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GS-5734 to Assess the Antiviral Activity, Longer-Term Clearance of Ebola Virus, and Safety in Male Ebola Survivors With Evidence of Ebola Virus Persistence in Semen

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ClinicalTrials.gov Identifier: NCT02818582
Recruitment Status : Completed
First Posted : June 29, 2016
Last Update Posted : October 9, 2019
Sponsor:
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Institute of Allergy and Infectious Diseases (NIAID) )

Brief Summary:

Background:

Some people have Ebola virus in their body for months after they recover from Ebola virus disease. Some may have health problems from the virus while others are fine. These people may be able to pass the virus to others. There are currently no drugs for people who have survived Ebola virus disease but still have the virus in their body. A new drug, GS-5734, might help get rid of Ebola virus in semen.

Objective:

To test if GS-5734 helps get rid of Ebola virus in semen and is safe for humans.

Eligibility:

Men who participated in the Ebola survivor study (PREVAIL III) and have evidence of the Ebola virus in their semen

Design:

Participants will be screened with:

Questions

Physical exam

Eye exam

Blood tests

2 semen samples if they have not had it tested recently

Participants must live near the study site in Liberia for 6 months.

Participants will be put into 1 of 2 study groups. They will have an infusion of either GS-5734 or a placebo every day for 5 days. A plastic tube is put into an arm vein. The infusion lasts 1 hour.

Participants will be observed for 1 hour after. They will provide a semen sample on infusion day 4.

After the infusions, participants will have 5 visits in the first month, then 1 per month for 5 more months. These include giving a blood and semen sample.

Blood tests are performed before and after each infusion and the last visit (5 month visit) will also include an eye exam.

When the study is over, if the study drug works and is safe, participants who got the placebo can get the study drug.


Condition or disease Intervention/treatment Phase
Ebola Drug: GS-5734 Other: Placebo Comparator Phase 2

Detailed Description:

With the unprecedented size of the recent 2014-2016 West African Ebola outbreak, the scientific community is learning a great deal about the psychological and physical consequences of Ebola, Ebola viral persistence in survivors, risk of Ebola disease relapse in survivors, and the potential for survivors to transmit the virus to others. Data from PREVAIL III has demonstrated that persistence of Ebola virus in the semen of male survivors is common. In addition to Ebola virus persistence, Ebola relapse causing clinical disease has been well documented.

There are no licensed therapies for the treatment of Ebola virus disease nor for the clearance of persistent Ebola virus in survivors. A safe, effective therapy that can reduce and/or eliminate persistent Ebola virus from semen would reduce the risk of transmission and enable male survivors to resume normal sexual relations without fear of harming loved ones. The mechanism underlying Post-Ebola Syndrome is as yet unknown, but improvement in Post-Ebola signs and symptoms resulting from GS-5734 treatment would be an added benefit.

This study is a double-blind, randomized, two-phase (treatment and longer-term follow-up), two- arm trial of GS-5734 versus placebo among male Ebola survivors with persistent Ebola virus RNA in their semen. Participants are randomized 1:1 to receive either 100 mg of GS-5734 or placebo once daily by intravenous catheter for 5 days. Informed by transaminase elevations in prior Phase I studies in normal healthy subjects, a risk-mitigation strategy includes a built-in dose de-escalation. Participants will be stratified by country and on the basis of one versus two positive semen samples for Ebola virus RNA using the Cepheid GeneXpert platform assessed within 42 days prior to study enrollment. The early DSMB review in August 2016 concluded there was no need for a cohort dose reduction. The protocol expanded to Guinea in October 2017, where the outbreak ended later. Currently there is an outbreak in the Democratic Republic of the Congo where the study team may evaluate conducting this study following the completion of the outbreak.

Antiviral activity, as well as safety and tolerability, will be assessed during the treatment phase. Longer-term clearance of Ebola virus will be assessed during the 5-month follow-up phase. Primary analyses for the assessment of antiviral activity in the treatment phase will focus on the assay negativity rate (ANR; percentage of genital samples that are negative for Ebola) over the first 28 days of the study, as well as clinical and laboratory adverse events. A sample is considered negative by PCR if the test result is undetectable. Primary analysis for the follow-up phase will focus on the ANR collected monthly from months 2 to 6.


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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 38 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: PREVAIL IV: Double-Blind, Randomized, Two-Phase, Placebo-Controlled, Phase II Trial of GS-5734 to Assess the Antiviral Activity, Longer-Term Clearance of Ebola Virus, and Safety in Male Ebola Survivors With Evidence of Ebola Virus Persistence in Semen
Actual Study Start Date : July 1, 2016
Actual Primary Completion Date : October 7, 2019
Actual Study Completion Date : October 7, 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Ebola

Arm Intervention/treatment
Active Comparator: 1
Active
Drug: GS-5734
Daily GS-5734 or placebo delivered intravenously (IV) for 5 days

Placebo Comparator: 2
Placebo
Other: Placebo Comparator
Placebo delivered intravenously (IV) for 5 days.




Primary Outcome Measures :
  1. Treatment phase: To compare the antiviral activity over 28 days following the administration of 5 days of IV GS-5734 versus placebo in male Ebola Virus Disease survivors with evidence of Ebola virus RNA in their semen. [ Time Frame: Day 4, 8, 11, 16, 24, and 28 ]
    Treatment phase: Assay Negativity Rate (ANR) over days 4, 8, 11, 16, 24, and 28.

  2. Follow-up phase: To compare the effect of 5 days of IV GS- 5734 versus placebo on the detection of Ebola virus RNA in semen of male survivors of Ebola Virus Disease over 24 weeks [ Time Frame: Week 8, 12, 16, 20, 24 ]
    Follow-up phase: Assay Negativity Rate (ANR) over weeks 8, 12, 16, 20, and 24.


Secondary Outcome Measures :
  1. To evaluate the safety and tolerability of GS-5734 in male Ebola survivors with evidence of Ebola virus RNA in their semen [ Time Frame: days 1, 2, 3, 4, 5, 8, 11, 16, 24, and 28. ]
    Proportion of Grade 1, Grade 2, Grade 3, or Grade 4 aspartate transaminase (AST) and alanine transaminase (ALT) levels at days 1, 2, 3, 4, 5, 8, 11, 16, 24, and 28

  2. To evaluate 24-week safety outcomes following IV GS- 5734 treatment in male Ebola survivors [ Time Frame: weeks 8, 12, 16, 20, and 24 ]
    Sustained Negativity Rate at weeks 8, 12, 16, 20, and 24.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 99 Years   (Adult, Older Adult)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA:

Individuals must meet all of the following criteria to be eligible for study participation:

  • Men more than or equal to 18 years of age.
  • One of two semen samples with Ebola virus RNA detection (defined as a positive PCR for NP or GP using the GeneXpert assay within 42 days prior to randomization).
  • Willingness to be available for study evaluations for 6 months.
  • Willingness to allow storage of biological samples.
  • Willingness to be followed by a Participant Tracker.
  • Willingness to refrain from alcohol consumption for study days -7 to 14.
  • Willingness to comply with MOH & CDC guidance on using a condom for sexual activity and at least through week 24 of the study.

EXCLUSION CRITERIA:

Individuals meeting any of the following criteria will be excluded from study participation:

  • Estimated glomerular filtration rate less than 60 mL/min/1.73m^2
  • History of significant renal disease
  • History of significant liver disease
  • Evidence of liver disease on physical exam such as ascites
  • AST or ALT, greater than the upper limit of normal, a prothrombin time 1.1 times greater than the upper limits of normal, normal, or a total bilirubin > 1.5 times the upper limits of normal(per DAIDS toxicity tables version 2.0 Nov. 2014).
  • Presence of Grade 2 or higher abnormalities for: low hemoglobin, low white blood count (WBC), low platelets, or low or high potassium (per DAIDS toxicity tables version 2.0 Nov. 2014).
  • Presence of greater than Grade 2 abnormalities for low or high sodium (per DAIDS toxicity tables version 2.0 Nov. 2014).
  • Any condition that, in the opinion of the investigator, would compromise the safety of the study subject or staff, or would prevent proper conduct of the study.

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): NCT02818582


Locations
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Guinea
National Center for Trainingand Research in Rural Health
Conakry, Guinea, CKRY 001
Physician at the service of the Infectious and Tropical Diseases
Conakry, Guinea, CKRY 001
Liberia
JFK Hospital
Monrovia, Liberia, FWA00021658
Duport Road PREVAIL Clinic
Paynesville, Liberia
Sponsors and Collaborators
National Institute of Allergy and Infectious Diseases (NIAID)
Investigators
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Principal Investigator: Elizabeth S Higgs, M.D. National Institute of Allergy and Infectious Diseases (NIAID)

Publications:
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Responsible Party: National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier: NCT02818582     History of Changes
Other Study ID Numbers: 999916137
16-I-N137
First Posted: June 29, 2016    Key Record Dates
Last Update Posted: October 9, 2019
Last Verified: October 7, 2019

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by National Institutes of Health Clinical Center (CC) ( National Institute of Allergy and Infectious Diseases (NIAID) ):
Liberia
Guinea
Additional relevant MeSH terms:
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Hemorrhagic Fever, Ebola
Hemorrhagic Fevers, Viral
RNA Virus Infections
Virus Diseases
Filoviridae Infections
Mononegavirales Infections
Antiviral Agents
Anti-Infective Agents