Chloroquine diphosphate in two different dosages as adjunctive therapy of hospitalized patients with severe respiratory syndrome in the context of coronavirus (SARS-CoV-2) infection: Preliminary safety results of a randomized, double-blinded, phase IIb clinical trial (CloroCovid-19 Study)

Borba, Mayla Gabriela Silva; Val, Fernando de Almeida; Sampaio, Vanderson Sousa; Alexandre, Marcia Almeida Araújo; Melo, Gisely Cardoso; Brito, Marcelo; Mourão, Maria Paula Gomes; Brito Sousa, José Diego; Baia-da-Silva, Djane Clarys; Guerra, Marcus Vinitius Farias; Hajjar, Ludhmila Abrahāo; Pinto, Rosemary Costa; Balieiro, Antonio Alcirley Silva; Naveca, Felipe Gomes; Xavier, Mariana Simāo; Salomão, Alexandre; Siqueira, André Machado; Schwarzbolt, Alexandre; Croda, Júlio Henrique Rosa; Nogueira, Maurício Lacerda; Romero, Gustavo Adolfo Sierra; Bassat, Quique; Fontes, Cor Jesus; Albuquerque, Bernardino Cláudio; Daniel-Ribeiro, Cláudio Tadeu; Monteiro, Wuelton Marcelo; Lacerda, Marcus Vinícus Guimarães

Background There is no specific antiviral therapy recommended for the disease caused by SARS-CoV-2 (COVID-19). Recent publications have drawn attention to the possible benefit of chloroquine (CQ). Our study aimed to comprehensively evaluate the safety and efficacy of two different CQ dosages in patients with established severe COVID-19. Methods We performed a parallel, double-blinded, randomized, phase IIb clinical trial, aiming to assess safety and efficacy of two different CQ dosages as adjunctive therapy of hospitalized patients with SARS in Manaus, Brazilian Amazon. Eligible participants were allocated to receive orally or via nasogastric tube high dose CQ (600mg CQ twice daily for 10 days or total dose 12g); or low dose CQ (450mg for 5 days, twice daily only on the first day, or total dose 2.7g). In addition, all patients received ceftriaxone and azithromycin. This study was registered with ClinicalTrials.gov, number NCT04323527. Findings Out of a pre-defined 440 patients sample size, 81 patients were enrolled. The high dose CQ arm presented more QTc>500ms (25%), and a trend toward higher lethality (17%) than the lower dosage. Fatality rate was 13.5% (95%CI=6.9-23.0%), overlapping with the CI of historical data from similar patients not using CQ (95%CI=14.5-19.2%). In 14 patients with paired samples, respiratory secretion at day 4 was negative in only one patient. Interpretation Preliminary findings suggest that the higher CQ dosage (10-day regimen) should not be recommended for COVID-19 treatment because of its potential safety hazards. Such results forced us to prematurely halt patient recruitment to this arm. Given the enormous global push for the use of CQ for COVID-19, results such as the ones found in this trial can provide robust evidence for updated COVID-19 patient management recommendations.