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Baloxavir in Combination With Oseltamivir in Allogenic Bone Marrow Transplant Recipients With Influenza

Randomized Double-blind, Placebo-controlled Single Center Pilot Study to Evaluate the Efficacy and Safety of Baloxavir in Combination With Oseltamivir in Adult Allogeneic Bone Marrow Transplant Recipients With Influenza

Status
Terminated
Phases
Phase 2Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT05170009
Enrollment
2
Registered
2021-12-27
Start date
2022-04-22
Completion date
2024-02-07
Last updated
2025-02-26

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

Conditions

Influenza

Keywords

Influenza, Bone marrow transplant, Flu, Baloxavir Marboxil, Xofluza, Oseltamivir

Brief summary

This is a randomized, double-blind, placebo-controlled pilot study of the efficacy and safety of baloxavir in combination with oseltamivir (standard of care) for the treatment of influenza in allogeneic stem cell transplant patients. Although there are no data about this treatment option currently available, the investigator hypothesizes that combination therapy may be more effective in clearing influenza virus infection and decreasing the rate of emergence of resistant influenza in immunocompromised human hosts.

Detailed description

This is a randomized double-blind placebo-controlled pilot study of the efficacy and safety of baloxavir in combination with oseltamivir (standard of care) for the treatment of influenza in allogeneic stem cell transplant patients. 30 SCT recipients will take part in the study. Participants with be randomly assigned (1:1) to either baloxavir + oseltamivir or baloxavir-matched placebo +oseltamivir. Before randomization, patients will be stratified by hospitalization status and influenza type A (yes/no). Patients in the baloxavir combination arm will receive weight-adjusted baloxavir (40 mg for patients weighing \<80 kg and 80 mg for those weighing ≥80 kg) at baseline and at day 4 and day 7. They will also receive oseltamivir 75 mg twice daily for 10 days. Patients in the baloxavir-matched placebo + oseltamivir arm will receive baloxavir-matched placebo at baseline and at day 3 and day 7and oseltamivir 75 mg twice daily for 10 days.

Interventions

Weight-adjusted Baloxavir Marboxil (40 mg for patients weighing \<80 kg and 80 mg for those weighing ≥80 kg) at baseline, day 4, and day 7.

DRUGPlacebo

Placebo at baseline, day 4, and day 7.

DRUGOseltamivir

Oseltamivir 75 mg twice daily for 10 days.

Sponsors

Genentech, Inc.
CollaboratorINDUSTRY
Weill Medical College of Cornell University
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

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

Inclusion criteria

* Adult patients: Signed informed consent by any patient capable of giving consent, or, where the patient is not capable of giving consent, by his or her legal/authorized representative * Age greater than or equal to 18 years at the time of signing the Informed Consent Form/Assent Form * Ability to comply with the study protocol, in the investigator's judgment * Have received allogeneic bone marrow transplant * Tested positive for influenza infection after the onset of symptoms using a polymerase chain reaction (PCR)-based diagnostic assay. * Presence of (a) fever (≥38.0 °C per tympanic or rectal thermometer; ≥ 37.5 °C per axillary, oral or forehead/temporal thermometer) or (b) any influenza symptoms (cough, sore throat, nasal congestion, headache, feverishness or chills, muscle or joint pain, fatigue). * The time interval between the diagnosis of influenza and the pre-dose examinations is 48 hours or less. * For women of childbearing potential: Agreement to remain abstinent (refrain from heterosexual intercourse): * Women must remain abstinent or use contraceptive methods with a failure rate of \< 1% per year during the treatment period and for 28 days after the last dose of study treatment. Hormonal contraceptive methods must be supplemented by a barrier method. A woman is considered to be of childbearing potential if she is postmenarcheal, has not reached a postmenopausal state greater than or equal to 12 continuous months of amenorrhea with no identified cause other than menopause), and has not undergone surgical sterilization (removal of ovaries and/or uterus). Examples of contraceptive methods with a failure rate of \< 1% per year include bilateral tubal ligation, male sterilization, hormonal contraceptives that inhibit ovulation, hormone-releasing intrauterine devices, and copper intrauterine devices. The reliability of sexual abstinence should be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or postovulation methods) and withdrawal are not acceptable methods of contraception.

Exclusion criteria

* Patients who have received more than 48 hours of antiviral treatment for the current influenza infection prior to screening * Patients who have received Baloxavir for the current influenza infection * Known contraindication to neuraminidase inhibitors * Patients weighing \< 40 kg * Patients unable to swallow tablets * Patients with known severe renal impairment (estimated glomerular filtration rate \< 30 mL/min/1.73 m2) or receiving continuous renal replacement therapy, hemodialysis, peritoneal dialysis * Patients with any of the following laboratory abnormalities detected within 24 hours prior to or during screening (according to local laboratory reference ranges: ALT or AST level \> 5 times the upper limit of normal (ULN) OR ALT or AST \> 3 times the ULN and total bilirubin level \> 2 times the ULN * Pregnant or breastfeeding, or positive pregnancy test in a predose examination, or intending to become pregnant during the study or within 28 days after the last dose of study treatment * Exposure to an investigational drug within 5 half-lives or 30 days (whichever is longer) of randomization * Any serious medical condition or abnormality in clinical laboratory tests that, in the investigator's judgment, precludes the patient's safe participation in and completion of the study * Known hypersensitivity to baloxavir marboxil or the drug product excipients * Known COVID-19 coinfection * Unwilling to undergo nasopharyngeal (NP) swabs as per study schedule

Design outcomes

Primary

MeasureTime frameDescription
Change of Influenza Viral RNA Loads From Baseline at the End of Treatment as Measured by Quantitative Real Time Polymerase Chain Reaction.Baseline; Day 10Influenza viral RNA loads will be measured by quantitative real time polymerase chain reaction.
Between-treatment-arm Difference in the Change of Influenza Viral RNA Loads From Baseline at the End of Treatment as Measured by Quantitative Real Time Polymerase Chain Reaction.Baseline; Day 10Influenza viral load will be measured by the quantitative real time polymerase chain reaction.
Between-treatment-arm Difference in the Change of Influenza Viral RNA Loads From Baseline at the End of Treatment as Measured by Influenza Plaque Assay (Replicating Virus).Baseline; Day 10Influenza viral load will be measured by the influenza plaque assay.

Secondary

MeasureTime frameDescription
Difference in Change of Influenza Viral Loads From Baseline at Day 4, 7 and 10 Between the Two Treatment Arms as Measured by Influenza Plaque Assay (Replicating Virus)Baseline; Day 4; Day 7; Day 10Influenza viral load will be measured by the influenza plaque assay (replicating virus).
Percentage of Participants With Adverse Events (AEs)Day 1 to Day 15Adverse events will only include those that are determined to be related to the study drug and will assess the safety and tolerability of Baloxavir in Combination with SOC treatment.
Time to Improvement of Individual Influenza Symptoms as Assessed by Patient-reported Outcome Measures on a Single ScaleBaseline to Day 30Patients will self-assess the severity of 7 influenza-associated symptoms on a 4-point single scale with 0 indicating no symptoms and higher scores indicating mild, moderate, and severe symptoms. Time to improvement of individual influenza symptoms are defined as the time from the start of treatment to the time when each of the influenza symptoms are alleviated, maintained, or improved for a duration of at least 21.5 hours. These are defined as: pre-existing symptoms (cough, fatigue, or muscle/join pain that existed prior to influenza) that were worse at baseline and had improved at least 1 point from baseline; pre-existing symptoms not worse at baseline that maintained baseline severity; and new symptoms that were alleviated, defined as a symptom score of non (0) or mild (1).
Percentage of Patients Who Experience Each Influenza-related Complications: Hospitalization, Death, Sinusitis, Otitis Media, Bronchitis, and Radiologically-confirmed Pneumonia as an Adverse Event After the Initiation of Study TreatmentDay 1 to Day 30A composite score of multiple measures will be used and calculated by count of patients who experience each influenza-related complications. Adverse events will only include those that are determined to be related to the study drug.
Change of Influenza Viral RNA Load From Baseline at Day 4 and Day 7 and 10 in Each Treatment ArmBaseline; Day 4; Day 7; Day 10Influenza viral RNA load will be measured by quantitative real time polymerase chain reaction.
Time to Viral Clearance, as Assessed by Difference in Percentage of Participants Positive by Influenza Plaque Assay at Each Time-point (in Each Treatment Group)Baseline to Day 30Time to viral clearance will be assessed by percentage of participants positive by influenza plaque assay at each time-point.
Time to Viral Clearance, as Assessed by Difference in Percentage of Participants Positive by Quantitative Real Time Polymerase Chain ReactionBaseline to Day 30Time to viral clearance will be assessed by percentage of participants positive by qPCR at each time-point.
Change of Treatment-emergent Variants of Neuraminidase and Polymerase Known to Confer Antiviral Resistance to Oseltamivir in Each Arm by Direct Next-generation Sequencing SymptomsBaseline to Day 30Treatment-emergent variants will be identified using direct next-generation sequencing of a comprehensive panel of genes.
Time to Return to Preinfluenza Health StatusDay 1 to Day 30Preinfluenza health status will be measured on a score from 0 (worst possible health) to 10 (normal health \[for someone your age and condition\]).
Difference in Change of Influenza Viral Loads From Baseline at Day 4, 7 and 10 Between the Two Treatment Arms as Measured by Quantitative Real Time Polymerase Chain ReactionBaseline; Day 4; Day 7; Day 10Influenza viral RNA load will be measured by quantitative real time polymerase chain reaction.
Change of Influenza Viral Loads From Baseline at Day 4, 7 and 10 as Measured by Influenza Plaque Assay (Replicating Virus) in Each Treatment ArmBaseline; Day 4; Day 7; Day 10Influenza viral load will be measured by the influenza plaque assay (replicating virus).

Countries

United States

Participant flow

Recruitment details

Recruitment for this study was challenging because of changed flu seasonality and low flu cases following covid-19

Participants by arm

ArmCount
Active and Standard of Care
Active Baloxavir Marboxil and standard of care Oseltamivir Baloxavir Marboxil: Weight-adjusted Baloxavir Marboxil (40 mg for patients weighing \<80 kg and 80 mg for those weighing ≥80 kg) at baseline, day 4, and day 7. Oseltamivir: Oseltamivir 75 mg twice daily for 10 days.
0
Placebo and Standard of Care
Placebo-matched Baloxavir Marboxil and standard of care Oseltamivir Placebo: Placebo at baseline, day 4, and day 7. Oseltamivir: Oseltamivir 75 mg twice daily for 10 days.
2
Total2

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyPhysician Decision01

Baseline characteristics

CharacteristicPlacebo and Standard of CareTotalActive and Standard of Care
Age, Continuous45 years
STANDARD_DEVIATION 30
45 years
STANDARD_DEVIATION 30
Ethnicity (NIH/OMB)
Hispanic or Latino
1 Participants1 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
1 Participants1 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants
Race (NIH/OMB)
Asian
0 Participants0 Participants
Race (NIH/OMB)
Black or African American
1 Participants1 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants
Race (NIH/OMB)
White
1 Participants1 Participants
Sex: Female, Male
Female
1 Participants1 Participants0 Participants
Sex: Female, Male
Male
1 Participants1 Participants0 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 01 / 2
other
Total, other adverse events
0 / 01 / 2
serious
Total, serious adverse events
0 / 01 / 2

Outcome results

Primary

Between-treatment-arm Difference in the Change of Influenza Viral RNA Loads From Baseline at the End of Treatment as Measured by Influenza Plaque Assay (Replicating Virus).

Influenza viral load will be measured by the influenza plaque assay.

Time frame: Baseline; Day 10

Population: The only patient that completed the study, was randomized into the placebo arm. Difference cannot be calculated as one arm has zero patients.

ArmMeasureGroupValue (NUMBER)
Placebo and Standard of CareBetween-treatment-arm Difference in the Change of Influenza Viral RNA Loads From Baseline at the End of Treatment as Measured by Influenza Plaque Assay (Replicating Virus).Baseline2300000 PFU per mL
Placebo and Standard of CareBetween-treatment-arm Difference in the Change of Influenza Viral RNA Loads From Baseline at the End of Treatment as Measured by Influenza Plaque Assay (Replicating Virus).Day 100 PFU per mL
Primary

Between-treatment-arm Difference in the Change of Influenza Viral RNA Loads From Baseline at the End of Treatment as Measured by Quantitative Real Time Polymerase Chain Reaction.

Influenza viral load will be measured by the quantitative real time polymerase chain reaction.

Time frame: Baseline; Day 10

Population: The only patient that completed the study, was randomized into the placebo arm. Difference cannot be calculated as one arm has zero patients.

ArmMeasureGroupValue (NUMBER)
Placebo and Standard of CareBetween-treatment-arm Difference in the Change of Influenza Viral RNA Loads From Baseline at the End of Treatment as Measured by Quantitative Real Time Polymerase Chain Reaction.Baseline2300000 copies per mL
Placebo and Standard of CareBetween-treatment-arm Difference in the Change of Influenza Viral RNA Loads From Baseline at the End of Treatment as Measured by Quantitative Real Time Polymerase Chain Reaction.Day 100 copies per mL
Primary

Change of Influenza Viral RNA Loads From Baseline at the End of Treatment as Measured by Quantitative Real Time Polymerase Chain Reaction.

Influenza viral RNA loads will be measured by quantitative real time polymerase chain reaction.

Time frame: Baseline; Day 10

Population: The only patient that completed the study, was randomized into the placebo arm.

ArmMeasureGroupValue (NUMBER)
Placebo and Standard of CareChange of Influenza Viral RNA Loads From Baseline at the End of Treatment as Measured by Quantitative Real Time Polymerase Chain Reaction.Baseline2300000 copies per mL
Placebo and Standard of CareChange of Influenza Viral RNA Loads From Baseline at the End of Treatment as Measured by Quantitative Real Time Polymerase Chain Reaction.Day 100 copies per mL
Secondary

Change of Influenza Viral Loads From Baseline at Day 4, 7 and 10 as Measured by Influenza Plaque Assay (Replicating Virus) in Each Treatment Arm

Influenza viral load will be measured by the influenza plaque assay (replicating virus).

Time frame: Baseline; Day 4; Day 7; Day 10

Population: The only patient that completed the study, was randomized into the placebo arm.

ArmMeasureGroupValue (NUMBER)
Placebo and Standard of CareChange of Influenza Viral Loads From Baseline at Day 4, 7 and 10 as Measured by Influenza Plaque Assay (Replicating Virus) in Each Treatment ArmBaseline2300000 PFU per mL
Placebo and Standard of CareChange of Influenza Viral Loads From Baseline at Day 4, 7 and 10 as Measured by Influenza Plaque Assay (Replicating Virus) in Each Treatment ArmDay 4800 PFU per mL
Placebo and Standard of CareChange of Influenza Viral Loads From Baseline at Day 4, 7 and 10 as Measured by Influenza Plaque Assay (Replicating Virus) in Each Treatment ArmDay 71300 PFU per mL
Placebo and Standard of CareChange of Influenza Viral Loads From Baseline at Day 4, 7 and 10 as Measured by Influenza Plaque Assay (Replicating Virus) in Each Treatment ArmDay 100 PFU per mL
Secondary

Change of Influenza Viral RNA Load From Baseline at Day 4 and Day 7 and 10 in Each Treatment Arm

Influenza viral RNA load will be measured by quantitative real time polymerase chain reaction.

Time frame: Baseline; Day 4; Day 7; Day 10

Population: The only patient that completed the study, was randomized into the placebo arm.

ArmMeasureGroupValue (NUMBER)
Placebo and Standard of CareChange of Influenza Viral RNA Load From Baseline at Day 4 and Day 7 and 10 in Each Treatment ArmBaseline2300000 copies per mL
Placebo and Standard of CareChange of Influenza Viral RNA Load From Baseline at Day 4 and Day 7 and 10 in Each Treatment ArmDay 4800 copies per mL
Placebo and Standard of CareChange of Influenza Viral RNA Load From Baseline at Day 4 and Day 7 and 10 in Each Treatment ArmDay 71300 copies per mL
Placebo and Standard of CareChange of Influenza Viral RNA Load From Baseline at Day 4 and Day 7 and 10 in Each Treatment ArmDay 100 copies per mL
Secondary

Change of Treatment-emergent Variants of Neuraminidase and Polymerase Known to Confer Antiviral Resistance to Oseltamivir in Each Arm by Direct Next-generation Sequencing Symptoms

Treatment-emergent variants will be identified using direct next-generation sequencing of a comprehensive panel of genes.

Time frame: Baseline to Day 30

Population: The only patient that completed the study, was randomized into the placebo arm.

ArmMeasureValue (NUMBER)
Placebo and Standard of CareChange of Treatment-emergent Variants of Neuraminidase and Polymerase Known to Confer Antiviral Resistance to Oseltamivir in Each Arm by Direct Next-generation Sequencing Symptoms0 Resistant variant
Secondary

Difference in Change of Influenza Viral Loads From Baseline at Day 4, 7 and 10 Between the Two Treatment Arms as Measured by Influenza Plaque Assay (Replicating Virus)

Influenza viral load will be measured by the influenza plaque assay (replicating virus).

Time frame: Baseline; Day 4; Day 7; Day 10

Population: The only patient that completed the study, was randomized into the placebo arm. Difference cannot be calculated as one arm has zero patients.

ArmMeasureGroupValue (NUMBER)
Placebo and Standard of CareDifference in Change of Influenza Viral Loads From Baseline at Day 4, 7 and 10 Between the Two Treatment Arms as Measured by Influenza Plaque Assay (Replicating Virus)Baseline2300000 PFU per mL
Placebo and Standard of CareDifference in Change of Influenza Viral Loads From Baseline at Day 4, 7 and 10 Between the Two Treatment Arms as Measured by Influenza Plaque Assay (Replicating Virus)Day 4800 PFU per mL
Placebo and Standard of CareDifference in Change of Influenza Viral Loads From Baseline at Day 4, 7 and 10 Between the Two Treatment Arms as Measured by Influenza Plaque Assay (Replicating Virus)Day 71300 PFU per mL
Placebo and Standard of CareDifference in Change of Influenza Viral Loads From Baseline at Day 4, 7 and 10 Between the Two Treatment Arms as Measured by Influenza Plaque Assay (Replicating Virus)Day 100 PFU per mL
Secondary

Difference in Change of Influenza Viral Loads From Baseline at Day 4, 7 and 10 Between the Two Treatment Arms as Measured by Quantitative Real Time Polymerase Chain Reaction

Influenza viral RNA load will be measured by quantitative real time polymerase chain reaction.

Time frame: Baseline; Day 4; Day 7; Day 10

Population: The only patient that completed the study, was randomized into the placebo arm. Difference cannot be calculated as one arm has zero patients.

ArmMeasureGroupValue (NUMBER)
Placebo and Standard of CareDifference in Change of Influenza Viral Loads From Baseline at Day 4, 7 and 10 Between the Two Treatment Arms as Measured by Quantitative Real Time Polymerase Chain ReactionBaseline2300000 copies per mL
Placebo and Standard of CareDifference in Change of Influenza Viral Loads From Baseline at Day 4, 7 and 10 Between the Two Treatment Arms as Measured by Quantitative Real Time Polymerase Chain ReactionDay 4800 copies per mL
Placebo and Standard of CareDifference in Change of Influenza Viral Loads From Baseline at Day 4, 7 and 10 Between the Two Treatment Arms as Measured by Quantitative Real Time Polymerase Chain ReactionDay 71300 copies per mL
Placebo and Standard of CareDifference in Change of Influenza Viral Loads From Baseline at Day 4, 7 and 10 Between the Two Treatment Arms as Measured by Quantitative Real Time Polymerase Chain ReactionDay 100 copies per mL
Secondary

Percentage of Participants With Adverse Events (AEs)

Adverse events will only include those that are determined to be related to the study drug and will assess the safety and tolerability of Baloxavir in Combination with SOC treatment.

Time frame: Day 1 to Day 15

Population: The only patient that completed the study, was randomized into the placebo arm.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Placebo and Standard of CarePercentage of Participants With Adverse Events (AEs)1 Participants
Secondary

Percentage of Patients Who Experience Each Influenza-related Complications: Hospitalization, Death, Sinusitis, Otitis Media, Bronchitis, and Radiologically-confirmed Pneumonia as an Adverse Event After the Initiation of Study Treatment

A composite score of multiple measures will be used and calculated by count of patients who experience each influenza-related complications. Adverse events will only include those that are determined to be related to the study drug.

Time frame: Day 1 to Day 30

Population: The only patient that completed the study, was randomized into the placebo arm.

ArmMeasureValue (NUMBER)
Placebo and Standard of CarePercentage of Patients Who Experience Each Influenza-related Complications: Hospitalization, Death, Sinusitis, Otitis Media, Bronchitis, and Radiologically-confirmed Pneumonia as an Adverse Event After the Initiation of Study Treatment0 Number of patients with complications.
Secondary

Time to Improvement of Individual Influenza Symptoms as Assessed by Patient-reported Outcome Measures on a Single Scale

Patients will self-assess the severity of 7 influenza-associated symptoms on a 4-point single scale with 0 indicating no symptoms and higher scores indicating mild, moderate, and severe symptoms. Time to improvement of individual influenza symptoms are defined as the time from the start of treatment to the time when each of the influenza symptoms are alleviated, maintained, or improved for a duration of at least 21.5 hours. These are defined as: pre-existing symptoms (cough, fatigue, or muscle/join pain that existed prior to influenza) that were worse at baseline and had improved at least 1 point from baseline; pre-existing symptoms not worse at baseline that maintained baseline severity; and new symptoms that were alleviated, defined as a symptom score of non (0) or mild (1).

Time frame: Baseline to Day 30

Population: The only patient that completed the study, was randomized into the placebo arm.

ArmMeasureValue (NUMBER)
Placebo and Standard of CareTime to Improvement of Individual Influenza Symptoms as Assessed by Patient-reported Outcome Measures on a Single Scale8 Days to recovery
Secondary

Time to Return to Preinfluenza Health Status

Preinfluenza health status will be measured on a score from 0 (worst possible health) to 10 (normal health \[for someone your age and condition\]).

Time frame: Day 1 to Day 30

Population: The only patient that completed the study, was randomized into the placebo arm.

ArmMeasureValue (NUMBER)
Placebo and Standard of CareTime to Return to Preinfluenza Health Status8 Days
Secondary

Time to Viral Clearance, as Assessed by Difference in Percentage of Participants Positive by Influenza Plaque Assay at Each Time-point (in Each Treatment Group)

Time to viral clearance will be assessed by percentage of participants positive by influenza plaque assay at each time-point.

Time frame: Baseline to Day 30

Population: The only patient that completed the study, was randomized into the placebo arm.

ArmMeasureValue (NUMBER)
Placebo and Standard of CareTime to Viral Clearance, as Assessed by Difference in Percentage of Participants Positive by Influenza Plaque Assay at Each Time-point (in Each Treatment Group)8 Days
Secondary

Time to Viral Clearance, as Assessed by Difference in Percentage of Participants Positive by Quantitative Real Time Polymerase Chain Reaction

Time to viral clearance will be assessed by percentage of participants positive by qPCR at each time-point.

Time frame: Baseline to Day 30

Population: The only patient that completed the study, was randomized into the placebo arm.

ArmMeasureValue (NUMBER)
Placebo and Standard of CareTime to Viral Clearance, as Assessed by Difference in Percentage of Participants Positive by Quantitative Real Time Polymerase Chain Reaction8 Days

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026