GS-5734 to Assess the Antiviral Activity, Longer-Term Clearance of Ebola Virus, and Safety in Male Ebola Survivors With Evidence of Ebola Virus Persistence in Semen
- Conditions
- Ebola
- Interventions
- Drug: GS-5734Other: Placebo Comparator
- Registration Number
- NCT02818582
- Brief Summary
Background:
Some people have Ebola virus in their body for months after they recover from Ebola virus disease. Some may have health problems from the virus while others are fine. These people may be able to pass the virus to others. There are currently no drugs for people who have survived Ebola virus disease but still have the virus in their body. A new drug, GS-5734, might help get rid of Ebola virus in semen.
Objective:
To test if GS-5734 helps get rid of Ebola virus in semen and is safe for humans.
Eligibility:
Men who participated in the Ebola survivor study (PREVAIL III) and have evidence of the Ebola virus in their semen
Design:
Participants will be screened with:
Questions
Physical exam
Eye exam
Blood tests
2 semen samples if they have not had it tested recently
Participants must live near the study site in Liberia for 6 months.
Participants will be put into 1 of 2 study groups. They will have an infusion of either GS-5734 or a placebo every day for 5 days. A plastic tube is put into an arm vein. The infusion lasts 1 hour.
Participants will be observed for 1 hour after. They will provide a semen sample on infusion day 4.
After the infusions, participants will have 5 visits in the first month, then 1 per month for 5 more months. These include giving a blood and semen sample.
Blood tests are performed before and after each infusion and the last visit (5 month visit) will also include an eye exam.
When the study is over, if the study drug works and is safe, participants who got the placebo can get the study drug.
- Detailed Description
With the unprecedented size of the recent 2014-2016 West African Ebola outbreak, the scientific community is learning a great deal about the psychological and physical consequences of Ebola, Ebola viral persistence in survivors, risk of Ebola disease relapse in survivors, and the potential for survivors to transmit the virus to others. Data from PREVAIL III has demonstrated that persistence of Ebola virus in the semen of male survivors is common. In addition to Ebola virus persistence, Ebola relapse causing clinical disease has been well documented.
There are no licensed therapies for the treatment of Ebola virus disease nor for the clearance of persistent Ebola virus in survivors. A safe, effective therapy that can reduce and/or eliminate persistent Ebola virus from semen would reduce the risk of transmission and enable male survivors to resume normal sexual relations without fear of harming loved ones. The mechanism underlying Post-Ebola Syndrome is as yet unknown, but improvement in Post-Ebola signs and symptoms resulting from GS-5734 treatment would be an added benefit.
This study is a double-blind, randomized, two-phase (treatment and longer-term follow-up), two- arm trial of GS-5734 versus placebo among male Ebola survivors with persistent Ebola virus RNA in their semen. Participants are randomized 1:1 to receive either 100 mg of GS-5734 or placebo once daily by intravenous catheter for 5 days. Informed by transaminase elevations in prior Phase I studies in normal healthy subjects, a risk-mitigation strategy includes a built-in dose de-escalation. Participants will be stratified by country and on the basis of one versus two positive semen samples for Ebola virus RNA using the Cepheid GeneXpert platform assessed within 42 days prior to study enrollment. The early Data Safety and Monitoring Board (DSMB) review in August 2016 concluded there was no need for a cohort dose reduction. The protocol expanded to Guinea in October 2017, where the outbreak ended later. Currently there is an outbreak in the Democratic Republic of the Congo where the study team may evaluate conducting this study following the completion of the outbreak.
Antiviral activity, as well as safety and tolerability, will be assessed during the treatment phase. Longer-term clearance of Ebola virus will be assessed during the 5-month follow-up phase. Primary analyses for the assessment of antiviral activity in the treatment phase will focus on the assay negativity rate (ANR; percentage of genital samples that are negative for Ebola) over the first 28 days of the study, as well as clinical and laboratory adverse events. A sample is considered negative by PCR if the test result is undetectable. Primary analysis for the follow-up phase will focus on the ANR collected monthly from months 2 to 6.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Male
- Target Recruitment
- 38
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description GS-5734 100mg given intravenously daily for 5 days GS-5734 Male Ebola survivors with persistent Ebola virus in their semen were given GS-5734 100mg intravenously daily for 5 days Normal saline intravenously for 5 days Placebo Comparator Male Ebola survivors with persistent Ebola virus in their semen were given normal saline intravenously daily for 5 days
- Primary Outcome Measures
Name Time Method Mean Assay Negativity Rate (ANR) for Ebola Virus During the Follow-up Phase Follow-up phase (assessed on weeks 8, 12, 16, 20, & 24) Mean assay negativity rate (ANR) of semen samples collected during the follow-up phase on weeks 8, 12, 16, 20, \& 24. Average of all time points for negative values were compiled for the collected assay values.
Negativity rate per participant was calculated using all time points by calculating the number of negative results over total number of time points (5). The assay negativity rate was averaged over all participants to get the mean assay negativity rate.Mean Assay Negativity Rate (ANR) for Ebola Virus During the Treatment Phase Treatment Phase (assessed at days 4, 8, 11, 16, 20, 24, & 28) Mean assay negativity rate (ANR) of semen samples collected during the treatment phase on days 4, 8, 11, 16, 20, 24, \& 28. Average of all time points for negative values were compiled for the collected assay values.
Negativity rate per participant was calculated using all time points by calculating the number of negative results over total number of time points (7). The assay negativity rate was averaged over all participants to get the mean assay negativity rate.
- Secondary Outcome Measures
Name Time Method Mean Change From Baseline in ALT Value Follow-up phase - Week 24 Mean change from baseline in alanine transaminase (ALT) value at week 24
Mean Change From Baseline in aPTT Value Follow-up phase - Week 24 Mean change from baseline in activated partial thromboplastin time (aPTT) value at week 24
Number of Participants With Increase in Grade From Baseline for ALT Value Follow-up phase - Week 24 Number of participants with increase in grade from baseline in alanine transaminase (ALT) value at week 24.
Lab values were graded using Division of Acquired Immunodeficiency Syndrome (DAIDS) table for Grading the Severity of Adult and Pediatric Adverse Events (DAIDS AE grading table) version 2.0, November 2014 with grade 1 (mild), grade 2 (moderate), grade 3 (severe), and grade 4 (potentially life-threatening).
ALT grade ranges include grade 1 (1.25-2.5 x ULN), grade 2 (2.6-5.0 x ULN), grade 3 (5.1-10.0 x ULN), \& grade 4 (\> 10 x ULN)Number of Participants With Increase in Grade From Baseline for aPTT Value Follow-up phase - Week 24 Number of participants with increase in grade from baseline in activated partial thromboplastin time (aPTT) value at week 24.
Lab values were graded using Division of Acquired Immunodeficiency Syndrome (DAIDS) table for Grading the Severity of Adult and Pediatric Adverse Events (DAIDS AE grading table) version 2.0, November 2014 with grade 1 (mild), grade 2 (moderate), grade 3 (severe), and grade 4 (potentially life-threatening).
aPTT grade ranges include grade 1 (1.1 - 1.66 x ULN), grade 2 (1.67 - 2.33 x ULN), grade 3 (2.34 - 3.00 x ULN), \& grade 4 (\> 3.00 x ULN)Participants With Grade 3 AST Level Follow-up phase - Week 28 Participants with grade 3 (5.1 - 10.0 x ULN) aspartate transaminase (AST) level at week 28
Mean Assay Negativity Rate (ANR) for Ebola Virus During the Treatment Phase Treatment Phase (assessed on days 4, 8, 11, 16, 20, 24, & 28) Mean assay negativity rate (ANR) of semen samples collected during the treatment phase on days 4, 8, 11, 16, 20, 24, \& 28. Average of all time points for negative values were compiled for the collected assay values.
Negativity rate per participant was calculated using all time points by calculating the number of negative results over total number of time points (7). The assay negativity rate was averaged over all participants to get the mean assay negativity rate.Mean Change From Baseline in ALT Value at Day 11 Treatment phase - Day 11 Mean change from baseline in alanine transaminase (ALT) value at day 11
Mean Change From Baseline in AST Value Follow-up phase - Week 24 Mean change from baseline in aspartate transaminase (AST) value at week 24
Mean Change From Baseline in PT Value Follow-up phase - Week 24 Mean change from baseline in prothrombin time (PT) value at week 24
Number of Participants With Increase in Grade From Baseline for AST Value Follow-up phase - Week 24 Number of participants with increase in grade from baseline in aspartate transaminase (AST) Value at week 24.
Lab values were graded using Division of Acquired Immunodeficiency Syndrome (DAIDS) table for Grading the Severity of Adult and Pediatric Adverse Events (DAIDS AE grading table) version 2.0, November 2014 with grade 1 (mild), grade 2 (moderate), grade 3 (severe), and grade 4 (potentially life-threatening).
AST grade ranges include grade 1 (1.25-2.5 x ULN), grade 2 (2.6-5.0 x ULN), grade 3 (5.1-10.0 x ULN), \& grade 4 (\> 10 x ULN)Participants With Grade 2 AST Level Follow-up phase - Week 28 Participants with grade 2 (2.6 - 5.0 x ULN) aspartate transaminase (AST) level at week 28
Participants With Grade 1 AST Level Follow-up phase - Week 28 Participants with grade 1 (1.25 - 2.5 x ULN) aspartate transaminase (AST) level at week 28
Participants With Grade 2 ALT Level Follow-up phase - Week 24 Participants with grade 2 (2.6 - 5.0 x ULN) alanine transaminase (ALT) level at week 24
Mean Assay Negativity Rate (ANR) for Ebola Virus During the Follow-up Phase Follow-up phase (assessed on weeks 8, 12, 16, 20, & 24) Mean assay negativity rate (ANR) of semen samples collected during the follow-up phase - weeks 8, 12, 16, 20, \& 24. Average of all time points for negative values were compiled for the collected assay values.
Negativity rate per participant was calculated using all time points by calculating the number of negative results over total number of time points (5). The assay negativity rate was averaged over all participants to get the mean assay negativity rate.Participants With Grade 1 ALT Level Follow-up phase - Week 24 Participants with grade 1 (1.25 - 2.5 x ULN) alanine transaminase (ALT) level at week 24
Participants With Grade 3 ALT Level Follow-up phase - Week 24 Participants with grade 3 (5.1 - 10.0 x ULN) alanine transaminase (ALT) level at week 24
Participants With Grade 4 ALT Level Follow-up phase - Week 24 Participants with grade 4 (\> 10 x ULN) alanine transaminase (ALT) level at week 24
Participants With Grade 4 AST Level Follow-up phase - Week 28 Participants with grade 4 (\> 10 x ULN) aspartate transaminase (AST) level at week 28
Mean Change From Baseline in INR Value Follow-up phase - Week 24 Mean change from baseline in international normalized ratio (INR) value at week 24
Number of Participants With Increase in Grade From Baseline for PT Value Follow-up phase - Week 24 Number of participants increase in grade from baseline in prothrombin time (PT) value at week 24.
Lab values were graded using Division of Acquired Immunodeficiency Syndrome (DAIDS) table for Grading the Severity of Adult and Pediatric Adverse Events (DAIDS AE grading table) version 2.0, November 2014 with grade 1 (mild), grade 2 (moderate), grade 3 (severe), and grade 4 (potentially life-threatening).
PT grade ranges include grade 1 (1.1 - 1.25 x ULN), grade 2 (1.26 - 1.50 x ULN), grade 3 (1.51 - 3.00 x ULN), \& grade 4 (\> 3.00 x ULN)
Trial Locations
- Locations (2)
JFK Hospital Partnership for Research for Vaccines and Infectious Diseases in Liberia (PREVAIL)
🇱🇷Monrovia, Liberia
Partnership of Clinical Research in Guinea (PREGUI) / Centre National de Formation et de Recherche en Santé Rurale de Mafèrinyah
🇬🇳Forécariah, Maferinyah, Guinea