Frontiers in Medicine (Sep 2022)

A randomized, open-label trial of combined nitazoxanide and atazanavir/ritonavir for mild to moderate COVID-19

  • Adeola Fowotade,
  • Folasade Bamidele,
  • Boluwatife Egbetola,
  • Adeniyi F. Fagbamigbe,
  • Babatunde A. Adeagbo,
  • Bolanle O. Adefuye,
  • Ajibola Olagunoye,
  • Temitope O. Ojo,
  • Akindele O. Adebiyi,
  • Omobolanle I. Olagunju,
  • Olabode T. Ladipo,
  • Abdulafeez Akinloye,
  • Adedeji Onayade,
  • Oluseye O. Bolaji,
  • Steve Rannard,
  • Christian Happi,
  • Andrew Owen,
  • Adeniyi Olagunju

DOI
https://doi.org/10.3389/fmed.2022.956123
Journal volume & issue
Vol. 9

Abstract

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BackgroundThe nitazoxanide plus atazanavir/ritonavir for COVID-19 (NACOVID) trial investigated the efficacy and safety of repurposed nitazoxanide combined with atazanavir/ritonavir for COVID-19.MethodsThis is a pilot, randomized, open-label multicenter trial conducted in Nigeria. Mild to moderate COVID-19 patients were randomly assigned to receive standard of care (SoC) or SoC plus a 14-day course of nitazoxanide (1,000 mg b.i.d.) and atazanavir/ritonavir (300/100 mg od) and followed through day 28. Study endpoints included time to clinical improvement, SARS-CoV-2 viral load change, and time to complete symptom resolution. Safety and pharmacokinetics were also evaluated (ClinicalTrials.gov ID: NCT04459286).ResultsThere was no difference in time to clinical improvement between the SoC (n = 26) and SoC plus intervention arms (n = 31; Cox proportional hazards regression analysis adjusted hazard ratio, aHR = 0.898, 95% CI: 0.492–1.638, p = 0.725). No difference was observed in the pattern of saliva SARS-CoV-2 viral load changes from days 2–28 in the 35% of patients with detectable virus at baseline (20/57) (aHR = 0.948, 95% CI: 0.341–2.636, p = 0.919). There was no significant difference in time to complete symptom resolution (aHR = 0.535, 95% CI: 0.251–1.140, p = 0.105). Atazanavir/ritonavir increased tizoxanide plasma exposure by 68% and median trough plasma concentration was 1,546 ng/ml (95% CI: 797–2,557), above its putative EC90 in 54% of patients. Tizoxanide was undetectable in saliva.ConclusionNitazoxanide co-administered with atazanavir/ritonavir was safe but not better than standard of care in treating COVID-19. These findings should be interpreted in the context of incomplete enrollment (64%) and the limited number of patients with detectable SARS-CoV-2 in saliva at baseline in this trial.Clinical trial registration[https://clinicaltrials.gov/ct2/show/NCT04459286], identifier [NCT04459286].

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