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Congenital Cytomegalovirus: Efficacy of Antiviral Treatment (CONCERT 2)

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ClinicalTrials.gov Identifier: NCT02005822
Recruitment Status : Unknown
Verified June 2015 by Dr. Ann C.T.M. Vossen, Leiden University Medical Center.
Recruitment status was:  Recruiting
First Posted : December 9, 2013
Last Update Posted : June 18, 2015
Sponsor:
Collaborators:
Stichting Nuts Ohra
Leiden University Medical Center
Information provided by (Responsible Party):
Dr. Ann C.T.M. Vossen, Leiden University Medical Center

Brief Summary:
The objective of the trial is to investigate whether early treatment with oral valganciclovir of infants with both congenital cytomegalovirus infection and sensorineural hearing loss can prevent progression of hearing loss.

Condition or disease Intervention/treatment Phase
Congenital Cytomegalovirus Infection Sensorineural Hearing Loss Drug: Valganciclovir Phase 3

Detailed Description:

In the Netherlands all neonates are routinely screened for hearing during the first weeks after birth with the Otoacoustic Emissions (OAE) procedure. After the second refer an Automated Auditory Brainstem Response (AABR) is performed. The parents of all newborns, born at ≥ 37 weeks gestational age, that fail this AABR in the Netherlands (about 550 yearly) will be asked for consent for CMV-testing on the dried blood spots. Newborns diagnosed with congenital CMV and with confirmed SNHL (≥ 20 dB) are eligible for inclusion. After informed consent infants will be offered treatment before the age of 13 weeks (6 weeks valganciclovir 32 mg/kg daily dose; oral solution). Parents may decide to participate in the trial in the control group (no antiviral treatment). Infants will be monitored for leucopenia and liver- and kidney function. Inclusion will continue for at least 1.5 years, or until at least 40 infants have been included in the trial.

At age 20 months hearing and child development are assessed in the follow-up. Hearing will be assessed with Brainstem Evoked Response Audiometry with the Vivosonic Integrity. Child development will be assessed with the Bayley Scales of Infant Development III (official Dutch translation) and parents will fill in the Dutch Child Development Inventory (NCDI) which will give more detailed information on communicative development of their child. The hearing assessment and developmental examination will be fulfilled during a home visit. Viral loads in blood and urine will be monitored during antiviral treatment as well as twice in the control group.

This study will provide information on the percentage of infants with a congenital CMV infection who fail the neonatal hearing screening . The trial will show whether early treatment of congenital CMV infected children with hearing impairment prevents deterioration of hearing loss and to what extent. The outcome may lead to implementation of congenital CMV testing in the neonatal hearing screening program or possibly into the newborn blood screening.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 40 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: The Leiden CONCERT Study 2.0 Congenital Cytomegalovirus: Efficacy of Antiviral Treatment in a Non-Randomized Trial With Historical Control Group
Study Start Date : October 2013
Estimated Primary Completion Date : October 2016
Estimated Study Completion Date : October 2016


Arm Intervention/treatment
Experimental: Valganciclovir
Valganciclovir 32 mg/kg per day in two doses (16 mg/kg per dose) during 6 weeks in an oral solution.
Drug: Valganciclovir
Infants will be treated with valganciclovir for 6 weeks, 32 mg/kg daily dose in two doses, oral solution.
Other Names:
  • Valcyte
  • Valganciclovirhydrochloride

No Intervention: Control

Refusal control group:

Infants in the control group receive no antiviral therapy. Counseling and treatment assigned by an audiological center remain unchanged.

Historical control group:

Infants with birth date 1-11-2011 till 1-07-2012 with sensorineural hearing loss and congenital CMV.




Primary Outcome Measures :
  1. Hearing assessment [ Time Frame: Age: 20 months ]
    At 20 months of age hearing will be assessed with Brainstem Evoked Response Audiometry using the Vivosonic Integrity during a home visit.


Secondary Outcome Measures :
  1. Child development [ Time Frame: Age: 20 months ]
    At age 20 months child development will be assessed during a home visit with the Bayley Scales of Infant Development III (official Dutch translation). Additionally, parents will fill in the Dutch Child Development Inventory.

  2. Viral load [ Time Frame: Baseline, weekly during 7 weeks, and at 20 months of age ]

    Viral blood load will be monitored in the treatment group(at baseline, weekly during antiviral treatment, and one week after treatment) as well as in the control group (baseline and 7 weeks after inclusion).

    Viral urine load will be monitored in the treatment group and in the control group (at baseline, weekly during 7 weeks after inclusion, and at the age of 20 months).




Information from the National Library of Medicine

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Ages Eligible for Study:   up to 12 Weeks   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria Treatment group and refusal control group

  • Infants with congenital CMV infection, and hearing loss (≥ 20 dB, in one or both ears).
  • Age at time of inclusion is ≤ 12 weeks after birth.
  • Born at ≥ 37 weeks gestational age.
  • Birth weight > -2 SD corrected for duration of pregnancy and ethnic origin.
  • Parental signed informed consent.

Historical control group

  • Infants with congenital CMV infection, and hearing loss (≥ 20 dB, in one or both ears).
  • Age at time of inclusion is > 13 weeks after birth.
  • Born at ≥ 37 weeks gestational age.
  • Birth weight > -2 SD corrected for duration of pregnancy and ethnic origin.
  • Parental signed informed consent.

Exclusion Criteria Treatment group and refusal control group

  • Previously noted (≤ 12 weeks after birth) symptoms possibly related to congenital CMV, for which medical attention was requested. For example: intra uterine growth retardation, petechiae, hepatosplenomegaly, jaundice, microcephaly, thrombocytopenia, elevated transaminases, elevated bilirubin.
  • Treatment with other antiviral agents or immunoglobulins.
  • Solely applicable for treatment group: leucopenia < 0,5 x 10*9/L (blood sample tested at t=0).

Historical control group

  • Previously encountered (≤ 12 weeks after birth) symptoms possibly related to congenital CMV, for which medical attention was requested For example: intra uterine growth retardation, petechiae, hepatosplenomegaly, jaundice, microcephaly, thrombocytopenia, elevated transaminases, elevated bilirubin.
  • Treatment with (val)ganciclovir.
  • Treatment with other antiviral agents or immunoglobulins.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02005822


Contacts
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Contact: Fleurtje AJ Schornagel, Drs. +31 (0)71 525 5383 / 3931 f.a.j.schornagel@lumc.nl
Contact: Ann CTM Vossen, Dr. +31 (0)71 526 3646 / 3931 a.vossen@lumc.nl

Locations
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Netherlands
Department Medical Microbiology Recruiting
Leiden, Zuid Holland, Netherlands, 2300 RC
Contact: Fleurtje AJ Schornagel, Drs.    +31 (0)71 526 5383 / 3931    f.a.j.schornagel@lumc.nl   
Sub-Investigator: Fleurtje AJ Schornagel, Drs.         
Principal Investigator: Anne Marie Oudesluys - Murphy, Prof. Dr.         
Sponsors and Collaborators
Dr. Ann C.T.M. Vossen
Stichting Nuts Ohra
Leiden University Medical Center
Investigators
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Study Director: Ann CTM Vossen, Dr. Leiden University Medical Center
Principal Investigator: Anne Marie Oudesluys - Murphy, Prof. Dr. Leiden University Medical Center

Additional Information:
Publications:

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Responsible Party: Dr. Ann C.T.M. Vossen, MD, PhD, Dept of Medical Microbiology, Leiden University Medical Center
ClinicalTrials.gov Identifier: NCT02005822     History of Changes
Other Study ID Numbers: CMV-MM-2
2013-003068-30 ( EudraCT Number )
First Posted: December 9, 2013    Key Record Dates
Last Update Posted: June 18, 2015
Last Verified: June 2015

Keywords provided by Dr. Ann C.T.M. Vossen, Leiden University Medical Center:
Cytomegalovirus
Congenital infection
Sensorineural hearing loss
Valganciclovir

Additional relevant MeSH terms:
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Cytomegalovirus Infections
Hearing Loss
Deafness
Hearing Loss, Sensorineural
Hearing Disorders
Ear Diseases
Otorhinolaryngologic Diseases
Sensation Disorders
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms
Herpesviridae Infections
DNA Virus Infections
Virus Diseases
Antiviral Agents
Valganciclovir
Anti-Infective Agents