3x ULN or bilirubin \>2x ULN in the absence of Gilbert's or hemolysis, Uncontrolled acute or chronic liver disease (e.g. acute hepatitis A, unstable autoimmune hepatitis)
3. Pregnancy or breast feeding.
4. History of a seizure disorder.
5. Patient is taking Fluvoxamine, Capmatinib, Ciprofloxacin (Systemic), Deferasirox, Givosiran, Methoxsalen (Systemic), Mexiletine, Rucaparib, Stiripentol, Thiabendazole, Vemurafenib, Methoxsalen, Sodium oxybate or Echinacea.
6. Allergy to the study medication
7. Currently taking melatonin
8. Currently taking high dose (\>500 mg/day) Vitamin C.
9. Meets criteria for Severe or Critical COVID-19