Cytomegalovirus Infection
Conditions
Keywords
human cytomegalovirus, immune globulin, congenital infection, prevention, pregnancy
Brief summary
The aim of this trial is to verify, under controlled conditions, the reported efficacy of human cytomegalovirus (HCMV)-specific hyperimmune globulin administration to pregnant women suffering from primary HCMV infection for the prevention of intrauterine HCMV transmission.
Detailed description
HCMV is the leading infectious cause of mental retardation and deafness in infants with congenital HCMV infection. Primary HCMV infections during pregnancy carry the highest risk of fetal infection and disease. No intervention of proven efficacy is available in case of primary HCMV infection in pregnancy. However, a study published in 2005 (Nigro et al., NEJM 353:1350-62, 2005) reported that in pregnant women with primary HCMV infection treated with HCMV-specific hyperimmune globulin (Cytotect®, Biotest) the risk of transmitting the infection to the fetus was reduced from 40% to 16%. Unfortunately, since the study was conducted with inadequate controls, the actual efficacy of hyperimmune globulin could not be properly assessed. In the present randomized, double-blind, placebo-controlled, multicenter trial pregnant women with ascertained primary HCMV infection at 4-26 weeks of gestation will be randomized to receive Cytotect® or placebo intravenously within 6 weeks after the presumed onset of infection. Primary efficacy parameter will be the number of HCMV-infected newborns or fetuses.
Interventions
DRUGHCMV-specific hyperimmune globulin (Cytotect®)
100U (2.0ml)/Kg i.v. every 4 weeks up to 38 weeks' gestation or HCMV-positive amniocentesis or pregnancy termination.
DRUGIsotonic solution of sodium chloride (placebo)
2.0ml/Kg i.v. every 4 weeks until 38 weeks'gestation or HCMV-positive amniocentesis or pregnancy termination
Sponsors
Fondazione IRCCS Policlinico San Matteo di Pavia
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* pregnant women (in vitro fertilization permitted) * \>= 18 years of age * primary HCMV infection at 5-26 weeks' gestation * \<= 6 weeks from presumed onset of infection * gestational age between 5-32 weeks' gestation * written informed consent
Exclusion criteria
* multiple pregnancy * history of HIV or HBV or HCV infection * known immunodeficiency or immunosuppression * congenital or acquired autoimmune disease * known intolerance to protein of human origin * known intolerance to immune globulin * history of adverse effects to vaccination * hypersensitivity to human immune globulin (pathological IgG or IgA deficiences) * renal failure * serious organic or psychiatric disease * lack of motivation to participate in the study * women unable to satisfy study requirements * women not willing or unable to provide written informed consent * women not willing to give consent to transmission of anonymised data
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Evidence of congenital HCMV infection in the fetus/newborn | At amniocentesis and/or within one week after birth |
Secondary
| Measure | Time frame |
|---|---|
| HCMV-specific immune response (humoral and cell-mediated) | 36-48 months |
| Virological and histological findings in placentas | 36-48 months |
| Clinical outcome of newborns with congenital HCMV infection | within 2 weeks after birth |
| Safety of Cytotect in the mother and newborn | within 24 hours after delivery |
Countries
Italy
Outcome results
None listed