The goal of this clinical trial (phase 2/phase 3) is to evaluate the efficacy and safetyof emetine administered orally for symptomatic Covid-19 patients in patients ages 30years and above. Participants will be asked to: - Take Emetine 6mg orally for 10 consecutive days - Be monitored by healthcare staff or self-monitor for daily vital signs and symptoms - Undergo blood drawsResearchers will compare the control group given placebo medicine to assess if emetineimproved the symptoms of Covid-19.
More than 675 million cases of coronavirus disease-19 (COVID-19) have occurred in this
ongoing pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).
More than 6.8 million people have died so far, with case count and deaths cumulating
every day. Despite the scale of the damage, there exists extremely limited antiviral
treatment options for Covid-19. Emetine exhibits broad spectrum antiviral activity
including inhibition of SARS-CoV-2 by inhibiting viral replication and protein
biosynthesis. It has been have recently shown that by lowering the standard amoebicidal
dose by a factor of 10, emetine can inhibit viral replication while avoiding
cardiovascular toxicity. Therefore, the investigators plan to evaluate emetine's efficacy
and safety for treatment of symptomatic Covid-19 in a randomized, clinical trial.
Emetine, an alkaloid extracted from ipecacuanha roots, was widely used for the treatment
of amoebic dysentery. Because of cardiotoxicity (cardiac dysrhythmias), emetine was
replaced by metronidazole. The toxicity was unequivocally associated with high-dose
emetine (60 mg/day for 10 days to achieve a minimum inhibitory concentration (MIC) of 25
µM against Entamoeba hystolytica); however, the cardiovascular side-effects were minimal
or none when emetine was used for various indications in low dose (<20 mg/day). In a
screening of 3000 potential compounds against SARS-CoV-2, emetine was found to have the
lowest half maximal inhibitory concentration (IC50) of 4.0e-4 µM and a half maximum
cytotoxicity concentration (CC50) >10 µM in Vero E6 cells providing it a high therapeutic
index. Likewise, several in-vitro studies have demonstrated very low IC50 (~0.05µM)
against SARS-CoV-2 for emetine. Based on this, a lower dose of emetine (6 mg/day for 10
days) has been calculated for the treatment of SARS-CoV-2. The investigators hypothesize
that low dose emetine will be effective and safe in the treatment of Covid-19. Extensive
use of the drug in the past has documented that low dose usage avoids the cardiovascular
side-effects there were present at higher doses (>20 mg per day); however, the safety has
not been systematically documented in a clinical trial, a key objective of this study.
The primary objective of the trial would be to evaluate the safety and efficacy of oral
formulation of emetine for patients diagnosed with Covid-19 in a phase 2 study to be
followed up by a multicenter phase 3 study based on the preliminary results. Proven
beneficial, this study has the potential to save millions of lives by providing a viable,
convenient option for treatment of Covid-19. Preliminary results can provide the basis
for additional research to evaluate added benefit to patients by combining emetine with
other drugs. Emetine has also been shown in-vitro to have activity against Middle East
Respiratory Syndrome (MERS), Zika, Cytomegalovirus and Ebola virus infections-this
highlights a broader application for emetine beyond coronavirus infections.
Drug: Emetine Hydrochloride
To administer Emetine Hydrochloride 6mg orally for 10 consecutive days to evaluate the
efficacy and safety of emetine for symptomatic Covid-19 patients.
Drug: Placebo
Participant takes a placebo for 10 consecutive days.
Inclusion Criteria:
- 30 years of age or older at time of randomization
- RT-PCR positive for SARS-CoV-2 infection within ≤ 10 days of the screening visit.
- In addition to confirmed RT-PCR, symptomatic Covid-19 patients with at least two or
more symptoms within 7 days of the screening visit: Cough, shortness of breath,
fever/chills, sore throat, nausea, vomiting, diarrhea, fatigue, body aches, headache
- Ability to give informed consent (administered in local language)
Exclusion Criteria
- Asymptomatic Covid-19 patients
- Pregnant or breastfeeding woman
- Current or recent use of the study drug
- Known allergy to study drug
- Current or planned participation in another interventional trial in next 10 days.
- Critical Covid-19 patients (ARDS) at the time of screening.
- Patients needing intubation, mechanical ventilation, or ICU care at screening
- Patients with prior cardiac disease including cardiac dysrhythmias, heart failure,
ischemic heart disease or cardiomyopathies.
Johns Hopkins University, Division of Infectious Diseases
Baltimore, Maryland, United States
Bharatpur Hospital
Bharatpur, Chitwan, Nepal
Kunchok Dorjee, MBBS, PhD
4105027135
kdorjee1@jhmi.edu
Kunchok Dorjee, MBBS, PhD, MPH, Principal Investigator
Johns Hopkins School of Medicine