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Safety Study of IV Peramivir in Hospitalized Subjects With Confirmed or Suspected Influenza

A Phase 3, Open-Label, Randomized Study of the Antiviral Activity, Safety, and Tolerability of Intravenous Peramivir in Hospitalized Subjects With Confirmed or Suspected Influenza Infection

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00957996
Enrollment
234
Registered
2009-08-13
Start date
2009-10-31
Completion date
2011-08-31
Last updated
2015-02-12

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Seasonal Influenza, Cough, Sore Throat, Nasal Congestion, Myalgia, Headache, Fatigue

Keywords

influenza, hospitalized, flu, antiviral

Brief summary

This is a Phase 3, open-label, randomized study of the antiviral activity, safety, and tolerability of intravenous Peramivir in hospitalized subjects with confirmed or suspected influenza infection.

Interventions

300 mg twice daily

Sponsors

Department of Health and Human Services
CollaboratorFED
BioCryst Pharmaceuticals
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
6 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Male and non-pregnant female subjects 6 years of age or older. * Able to provide written informed consent, or for whom written consent may be provided by a parent guardian or legally authorized representative, unless consent provided by a parent, guardian or legally authorized representative is not consistent with applicable local or ethical procedures, directives and /or guidelines. * Presence of clinical signs and/or symptoms consistent with an acute illness compatible with influenza infection; a measured temperature of ≥ 38.0°C (100.4°F) oral, or ≥ 38.6°C (101.4°F) rectal or tympanic and recent onset of at least one of the following: rhinorrhea or nasal congestion, sore throat or cough. Measured temperature can include fever meeting the above criteria as reported by the subject or their parent, guardian or legally authorized representative in the 24 hours prior to Screening. The requirement for fever is waived for any subject with influenza infection already confirmed by laboratory tests (including Rapid Antigen Tests). * Confirmation of influenza A or B infection in the local community by one of the following means: * the institution's local laboratory, * the local public health system * the national public health system * a laboratory of a recognized national or multinational influenza surveillance scheme. * Severity of illness requiring or anticipated to require in-hospital care.

Exclusion criteria

* Subjects who have been hospitalized for greater than 24 hours (not including time spent in the emergency department).Blood platelet count of \< 20 x 109/L. * Serum bilirubin \> 6 mg/dL at time of Screening evaluation. * Serum ALT or AST \> 5 X upper limit of normal at time of Screening evaluation. * Serum creatinine \> 5.0 mg/dL at time of Screening evaluation. * Subjects who require peritoneal dialysis or hemofiltration. * Altered neurologic status as defined by a Glasgow Coma Score of ≤ 9, unless medically induced. * Females who are pregnant (positive urine or serum pregnancy test at Screening evaluation) or breastfeeding. * Actively undergoing systemic chemotherapy or radiotherapy treatment for a malignancy. (Subjects who have completed treatment 30 days prior to enrollment are allowed to enroll in the study. Hormone treatment for cancer is also acceptable). * Prior hematopoietic stem cell transplantation or solid organ transplant during the previous 4 months. * HIV infection with a known CD4 count \< 200 cells/ mm3 unless on a stable highly active antiretroviral (HAART) regimen for at least 6 months. * Presence of a preexisting chronic infection that is undergoing or requiring medical therapy (eg, tuberculosis). (Subjects with chronic osteomyelitis or hepatitis B or C not requiring treatment are not excluded). * Presence of any preexisting illness that, in the opinion of the Investigator, would place the subject at an unreasonably increased risk through participation in this study. * Participation as a subject in any study of an experimental treatment for any condition within the 30 days prior to the time of the Screening evaluation. * Subjects diagnosed with cystic fibrosis. * Subjects with confirmed clinical evidence of acute non-influenzal infection at the time of Screening.

Design outcomes

Primary

MeasureTime frameDescription
Change From Baseline in Influenza Virus Titer (48 Hours)Baseline and 48 hoursThe time-weighted change from baseline in log10 tissue culture infective dose50 (TCID50/mL) was calculated on a by-subject basis through 48 hours using the trapezoidal rule with all available data minus the baseline value. Ninety-five percent confidence intervals about the median time-weighted change from baseline were presented for each treatment group.

Secondary

MeasureTime frameDescription
Change in Influenza Virus Titer, as Measured by Quantitative RT-PCR (log10 vp/mL)Baseline, 48, 108, 216 hoursThe time-weighted change from baseline in viral titer measured by RT-PCR was calculated on a by-subject basis through 216 hours using the trapezoidal rule with all available data minus the baseline value. Ninety-five percent confidence intervals about the median time-weighted change from baseline were presented for each treatment group.
Time to Clinical Resolution28 daysTime to clinical resolution was the number of hours from initiation of study treatment until 4 of the 5 signs of clinical stability (including both body temperature and transcutaneous oxygen saturation) met resolution criteria that was maintained for at least 24 hours. The median time to clinical resolution and associated 95% confidence interval were estimated for each treatment group using the method of Kaplan-Meier. Subjects who did not achieve clinical resolution were censored at the time of their last assessment.
Number of Participants With Clinical Resolution28 daysClinical resolution was defined as normalization of at least 4 of the 5 signs of clinical stability (including both body temperature and transcutaneous oxygen saturation) for at least 24 hours.
Time to Alleviation of Symptoms28 daysTime to alleviation of symptoms, defined as the time from initiation of study drug until the start of the 24 hour period where all seven symptoms of influenza are recorded as none or mild, was estimated using the method of Kaplan-Meier (adolescents and adults). The 95% confidence interval about the median was presented. Subjects who did not experience alleviation of symptoms were censored at the time of the last non-missing symptom assessment.
Time to Resolution of Fever28 daysTime to resolution of fever was the number of hours from initiation of study treatment until temperature was ≤37.2°C/≤99°F oral or ≤37.8°C/≤100°F rectal or tympanic for at least 24 hours with no antipyretic medication taken within 4 hours prior to the temperature measurement. Subjects who did not achieve resolution of fever were censored at the time of their last assessment. The 95% confidence interval about the median were presented.
Time to Hospital Discharge28 daysTime to hospital discharge, defined as the number of days from initiation of study drug until the subject is discharged from the hospital, was estimated using the method of Kaplan-Meier. The 95% confidence interval about the median was presented. Subjects who were not discharged during the study period were censored at the last study visit. Subjects who died prior to discharge were censored at the longest observed time to discharge.
Number of Participants Experiencing Influenza-related Complications28 daysInfluenza-related complications were defined as the occurrence of sinusitis, otitis, bronchitis and pneumonia as reported on the Influenza-related complications CRF.
Number of Participants Admitted to ICU After Initiation of Treatment28 daysThe number of subjects experiencing ICU admission after initiation of treatment.
Duration of Postbaseline ICU Admission (Kaplan-Meier Estimate)28 daysThe duration of ICU admission after initiation of treatment was estimated by the method of Kaplan-Meier. Subjects who were not discharged from the ICU were censored at the time of their last assessment
Survival (Kaplan-Meier Estimates)14 and 28 daysSurvival was calculated as the number of days from initiation of study drug until death or last contact. Overall survival was estimated by the method of Kaplan-Meier; 95% confidence intervals for 14- and 28-day survival were presented by treatment group. Subjects who had not died were censored at the date of last contact.
Time to Resumption of Usual Activities28 daysSubject's ability to perform usual activities as determined from the visual analog scale (scale ranges from 0 to 10 where 0 indicates subject was unable to perform usual activities at all and 10 indicates subject is able to perform all usual activities fully) was summarized by study visit day and treatment group. The median time to resumption of usual daily activities and associated 95% CI was estimated using the method of Kaplan-Meier for adults and adolescents. Subjects who did not return to the pre-study level of performance of usual daily activities were censored at the time of their last non-missing visual analog scale value. A separate analysis was conducted for children.

Other

MeasureTime frameDescription
Number of Participants Who Required More Than 5 Days of Peramivir Treatment28 daysThe number of subjects who continued more than 5 days were as reported on the Continuation of Treatment CRF page.

Countries

Australia, Canada, Mexico, New Zealand, Puerto Rico, United States

Participant flow

Participants by arm

ArmCount
Peramivir 300mg
300 mg twice daily Peramivir: 300 mg twice daily
117
Peramivir 600mg
600 mg once daily Peramivir: 600 mg once daily
117
Total234

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event21
Overall StudyDeath410
Overall StudyInfluenza-related complication01
Overall StudyLost to Follow-up47
Overall StudyMissing10
Overall StudyNoncompliance; Protocol Deviations56
Overall StudyPhysician Decision11
Overall StudyWithdrawal by Subject92

Baseline characteristics

CharacteristicPeramivir 600mgPeramivir 300mgTotal
Age, Continuous48.4 years48.3 years48.3 years
Age, Customized
Adolescents 12-17 years
1 participants3 participants4 participants
Age, Customized
Adults 18-24 years
8 participants4 participants12 participants
Age, Customized
Adults 25-34 years
19 participants17 participants36 participants
Age, Customized
Adults 35-44 years
18 participants29 participants47 participants
Age, Customized
Adults 45-54 years
29 participants26 participants55 participants
Age, Customized
Adults 55-64 years
27 participants18 participants45 participants
Age, Customized
Adults 65-74 years
10 participants11 participants21 participants
Age, Customized
Adults ≥75 years
5 participants9 participants14 participants
Age, Customized
Children 6-11 years
0 participants0 participants0 participants
APACHE II Score17 units on a scale
STANDARD_DEVIATION 5.4
14 units on a scale
STANDARD_DEVIATION 7.5
15 units on a scale
STANDARD_DEVIATION 6.6
Body mass index (BMI)31 kg/m^232 kg/m^231 kg/m^2
Chest X-ray at Screening
Abnormal
28 participants31 participants59 participants
Chest X-ray at Screening
Missing
3 participants4 participants7 participants
Chest X-ray at Screening
Normal
86 participants82 participants168 participants
Corticosteroid at enrollment
No
49 participants65 participants114 participants
Corticosteroid at enrollment
Yes
68 participants52 participants120 participants
Duration of hospital admission prior to first dose1.3 days
STANDARD_DEVIATION 2.86
1.1 days
STANDARD_DEVIATION 0.98
1.2 days
STANDARD_DEVIATION 2.13
Duration of illness
≤48 hours
16 participants18 participants34 participants
Duration of illness
>48 hours
101 participants99 participants200 participants
Hemisphere of enrollment
Northern Hemisphere 09-10
108 participants107 participants215 participants
Hemisphere of enrollment
Southern Hemisphere 10
9 participants10 participants19 participants
Influenza vaccination status
Missing
0 participants2 participants2 participants
Influenza vaccination status
Not vaccinated this year
81 participants74 participants155 participants
Influenza vaccination status
Vaccinated this year
36 participants41 participants77 participants
Moderate renal impairment
Impaired
11 participants10 participants21 participants
Moderate renal impairment
Missing
1 participants4 participants5 participants
Moderate renal impairment
Not impaired
105 participants103 participants208 participants
Number of subjects with ICU admission at Baseline21 participants18 participants39 participants
Race/Ethnicity, Customized
American Indian or Alaska Native
1 participants3 participants4 participants
Race/Ethnicity, Customized
Asian
5 participants5 participants10 participants
Race/Ethnicity, Customized
Black, of African Heritage or African American
13 participants16 participants29 participants
Race/Ethnicity, Customized
Native Hawaiian or other Pacific Islander
3 participants0 participants3 participants
Race/Ethnicity, Customized
Other
11 participants15 participants26 participants
Race/Ethnicity, Customized
White
84 participants78 participants162 participants
Screening lymphocytes
Grade 3/4
22 participants15 participants37 participants
Screening lymphocytes
Missing
6 participants13 participants19 participants
Screening lymphocytes
Other Grade
89 participants89 participants178 participants
Screening neutrophils
Grade 3/4
3 participants0 participants3 participants
Screening neutrophils
Missing
6 participants13 participants19 participants
Screening neutrophils
Other Grade
108 participants104 participants212 participants
Screening serum albumin
Grade 3
8 participants6 participants14 participants
Screening serum albumin
Missing
6 participants6 participants12 participants
Screening serum albumin
Other Grade
103 participants105 participants208 participants
Sex: Female, Male
Female
65 Participants74 Participants139 Participants
Sex: Female, Male
Male
52 Participants43 Participants95 Participants
Smoking status
Current smoker
45 participants43 participants88 participants
Smoking status
Missing
0 participants1 participants1 participants
Smoking status
Not current smoker
72 participants73 participants145 participants
Subjects who received antivirals prior to treatment82 participants88 participants170 participants
Supplemental oxygen required at Screening
Missing
2 participants1 participants3 participants
Supplemental oxygen required at Screening
No
32 participants41 participants73 participants
Supplemental oxygen required at Screening
Yes
83 participants75 participants158 participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
69 / 11465 / 116
serious
Total, serious adverse events
21 / 11426 / 116

Outcome results

Primary

Change From Baseline in Influenza Virus Titer (48 Hours)

The time-weighted change from baseline in log10 tissue culture infective dose50 (TCID50/mL) was calculated on a by-subject basis through 48 hours using the trapezoidal rule with all available data minus the baseline value. Ninety-five percent confidence intervals about the median time-weighted change from baseline were presented for each treatment group.

Time frame: Baseline and 48 hours

Population: The Intent-to-Treat Infected (ITTI) population included all randomized subjects who received at least 1 dose/infusion of study drug, and had confirmed influenza A or B by culture, PCR, or serology. Overall, 83 subjects were excluded due to negative Baseline titers (log10 TCID50 0.5).

ArmMeasureValue (MEDIAN)
Peramivir 300 mgChange From Baseline in Influenza Virus Titer (48 Hours)-1.66 log10 TCID50/mL
Peramivir 600 mgChange From Baseline in Influenza Virus Titer (48 Hours)-1.47 log10 TCID50/mL
Secondary

Change in Influenza Virus Titer, as Measured by Quantitative RT-PCR (log10 vp/mL)

The time-weighted change from baseline in viral titer measured by RT-PCR was calculated on a by-subject basis through 216 hours using the trapezoidal rule with all available data minus the baseline value. Ninety-five percent confidence intervals about the median time-weighted change from baseline were presented for each treatment group.

Time frame: Baseline, 48, 108, 216 hours

Population: The Intent-to-Treat Infected (ITTI) population included all randomized subjects who received at least 1 dose/infusion of study drug, and had confirmed influenza A or B by culture, PCR, or serology. Overall, 41 subjects were excluded due to negative Baseline titers (viral particles/mL RT-PCR value 1.58 for Influenza A and 1.49 for Influenza B).

ArmMeasureGroupValue (MEDIAN)
Peramivir 300 mgChange in Influenza Virus Titer, as Measured by Quantitative RT-PCR (log10 vp/mL)Change from baseline, 48 hours-1.00 log10 viral particles/mL
Peramivir 300 mgChange in Influenza Virus Titer, as Measured by Quantitative RT-PCR (log10 vp/mL)Change from baseline, 108 hours-1.65 log10 viral particles/mL
Peramivir 300 mgChange in Influenza Virus Titer, as Measured by Quantitative RT-PCR (log10 vp/mL)Change from baseline, 216 hours-2.15 log10 viral particles/mL
Peramivir 600 mgChange in Influenza Virus Titer, as Measured by Quantitative RT-PCR (log10 vp/mL)Change from baseline, 48 hours-1.07 log10 viral particles/mL
Peramivir 600 mgChange in Influenza Virus Titer, as Measured by Quantitative RT-PCR (log10 vp/mL)Change from baseline, 108 hours-1.59 log10 viral particles/mL
Peramivir 600 mgChange in Influenza Virus Titer, as Measured by Quantitative RT-PCR (log10 vp/mL)Change from baseline, 216 hours-1.79 log10 viral particles/mL
Secondary

Duration of Postbaseline ICU Admission (Kaplan-Meier Estimate)

The duration of ICU admission after initiation of treatment was estimated by the method of Kaplan-Meier. Subjects who were not discharged from the ICU were censored at the time of their last assessment

Time frame: 28 days

Population: The Intent-to-Treat Infected (ITTI) population included all randomized subjects who received at least 1 dose/infusion of study drug, and had confirmed influenza A or B by culture, PCR, or serology.

ArmMeasureValue (MEDIAN)
Peramivir 300 mgDuration of Postbaseline ICU Admission (Kaplan-Meier Estimate)7 days
Peramivir 600 mgDuration of Postbaseline ICU Admission (Kaplan-Meier Estimate)7 days
Secondary

Number of Participants Admitted to ICU After Initiation of Treatment

The number of subjects experiencing ICU admission after initiation of treatment.

Time frame: 28 days

Population: The Intent-to-Treat Infected (ITTI) population included all randomized subjects who received at least 1 dose/infusion of study drug, and had confirmed influenza A or B by culture, PCR, or serology.

ArmMeasureValue (NUMBER)
Peramivir 300 mgNumber of Participants Admitted to ICU After Initiation of Treatment2 participants
Peramivir 600 mgNumber of Participants Admitted to ICU After Initiation of Treatment6 participants
Secondary

Number of Participants Experiencing Influenza-related Complications

Influenza-related complications were defined as the occurrence of sinusitis, otitis, bronchitis and pneumonia as reported on the Influenza-related complications CRF.

Time frame: 28 days

Population: The Intent-to-Treat Infected (ITTI) population included all randomized subjects who received at least 1 dose/infusion of study drug, and had confirmed influenza A or B by culture, PCR, or serology.

ArmMeasureValue (NUMBER)
Peramivir 300 mgNumber of Participants Experiencing Influenza-related Complications39 participants
Peramivir 600 mgNumber of Participants Experiencing Influenza-related Complications48 participants
Secondary

Number of Participants With Clinical Resolution

Clinical resolution was defined as normalization of at least 4 of the 5 signs of clinical stability (including both body temperature and transcutaneous oxygen saturation) for at least 24 hours.

Time frame: 28 days

Population: The Intent-to-Treat Infected (ITTI) population included all randomized subjects who received at least 1 dose/infusion of study drug, and had confirmed influenza A or B by culture, PCR, or serology.

ArmMeasureValue (NUMBER)
Peramivir 300 mgNumber of Participants With Clinical Resolution41 participants
Peramivir 600 mgNumber of Participants With Clinical Resolution42 participants
Secondary

Survival (Kaplan-Meier Estimates)

Survival was calculated as the number of days from initiation of study drug until death or last contact. Overall survival was estimated by the method of Kaplan-Meier; 95% confidence intervals for 14- and 28-day survival were presented by treatment group. Subjects who had not died were censored at the date of last contact.

Time frame: 14 and 28 days

Population: The Intent-to-Treat Infected (ITTI) population included all randomized subjects who received at least 1 dose/infusion of study drug, and had confirmed influenza A or B by culture, PCR, or serology.

ArmMeasureGroupValue (NUMBER)
Peramivir 300 mgSurvival (Kaplan-Meier Estimates)14 Day Survival98 Percent Survival
Peramivir 300 mgSurvival (Kaplan-Meier Estimates)28 Day Survival94 Percent Survival
Peramivir 600 mgSurvival (Kaplan-Meier Estimates)14 Day Survival93 Percent Survival
Peramivir 600 mgSurvival (Kaplan-Meier Estimates)28 Day Survival86 Percent Survival
Secondary

Time to Alleviation of Symptoms

Time to alleviation of symptoms, defined as the time from initiation of study drug until the start of the 24 hour period where all seven symptoms of influenza are recorded as none or mild, was estimated using the method of Kaplan-Meier (adolescents and adults). The 95% confidence interval about the median was presented. Subjects who did not experience alleviation of symptoms were censored at the time of the last non-missing symptom assessment.

Time frame: 28 days

Population: The Intent-to-Treat Infected (ITTI) population included all randomized subjects who received at least 1 dose/infusion of study drug, and had confirmed influenza A or B by culture, PCR, or serology. Symptom data for 18 subjects was missing.

ArmMeasureValue (MEDIAN)
Peramivir 300 mgTime to Alleviation of Symptoms135 hours
Peramivir 600 mgTime to Alleviation of Symptoms158 hours
Secondary

Time to Clinical Resolution

Time to clinical resolution was the number of hours from initiation of study treatment until 4 of the 5 signs of clinical stability (including both body temperature and transcutaneous oxygen saturation) met resolution criteria that was maintained for at least 24 hours. The median time to clinical resolution and associated 95% confidence interval were estimated for each treatment group using the method of Kaplan-Meier. Subjects who did not achieve clinical resolution were censored at the time of their last assessment.

Time frame: 28 days

Population: The Intent-to-Treat Infected (ITTI) population included all randomized subjects who received at least 1 dose/infusion of study drug, and had confirmed influenza A or B by culture, PCR, or serology.

ArmMeasureValue (MEDIAN)
Peramivir 300 mgTime to Clinical Resolution44.7 hours
Peramivir 600 mgTime to Clinical Resolution166.1 hours
Secondary

Time to Hospital Discharge

Time to hospital discharge, defined as the number of days from initiation of study drug until the subject is discharged from the hospital, was estimated using the method of Kaplan-Meier. The 95% confidence interval about the median was presented. Subjects who were not discharged during the study period were censored at the last study visit. Subjects who died prior to discharge were censored at the longest observed time to discharge.

Time frame: 28 days

Population: The Intent-to-Treat Infected (ITTI) population included all randomized subjects who received at least 1 dose/infusion of study drug, and had confirmed influenza A or B by culture, PCR, or serology.

ArmMeasureValue (MEDIAN)
Peramivir 300 mgTime to Hospital Discharge6 days
Peramivir 600 mgTime to Hospital Discharge6 days
Secondary

Time to Resolution of Fever

Time to resolution of fever was the number of hours from initiation of study treatment until temperature was ≤37.2°C/≤99°F oral or ≤37.8°C/≤100°F rectal or tympanic for at least 24 hours with no antipyretic medication taken within 4 hours prior to the temperature measurement. Subjects who did not achieve resolution of fever were censored at the time of their last assessment. The 95% confidence interval about the median were presented.

Time frame: 28 days

Population: The Intent-to-Treat Infected (ITTI) population included all randomized subjects who received at least 1 dose/infusion of study drug, and had confirmed influenza A or B by culture, PCR, or serology.

ArmMeasureValue (MEDIAN)
Peramivir 300 mgTime to Resolution of Fever27.2 hours
Peramivir 600 mgTime to Resolution of Fever24.2 hours
Secondary

Time to Resumption of Usual Activities

Subject's ability to perform usual activities as determined from the visual analog scale (scale ranges from 0 to 10 where 0 indicates subject was unable to perform usual activities at all and 10 indicates subject is able to perform all usual activities fully) was summarized by study visit day and treatment group. The median time to resumption of usual daily activities and associated 95% CI was estimated using the method of Kaplan-Meier for adults and adolescents. Subjects who did not return to the pre-study level of performance of usual daily activities were censored at the time of their last non-missing visual analog scale value. A separate analysis was conducted for children.

Time frame: 28 days

Population: The Intent-to-Treat Infected (ITTI) population included all randomized subjects who received at least 1 dose/infusion of study drug, and had confirmed influenza A or B by culture, PCR, or serology.

ArmMeasureValue (MEDIAN)
Peramivir 300 mgTime to Resumption of Usual Activities27.7 hours
Peramivir 600 mgTime to Resumption of Usual Activities24.9 hours
Other Pre-specified

Number of Participants Who Required More Than 5 Days of Peramivir Treatment

The number of subjects who continued more than 5 days were as reported on the Continuation of Treatment CRF page.

Time frame: 28 days

Population: The Intent-to-Treat Infected (ITTI) population included all randomized subjects who received at least 1 dose/infusion of study drug, and had confirmed influenza A or B by culture, PCR, or serology.

ArmMeasureValue (NUMBER)
Peramivir 300 mgNumber of Participants Who Required More Than 5 Days of Peramivir Treatment16 participants
Peramivir 600 mgNumber of Participants Who Required More Than 5 Days of Peramivir Treatment28 participants

Source: ClinicalTrials.gov · Data processed: Mar 22, 2026