{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:30:42Z","timestamp":1793493042481,"version":"4.5.0"},"reference-count":0,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,6,10]],"date-time":"2020-06-10T00:00:00Z","timestamp":1591747200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,6,10]],"date-time":"2020-06-10T00:00:00Z","timestamp":1591747200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Fonden","doi-asserted-by":"publisher","award":["NNF20SA0062834"],"award-info":[{"award-number":["NNF20SA0062834"]}],"id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Trials"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Objectives<\/jats:title>\n<jats:p>The aim of this randomised GCP-controlled trial is to clarify whether combination therapy with the antibiotic azithromycin and hydroxychloroquine via anti-inflammation\/immune modulation, antiviral efficacy and pre-emptive treatment of supra-infections can shorten hospitalisation duration for patients with COVID-19 (measured as \"days alive and out of hospital\" as the primary outcome), reduce the risk of non- invasive ventilation, treatment in the intensive care unit and death.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Trial design<\/jats:title>\n<jats:p>This is a multi-centre<jats:bold>,<\/jats:bold> randomised, Placebo-controlled, 2-arm ratio 1:1, parallel group double-blind study.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Participants<\/jats:title>\n<jats:p>226 participants are recruited at the trial sites\/hospitals, where the study will take place in Denmark: Aalborg, Bispebjerg, Gentofte, Herlev, Hiller\u00f8d, Hvidovre, Odense and Slagelse hospitals.<\/jats:p>\n<jats:p>Inclusion criteria:<\/jats:p>\n<jats:p>\u2022 Patient admitted to Danish emergency departments, respiratory medicine departments or internal medicine departments<\/jats:p>\n<jats:p>\u2022 Age\u2265 18 years<\/jats:p>\n<jats:p>\u2022 Hospitalized \u226448 hours<\/jats:p>\n<jats:p>\u2022 Positive COVID-19 test \/ diagnosis during the hospitalization (confirmed).<\/jats:p>\n<jats:p>\u2022 Men or non-fertile women. Fertile women* must not be pregnant, i.e. negative pregnancy test must be available at inclusion<\/jats:p>\n<jats:p>\u2022 Informed consent signed by the patient<\/jats:p>\n<jats:p>*Defined as after menarche and until postmenopausal (no menstruation for 12 months)<\/jats:p>\n<jats:p>Exclusion criteria:<\/jats:p>\n<jats:p>\u2022 At the time of recruitment, the patient uses &gt;5 LO2\/min (equivalent to 40% FiO2 if measured)<\/jats:p>\n<jats:p>\u2022 Known intolerance\/allergy to azithromycin or hydroxychloroquine or hypersensitivity to quinine or 4-aminoquinoline derivatives<\/jats:p>\n<jats:p>\u2022 Neurogenic hearing loss<\/jats:p>\n<jats:p>\u2022 Psoriasis<\/jats:p>\n<jats:p>\u2022 Retinopathy<\/jats:p>\n<jats:p>\u2022 Maculopathy<\/jats:p>\n<jats:p>\u2022 Visual field changes<\/jats:p>\n<jats:p>\u2022 Breastfeeding<\/jats:p>\n<jats:p>\u2022 Severe liver diseases other than amoebiasis (INR&gt; 1.5 spontaneously)<\/jats:p>\n<jats:p>\u2022 Severe gastrointestinal, neurological and hematological disorders (investigator-assessed)<\/jats:p>\n<jats:p>\u2022 eGFR &lt;45 ml\/min\/1.73 m2<\/jats:p>\n<jats:p>\u2022 Clinically significant cardiac conduction disorders\/arrhythmias or prolonged QTc interval (QTc (f) of&gt; 480\/470 ms).<\/jats:p>\n<jats:p>\u2022 Myasthenia gravis<\/jats:p>\n<jats:p>\u2022 Treatment with digoxin*<\/jats:p>\n<jats:p>\u2022 Glucose-6-phosphate dehydrogenase deficiency<\/jats:p>\n<jats:p>\u2022 Porphyria<\/jats:p>\n<jats:p>\u2022 Hypoglycaemia (Blood glucose at any time since hospitalization of &lt;3.0 mmol\/L)<\/jats:p>\n<jats:p>\u2022 Severe mental illness which significantly impedes cooperation<\/jats:p>\n<jats:p>\u2022 Severe linguistic problems that significantly hinder cooperation<\/jats:p>\n<jats:p>\u2022 Treatment with ergot alkaloids<\/jats:p>\n<jats:p>*The patient must not be treated with digoxin for the duration of the intervention. For atrial fibrillation\/flutter, select according to the Cardiovascular National Treatment Guide (NBV): Calcium antagonist, Beta blocker, direct current (DC) conversion or amiodarone. In case of urgent need for digoxin treatment (contraindication for the aforementioned equal alternatives), the test drug should be paused, and ECG should be taken daily.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Intervention and comparator<\/jats:title>\n<jats:p>Control group:<\/jats:p>\n<jats:p>The control group will receive the standard treatment + placebo for both types of intervention medication at all times. If part or all the intervention therapy being investigated becomes standard treatment during the study, this may also be offered to the control group.<\/jats:p>\n<jats:p>Intervention group:<\/jats:p>\n<jats:p>The patients in the intervention group will also receive standard care. Immediately after randomisation to the intervention group, the patient will begin treatment with:<\/jats:p>\n<jats:p>Azithromycin:<\/jats:p>\n<jats:p>Day 1-3: 500 mg x 1<\/jats:p>\n<jats:p>Day 4-15: 250 mg x 1<\/jats:p>\n<jats:p>If the patient is unable to take the medication orally by themselves, the medication will, if possible, be administered by either stomach-feeding tube, or alternatively, temporary be changed to clarithromycin 500 mg x 2 (this only in agreement with either study coordinator Pradeesh Sivapalan or principal investigator Jens-Ulrik St\u00e6hr Jensen). This will also be done in the control group if necessary. The patient will switch back to azithromycin when possible.<\/jats:p>\n<jats:p>Hydroxychloroquine:<\/jats:p>\n<jats:p>Furthermore, the patient will be treated with hydroxychloroquine as follows:<\/jats:p>\n<jats:p>Day 1-15: 200 mg x 2<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Main outcomes<\/jats:title>\n<jats:p>\u2022 Number of days alive and discharged from hospital within 14 days (summarises both whether the patient is alive and discharged from hospital) (\"Days alive and out of hospital\")<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Randomisation<\/jats:title>\n<jats:p>The sponsor (Chronic Obstructive Pulmonary Disease Trial Network, COP:TRIN) generates a randomisation sequence. Randomisation will be in blocks of unknown size and the final allocation will be via an encrypted website (REDCap). There will be stratification for age (&gt;70 years vs. &lt;=70 years), site of recruitment and whether the patient has any of the following chronic lung diseases: COPD, asthma, bronchiectasis, interstitial lung disease (Yes vs. No).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Blinding (masking)<\/jats:title>\n<jats:p>Participants and study personnel will both be blinded, i.e. neither will know which group the participant is allocated to.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Numbers to be randomised (sample size)<\/jats:title>\n<jats:p>This study requires 226 patients randomised 1:1 with 113 in each group.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Trial Status<\/jats:title>\n<jats:p>Protocol version 1.8, from April 16, 2020. Recruitment is ongoing (first patient recruited April 6, 2020; final patient expected to be recruited October 31, 2020).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Trial registration<\/jats:title>\n<jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link> Identifier: NCT04322396 (registered March 26, 2020)<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Full protocol<\/jats:title>\n<jats:p>The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.<\/jats:p>\n<jats:p>The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s13063-020-04409-9","type":"journal-article","created":{"date-parts":[[2020,6,10]],"date-time":"2020-06-10T12:02:47Z","timestamp":1591790567000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Proactive Prophylaxis With Azithromycin and HydroxyChloroquine in Hospitalised Patients With COVID-19 (ProPAC-COVID): A structured summary of a study protocol for a randomised controlled 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St\u00e6hr","family":"Jensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,6,10]]},"container-title":["Trials"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13063-020-04409-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13063-020-04409-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13063-020-04409-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,9]],"date-time":"2021-06-09T23:14:05Z","timestamp":1623280445000},"score":1,"resource":{"primary":{"URL":"https:\/\/trialsjournal.biomedcentral.com\/articles\/10.1186\/s13063-020-04409-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,10]]},"references-count":0,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["4409"],"URL":"https:\/\/doi.org\/10.1186\/s13063-020-04409-9","relation":{},"ISSN":["1745-6215"],"issn-type":[{"value":"1745-6215","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,10]]},"assertion":[{"value":"7 May 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 May 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 June 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study has been approved by the Danish Committee on Health Research Ethics on April 3, 2020 with ref. no. H-20022574 (for protocol amendment report no. 73409). The study will ensure the protection of human participants according to the Helsinki Declaration and in accordance with Good Clinical Practice Guidelines. Participants (hospital admitted COVID-19 patients) will give written informed consent to participate. A completed patient informed consent form is required from all participants in the study and must be signed by the participant and the informing personnel.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"PS reports non-financial support from Novartis, personal fees from Boehringer Ingelheim, outside the submitted work. All the other authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"513"}}