Adaptive Dengue Antiviral Platform Trial
- Conditions
- DengueAntiviral Drugs
- Interventions
- Drug: VIS513 (a monoclonal antibody)Drug: Molnupiravir 400 mg
- Registration Number
- NCT06551844
- Brief Summary
This is a randomized, open-label adaptive platform trial aiming to screen the antiviral effectiveness of the experimental drug(s) in early dengue infection
* Primary objectives:
* To determine the antiviral effectiveness of the experimental drug(s) in early dengue infection
* To assess the safety and tolerability of the experimental drug(s) in dengue patients
* Secondary objective:
* To assess the effect of the experimental drug(s) in dengue patients on physiological, clinical and virological parameters
- Detailed Description
This is a randomized, open-label adaptive platform trial investigating the antiviral effectiveness of various intervention arms in patients with lab-confirmed dengue and less than 48 hours of fever. The antiviral candidates in this trial will include the repurposed antiviral drugs, novel small molecule drugs and dengue monoclonal antibody. Patients will be randomly allocated between available treatment arms and compared to standard of care ("no study drug": no placebos will be made for this trial).
The current sites include Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam. Other sites and countries may be added in due course.
This is a continually running adaptive platform trial, which begins with two initial candidate drugs (a total of 3 arms): molnupiravir and VIS513 (a dengue monoclonal antibody). New therapies may be added and poorly performing arms or interventions meeting pre-specific thresholds for in vivo antiviral efficacy will be removed.
The sample size is adaptive with multiple planned interim analyses. The number of patients recruited depends on the results. For each intervention studied the sample size will be adaptive and determined by pre-specified stopping rules for futility and efficacy. Patients are invited to participate in the trial if they present at the healthcare settings with early symptomatic dengue virus infection (less than 48 hours since the onset of fever and positive NS1 antigen test) and can be able to return for follow up visits at 30 and 60 days after randomization.
The randomization ratios will be uniform for all available and eligible arms (1:1:1...).
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 500
- Female or male patients with a clinical diagnosis of dengue virus infection and less than 48 hours of fever
- Positive NS1 rapid diagnostic test
- >= 10 years or ≥ 18 years of age (depending on license of therapeutic being evaluated)
- Patient is able to give written informed consent or assent for full participation in the study.
- Agreement to stay in hospital for duration of the intervention (most will be 5 days) and follow-up visits at day 30 and 60 post enrolment.
- Meets criteria for severe dengue at baseline (severe plasma leakage leading to dengue shock syndrome, fluid accumulation with respiratory distress, severe bleeding, severe organ involvement - AST/ALT>1000 U/L, impaired consciousness, multiple organ dysfunction)
- Pregnancy (either clinically confirmed or by urine dipstick for human chorionic gonadotrophin hormone)
- Breastfeeding women
- Localising features suggesting an alternative/additional diagnosis, e.g. pneumonia, sepsis
- Renal failure (baseline eGFR < 30ml/min)
- History or presence of clinically significant cardiovascular, respiratory, hepatic, renal, gastrointestinal, neuropsychiatric, autoimmune, dermatologic or immunosuppressive disorders
- History of allergic disease, allergic reactions or known hypersensitivity to any component of the study product (Mild non-medication allergies allowed)
- Any condition that, in the opinion of the investigator, would complicate or compromise the study or well-being of the participant
- Participation or planned participation in a study involving the administration of an investigational compound within the past one month.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SEQUENTIAL
- Arm && Interventions
Group Intervention Description Monoclonal antibody (arm C) VIS513 (a monoclonal antibody) Patients, who are randomly allocated into arm C, will receive a single dose of 6mg/Kg of the dengue monoclonal antibody via an intravenous line over 2 hours. Molnupiravir (arm B) Molnupiravir 400 mg Patients, who are randomly allocated into arm B, will receive 800mg po bid of Molnupiravir for 5 days
- Primary Outcome Measures
Name Time Method Viral clearance rate From randomization until day 5 of study Rate of viral clearance estimated under a hierarchical log-linear model fit to the serial viral load measurements over 5 days after enrolment. The viremia kinetics will be measured using the qRT-PCR assay, which will be performed on samples taken twice a day from day 1 to day 3 of study and then once a day on days 4 and 5 of study (total 9 samples per patient).
Number of AEs (grade 3, 4 and 5) Until day 30 post-enrolment All patients will be followed up daily until discharge and then at around days 30 after randomization to collect information on clinical progress of dengue illness and any adverse events occurring during the study course. All AEs and SAEs will be recorded.
- Secondary Outcome Measures
Name Time Method Viral log reduction up to 48 hours of study Reduction of viremia at the 24 and 48 hours compared to baseline
Number of patients requiring for ICU admission From enrolment until discharge, assessed up to 30 days All patients will be followed up daily until discharge to collect information about the clinical progress of dengue
Area under the viremia curve From randomisation until day 5 of study Area under the curve (AUC) of the serial viremia measurements during the first 5 days of study
NS1 clearance time up to day 5 Time to NS1 clearance as estimated under a non-linear model
Number of patients progress to severe dengue (WHO 2009 criteria) From enrolment until discharge, assessed up to 30 days All patients will be followed up daily until discharge to collect information about the clinical progress of dengue
Change in haematocrit Until day 30 post-enrolment Change in haematocrit during the hospitalisation
Fever clearance time From enrolment until discharge, assessed up to 30 days Time elapsed from enrolment to the afebrile time-point (defined as body temperature \<37.5 °C for at least 48 hours)
Platelet nadir Until day 30 post-enrolment The lowest platelet count recorded during admission
Maximum AST/ALT Until day 30 post-enrolment The highest values of AST/ALT measured
Trial Locations
- Locations (1)
Hospital for Tropical Diseases at Ho Chi Minh city
🇻🇳Ho Chi Minh City, Vietnam