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Prophylaxis for Patients at Risk of COVID-19 Infection: Results from the Intranasal Niclosamide Randomised, Double Blinded, Placebo Controlled Arm of the PROTECT-V Platform Trial

Humphrey et al., Elsevier BV, doi:10.2139/ssrn.4519538, PROTECT-V, NCT04870333
Jul 2023  
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Mortality 0% Improvement Relative Risk Ventilation 80% Hospitalization 13% Symp. case -2% Niclosamide  PROTECT-V  Prophylaxis  DB RCT Is prophylaxis with niclosamide beneficial for COVID-19? Double-blind RCT 1,651 patients in the United Kingdom (Feb 2021 - Nov 2022) Lower ventilation with niclosamide (not stat. sig., p=0.25) c19early.org Humphrey et al., Elsevier BV, July 2023 Favorsniclosamide Favorscontrol 0 0.5 1 1.5 2+
RCT 1,651 patients with kidney disease showing no significant difference in symptomatic COVID-19, hospitalization, or mortality with intranasal niclosamide compared to placebo. The UNI911 nasal spray had very poor adherence and a higher withdrawal rate (40% vs. 23.8% for placebo), partially due to local nasal and upper airway irritation.
risk of death, 0.1% lower, RR 1.00, p = 1.00, treatment 2 of 826 (0.2%), control 2 of 825 (0.2%), NNT 340725.
risk of mechanical ventilation, 80.0% lower, RR 0.20, p = 0.25, treatment 0 of 826 (0.0%), control 2 of 825 (0.2%), NNT 412, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
risk of hospitalization, 13.4% lower, RR 0.87, p = 0.71, treatment 13 of 826 (1.6%), control 15 of 825 (1.8%), NNT 409.
risk of symptomatic case, 2.0% higher, HR 1.02, p = 0.89, treatment 826, control 825.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Humphrey et al., 26 Jul 2023, Double Blind Randomized Controlled Trial, placebo-controlled, United Kingdom, preprint, median age 55.9, 22 authors, study period 19 February, 2021 - 28 November, 2022, trial NCT04870333 (history) (PROTECT-V).
This PaperNiclosamideAll
Prophylaxis for patients at risk of COVID-19 infection: results from the intranasal niclosamide randomised, double blinded, placebo controlled arm of the PROTECT-V platform trial
Toby Jl Humphrey, Wendi Qian, Michael Chen-Xu, Francis Dowling, Katrina Gatley, Rakshya Adhikari, Tracey Hensman, Louise Stockley, Abhinav Bassi, Nikita Bathla, Indranil Dasgupta, Davinder Ps Dosanjh, Mads Jellingsø, Morten Lind Jensen, Anne Weibel Callesen, John R Bradley, Vivekanand Jha, Morten Oa Sommer, Thomas F Hiemstra, Rona M Smith
Background PROTECT-V (PROphylaxis for paTiEnts at risk of COVID-19 infecTion) is a platform trial testing multiple pre-exposure COVID-19 prophylactic agents in vulnerable patient cohorts. The aim is to determine if these agents can confer additional protection, over and above vaccination, in patients who typically mount sub-optimal vaccine responses or are at particular risk of adverse clinical outcomes from COVID-19 infection. This paper reports the results from the intranasal niclosamide arm of the trial.
This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4519538 P r e p r i n t n o t p e e r r e v i e w e d Supplementary Figure 2 : Participant withdrawal according to treatment allocation
References
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Humphrey, Dosanjh, Hiemstra, Richter, Chen-Xu et al., PROphylaxis for paTiEnts at risk of COVID-19 infecTion (PROTECT-V), Trials, doi:10.1186/s13063-023-07128-z
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Singh, Weiss, Goodman, Fisk, Kulkarni et al., Niclosamide-A promising treatment for COVID-19, Br J Pharmacol, doi:10.1111/bph.15843
Smith, Cooper, Doffinger, Stacey, Al-Mohammad et al., SARS-COV-2 vaccine responses in renal patient populations, BMC Nephrol, doi:10.1186/s12882-022-02792-w
Van Assen, Holvast, Benne, Posthumus, Van Leeuwen et al., Humoral responses after influenza vaccination are severely reduced in patients with rheumatoid arthritis treated with rituximab, Arthritis Rheum, doi:10.1002/art.25033
Weiss, Hendrickx, Stensgaard, Jellingsø, Sommer, Kidney Transplant and Dialysis Patients Remain at Increased Risk for Succumbing to COVID-19, Transplantation, doi:10.1097/TP.0000000000004462
Weiss, Touret, Baronti, Gilles, Hoen et al., Niclosamide shows strong antiviral activity in a human airway model of SARS-CoV-2 infection and a conserved potency against the Alpha (B.1.1.7), Beta (B.1.351) and Delta variant (B.1.617, PLoS One
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