Camostat Efficacy vs. Placebo for Outpatient Treatment of COVID-19 (CAMELOT)

Participants will be randomized in a 2:1 ratio of camostat:placebo. Approximately 300 participants are planned to be enrolled (200 participants to camostat mesilate and 100 participants to placebo). Participants will be treated with camostat mesilate 200 mg or placebo drug orally 4 times a day for 14 days, and receive local standard of care (SOC) in addition to study drug. Participants will be followed until Day 28. Participants will be seen in the clinic for assessments, blood draws, and mid-turbinate nasal samples on Screening/Day 1, Day 7, Day 15 and early termination.

Inclusion criteria

• Adults willing and able to provide informed consent before performing study procedures
• Adults ≥18 years of age at time of informed consent
• Participants must have written notification of laboratory confirmed COVID-19 infection performed prior to screening, at a local laboratory by RT-PCR or other commercial or public health assay in any specimen; and participants must be randomized within 72 hours of receiving the above notification of laboratory confirmed COVID-19
• Have a mild or moderate form of COVID-19 defined as SpO2 > 94% at screening
• Participants must have at least 1 of the following risk factors for severe illness

• Aged 65 years or older
• Hypertension
• Diabetes mellitus
• Chronic lung disease including asthma, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (eg, idiopathic pulmonary fibrosis)
• Chronic cardiac conditions, including coronary artery disease (CAD), heart failure, congenital heart disease, cardiomyopathy
• Severe obesity (body mass index [BMI] ≥ 40 kg/m^2)
• Chronic liver disease, including cirrhosis
• Must agree not to enroll in another study of an investigational agent or take any other drug that has been granted Emergency Use Authorization prior to completion of Day 28
• If women of childbearing potential (WOCBP) or men whose sexual partners are WOCBP, must be able and willing to use at least 1 highly effective method of contraception during the study and for 90 days after receiving the last dose of study drug

Exclusion criteria

• Physician makes a decision that trial involvement is not in participants' best interest, or has any condition that does not allow the protocol to be followed safely
• Known severe liver disease (eg, Child Pugh score > 12, AST >5 times upper limit)
• SaO2/SPO2 ≤94% on room air condition, or the Pa02/Fi02 ratio < 300 mgHg
• Known allergic reaction to camostat mesilate or one of its excipients
• Known severe renal impairment (estimated glomerular filtration rate ≤30 mL/min/1.73 m^2) or receiving dialysis
• Pregnant or breastfeeding, or positive pregnancy test in a predose examination
• Receipt of any experimental treatment for COVID-19, including agents with demonstrated or possible direct acting antiviral activity, including, but not limited to, remdesivir, hydroxychloroquine, lopinavir/ritonavir, tocilizumab, or ivermectin, within the 30 days prior to the time of the screening evaluation. No off label use of a drug for COVID 19 is allowed.
• History of human immunodeficiency virus infection on highly active antiretroviral therapy (HAART)