Article
作者: Fischer, William ; Currier, Judith S ; Pillay, Sandy ; Evering, Teresa ; Hart, Phil A ; Riviere, Cynthia ; Giganti, Mark ; Kosmyna, Jan ; Cardoso, Sandra ; Singh, Upinder ; Hosey, Lara ; Eron, Joseph ; Kantor, Amy ; Ritz, Justin ; Murtaugh, William ; Jennings, Cheryl ; Wohl, David ; Chew, Kara W ; Moser, Carlee ; Greenfelder, Brian ; Gottesman, Joan ; Smith, Davey M ; Coombs, Robert ; Wohl, David A ; Giganti, Mark J ; Pedersen, Susan ; Dragavon, Joan ; Neytman, Gene ; Taiwo, Babafemi ; Eron, Joseph J ; Sieg, Scott ; Chew, Kara ; Li, Jonathan Z ; Jana, Atasi ; Hoover, Keila ; Jilg, Nikolaus ; Coombs, Robert W ; Ignacio, Rachel Bender ; Smith, David ; Newell, Matthew ; Beck, Justine ; Perelson, Alan ; Patel, Nilam ; Hughes, Michael ; Li, Jonathan ; Jagannathan, Prasanna ; Corado, Katya ; Fletcher, Courtney ; Colsh, Kelly ; Gapara, Morgan ; Hughes, Michael D ; Roa, Jhoanna ; Daar, Eric S ; Greninger, Alexander L ; Szurgot, Bob ; Rwakazina, Irene ; Currier, Judith ; Daar, Eric ; Javan, Arzhang Cyrus ; Shahkolahi, Akbar
Background:Camostat inhibits severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in vitro. We studied the safety and efficacy of camostat in ACTIV-2/A5401, a phase 2/3 platform trial of therapeutics for COVID-19 in nonhospitalized adults.
Methods:We conducted a phase 2 study in adults with mild-to-moderate COVID-19 randomized to oral camostat for 7 days or a pooled placebo arm. Primary outcomes were time to improvement in COVID-19 symptoms through day 28, proportion of participants with SARS-CoV-2 RNA below the lower limit of quantification (LLoQ) from nasopharyngeal swabs through day 14, and grade ≥3 treatment-emergent adverse events (TEAEs) through day 28.
Results:Of 216 participants (109 randomized to camostat, 107 to placebo) who initiated study intervention, 45% reported ≤5 days of symptoms at study entry and 26% met the protocol definition of higher risk of progression to severe COVID-19. Median age was 37 years. Median time to symptom improvement was 9 days in both arms (P = .99). There were no significant differences in the proportion of participants with SARS-CoV-2 RNA <LLoQ on days 3, 7, and 14. Through day 28, 6 (5.6%) participants in the camostat arm and 5 (4.7%) in the placebo arm were hospitalized; 1 participant in the camostat arm subsequently died. Grade ≥3 TEAEs occurred in 10.1% of camostat versus 6.5% of placebo participants (P = .35).
Conclusions:In a phase 2 study of nonhospitalized adults with mild-to-moderate COVID-19, oral camostat did not accelerate viral clearance or time to symptom improvement, or reduce hospitalizations or deaths.Clinical Trials Registration. ClinicalTrials.gov identifier: NCT 04518410.