Enterovirus, Rhinovirus
Conditions
Keywords
Enterovirus, Rhinovirus
Brief summary
Trial to evaluate the efficacy and safety of nitazoxanide in the treatment of colds due to enterovirus/rhinovirus infection
Detailed description
Multicenter, randomized, double-blind trial to evaluate the efficacy and safety of nitazoxanide in the treatment of colds due to enterovirus/rhinovirus infection
Interventions
DRUGNitazoxanide
Two nitazoxanide 300 mg tablets administered orally twice daily with food for 5 days
DRUGPlacebo
Two placebo tablets administered orally twice daily with food for 5 days
DIETARY_SUPPLEMENTVitamin Super B-Complex
Vitamin Super B-Complex administered orally twice daily to maintain the blind
Sponsors
Romark Laboratories L.C.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
12 Years to 120 Years
Healthy volunteers
No
Inclusion criteria
* Male or female outpatients at least 12 years of age * Presence of clinical signs and/or symptoms consistent with worsening or stable cold due to Enterovirus/Rhinovirus infection (one of the following is required): 1. Presence of at least two respiratory symptom domains (head, throat, nose, chest, cough) with a score of ≥2 as determined by Screening FLU-PRO OR 2. Presence of at least one respiratory symptom domain (head, throat, nose, chest, cough) with a score of ≥2 as determined by Screening FLU-PRO with pulse rate ≥90 OR 3. Presence of at least one respiratory symptom domain (head, throat, nose, chest, cough) with a score of ≥2 as determined by Screening FLU-PRO with respiratory rate ≥16 AND patient reported assessment that symptoms are present, the symptoms are not consistent with the subject's usual health, the symptoms interfere with daily activities, and the symptoms have worsened or remained the same relative to the previous day, as confirmed by responses to questions in the Screening FLU-PRO. * Onset of symptoms no more than 72 hours before enrollment in the trial. Onset of symptoms is defined as the earlier of the first time at which the subject experienced subjective fever or any respiratory symptom (head, throat, nose, chest, or cough symptoms). * Willing and able to provide written informed consent (including assent by legal guardian if under 18 years of age) and comply with the requirements of the protocol, including completion of the subject diary and all protocol procedures.
Exclusion criteria
* Subjects who experienced a previous episode of acute upper respiratory tract infection, otitis, bronchitis or sinusitis or received antibiotics for these conditions within two weeks prior to and including study day 1. * Severely immunodeficient persons including: 1. Subjects with immunologic disorders or receiving immunosuppressive therapy (e.g., for organ or bone marrow transplants, immunomodulatory therapies for certain autoimmune diseases). 2. Subjects with untreated human immunodeficiency viruses (HIV) infection or treated human immunodeficiency viruses (HIV) infection with a CD4 count below 350 cells/mm3 in the last six months. 3. Subjects actively undergoing systemic chemotherapy or radiotherapy treatment for malignancy. 4. Subjects using steroids as maintenance therapy for a chronic condition. * Subjects with active respiratory allergies or subjects expected to require anti- allergy medications during the study period for respiratory allergies. * Females of childbearing potential who are either pregnant or sexually active without the use of birth control. Female subjects of child-bearing potential that are sexually active must have a negative baseline pregnancy test and must agree to continue an acceptable method of birth control for the duration of the study and for 1 month post-treatment. A double barrier method, oral birth control pills administered for at least 2 monthly cycles prior to study drug administration, an Intrauterine Device (IUD), or medroxyprogesterone acetate administered intramuscularly for a minimum of one month prior to study drug administration are acceptable methods of birth control for inclusion into the study. Female subjects are considered of childbearing potential unless they are postmenopausal (absence of menstrual bleeding for 1 year - or 6 months if laboratory confirmation of hormonal status), or have had a hysterectomy, bilateral tubular ligation or bilateral oophorectomy. * Subjects residing in the same household with another subject participating in the study. * Treatment with any investigational drug or vaccine therapy within 30 days prior to screening and willing to avoid them during the course of the study. * Receipt of any dose of nitazoxanide (NTZ) within seven days prior to screening. * Known sensitivity to nitazoxanide (NTZ) or any of the excipients comprising the study medication. * Subjects unable to swallow oral tablets or capsules. * Subjects with known severe heart, lung, neurological or other systemic disease that the Investigator believes could preclude safe participation. * Subjects likely or expected to require hospitalization unrelated to cold during the study period. * Subjects who, in the judgment of the Investigator, will be unlikely to comply with the requirements of this protocol including completion of the subject diary. * Subjects taking medications considered to be major CYP2C8 substrates. * Persons with any clinical sign or symptoms suggestive of severe systemic illness with COVID-19, including the following: 1. shortness of breath at rest, 2. resting pulse ≥125 beats per minute, 3. resting respiratory rate ≥ breaths per minute, or 4. SpO2 ≤ 93% on room air at sea level. * Subjects known to have a diagnostic test positive for SARS-CoV-2 or influenza infection within the preceding three weeks.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time From First Dose to Sustained Response | 21 days | Time to Sustained Response is the time in days from the first dose of study medication to the first time at which the subject reports a decrease in total FLU-PRO score from the previous diary with assessment that symptoms are at least somewhat better than yesterday, no oral temperature ≥100.4 F in the prior 24 hours, and no future increase in any of the FLU-PRO domains except within validated background levels. NOTE: Data collection ended at study day 21 and \>25% of subjects in each treatment group had not yet achieved Sustained Response (32% in the Nitazoxanide group and 35% in the Placebo group). Therefore, it was impossible to calculate a third quartile for either group. Data presented here imputes 21 as the third quartile. No statistical analyses were performed as enrollment was terminated early. See caveats and limitations. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of Subjects Requiring Systemic Antibiotics | 21 days | Proportion of subjects requiring systemic antibiotics for an infection secondary to Enterovirus/Rhinovirus. NOTE: No statistical analyses were performed as enrollment was terminated early. See caveats and limitations. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Nitazoxanide Two nitazoxanide 300 mg tablets orally twice daily for 5 days
Nitazoxanide: Two nitazoxanide 300 mg tablets administered orally twice daily with food for 5 days
Vitamin Super B-Complex: Vitamin Super B-Complex administered orally twice daily to maintain the blind | 104 |
| Placebo Two placebo tablets orally twice daily for 5 days
Placebo: Two placebo tablets administered orally twice daily with food for 5 days
Vitamin Super B-Complex: Vitamin Super B-Complex administered orally twice daily to maintain the blind | 110 |
| Total | 214 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 2 | 3 |
| Overall Study | Withdrawal by Subject | 1 | 0 |
Baseline characteristics
| Characteristic | Nitazoxanide | Placebo | Total |
|---|---|---|---|
| Age, Continuous | 38 years STANDARD_DEVIATION 14.7 | 35 years STANDARD_DEVIATION 13.9 | 36 years STANDARD_DEVIATION 14.4 |
| Baseline Illness Severity Mild Illness | 73 Participants | 68 Participants | 141 Participants |
| Baseline Illness Severity Moderate Illness | 31 Participants | 42 Participants | 73 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 14 Participants | 19 Participants | 33 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 90 Participants | 90 Participants | 180 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 5 Participants | 13 Participants | 18 Participants |
| Race (NIH/OMB) More than one race | 1 Participants | 1 Participants | 2 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants | 4 Participants | 5 Participants |
| Race (NIH/OMB) White | 97 Participants | 92 Participants | 189 Participants |
| Sex: Female, Male Female | 69 Participants | 74 Participants | 143 Participants |
| Sex: Female, Male Male | 35 Participants | 36 Participants | 71 Participants |
| Subject Risk Status At Increased Risk of Complications | 62 Participants | 67 Participants | 129 Participants |
| Subject Risk Status Not At Increased Risk of Complications | 42 Participants | 43 Participants | 85 Participants |
| Time from Symptom Onset to Randomization | 39 hours STANDARD_DEVIATION 15 | 40 hours STANDARD_DEVIATION 15.6 | 39 hours STANDARD_DEVIATION 15.3 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 104 | 0 / 110 |
| other Total, other adverse events | 3 / 104 | 6 / 110 |
| serious Total, serious adverse events | 0 / 104 | 0 / 110 |
Outcome results
Primary
Time From First Dose to Sustained Response
Time to Sustained Response is the time in days from the first dose of study medication to the first time at which the subject reports a decrease in total FLU-PRO score from the previous diary with assessment that symptoms are at least somewhat better than yesterday, no oral temperature ≥100.4 F in the prior 24 hours, and no future increase in any of the FLU-PRO domains except within validated background levels. NOTE: Data collection ended at study day 21 and \>25% of subjects in each treatment group had not yet achieved Sustained Response (32% in the Nitazoxanide group and 35% in the Placebo group). Therefore, it was impossible to calculate a third quartile for either group. Data presented here imputes 21 as the third quartile. No statistical analyses were performed as enrollment was terminated early. See caveats and limitations.
Time frame: 21 days
Population: All randomized subjects who received at least one dose of study medication and were positive at Baseline for enterovirus/rhinovirus (EV/RV) infection.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nitazoxanide | Time From First Dose to Sustained Response | 13.5 days |
| Placebo | Time From First Dose to Sustained Response | 16.3 days |
Secondary
Proportion of Subjects Requiring Systemic Antibiotics
Proportion of subjects requiring systemic antibiotics for an infection secondary to Enterovirus/Rhinovirus. NOTE: No statistical analyses were performed as enrollment was terminated early. See caveats and limitations.
Time frame: 21 days
Population: All randomized subjects who received at least one dose of study medication and were positive at Baseline for enterovirus/rhinovirus (EV/RV) infection. Proportions rounded to the nearest hundredth.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Nitazoxanide | Proportion of Subjects Requiring Systemic Antibiotics | 0.03 proportion of participants |
| Placebo | Proportion of Subjects Requiring Systemic Antibiotics | 0.07 proportion of participants |