Prevention of Infection and Incidence of COVID-19 in Medical Personnel Assisting Patients With New Coronavirus Disease

Study Overview
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Brief Summary
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This is a randomized controlled trial of the efficacy and safety evaluation of oral administration of Bromhexine hydrochloride for the prevention of SARS-CoV-2 infection and COVID-19 disease in medical personnel assisting patients with a new coronavirus disease

Detailed Description
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This study aims to evaluate the oral administration of Bromhexine hydrochloride for the prevention of SARS-CoV-2 infection and COVID-19 disease in medical personnel assisting patients with a new coronavirus disease. The aim of the study is to determine the preventive role of this drug in the framework of reducing the incidence of coronavirus infection in risk groups (medical personnel). Several studies show, that the acute respiratory syndrome coronavirus SARS-CoV uses endosomal cysteine proteases cathepsin B and L (CatB/L) and the transmembrane protease serine type 2 (TMPRSS2) for the priming of the viral S-protein. The new coronavirus SARS-CoV-2 penetrates into alveolar epithelial type two cells through a similar mechanism. In detail, viral S-protein binds to pneumocyte angiotensin-converting enzyme 2 (ACE2) and then undergoes cleaving by TMPRSS2 in S1- and S2-subunits. This leads to the release of a fusion peptide, which allows the virus to enter the cell via endocytosis. Therefore, the protease TMPRSS2 can serve as a target for pharmacological agents to prevent the penetration of the SARS-CoV-2 into the cell. Bromhexine blocks the TMPRSS2 ability to activate a zymogen precursor of tissue plasminogen activator in vitro. Interestingly, TMPRSS2 is blocked by much lower concentrations then required to inactivate other proteases in the cell culture. However, these data cannot be simply extended to the clinical practice: whether the concentration of bromhexine in the lung tissue of properly treated patients would be enough to prevent the virus entry through the TMPRSS2-inactivation remains unclear. A randomized study in people at risk for coronavirus infection will clarify the role of Bromhexine hydrochloride as a prevention of this disease.

Official Title
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Prevention of Infection and Incidence of COVID-19 in Medical Personnel Assisting Patients With New Coronavirus Disease: a Randomised Controlled Trial

Conditions
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Increased Risk of SARS-CoV-2 Infection

Intervention / Treatment
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* Drug: Bromhexine Hydrochloride


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age of 18 years or more; Negative test (PCR) for SARS-CoV-2 infection; The absence of clinical manifestations of a respiratory infection; Contact with patients with laboratory and / or clinically confirmed SARS-CoV-2 infection; Signed informed consent to participate in the study. Exclusion Criteria: Intolerance to Bromhexine hydrochloride; Work out of contact with SARS-CoV-2 infection; Non-compliance with the rules for the use of personal protective equipment when working with SARS-CoV-2 infection (the rules for the use of personal protective equipment in accordance with the recommendations of the Ministry of Health of Russia and the internal orders of the Director General of Almazov NMRC, relevant to the dates of research); Pregnancy and the period of breastfeeding; Other circumstances that the researcher considers inappropriate to participate in this study

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Bromhexine hydrochloride Group<br>medical personnel at risk for COVID-19 infection with oral administration of Bromhexine hydrochloride | Drug: Bromhexine Hydrochloride<br>* Medical personnel at risk for COVID-19 infection will receive study medication for 14 days<br>|
| No Intervention: Control Group<br>medical personnel at risk for COVID-19 infection without oral administration of Bromhexine hydrochloride | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Negative Polymerase Chain Reaction (PCR) | Number of Participants with Negative PCR of SARS-CoV-2 and The Absence of Clinical Manifestations of COVID-19 Infection in individuals taking Bromhexine hydrochloride 4 weeks after randomization. | 4 weeks after randomization | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With Asymptomatic SARS-CoV-2 Infection | Number of Participants with Asymptomatic SARS-CoV-2 Infection | 14 days after last contact | 
| Number of Participants With Mild, Moderate and Severe COVID-19 Disease | number of participants with mild, moderate and severe COVID-19 disease | 14 days after last contact | 
| Number of Participants With Adverse Events | Number of Participants with Adverse Events | 14 days after last contact |